Next treatment options available for advancing disease

[Islandboy2021]

I have completed all scans available to me and they show new metastatic disease throughout my skeleton. PSA @ 4.65 ug/L. The disease continues to advance while being treated with Zoladex and abiraterone. I have switched prednisone for dexamethasone and haven't had an updated blood test yet to see if has improved.

Had consult with oncologist and urologist and I have 3 treatment option available.

1. Docetaxel or Cabazitaxel. 10 treatments. The oncologist believes the chemo would hit the disease the hardest. I agree but, I am not ready to go through with that again at this moment in time. I would like to enjoy some quality of life this summer. I can wait and have the chemo later.

2. Radium - 223, Xofigo. This is my preferred treatment option at the moment. The disease has only spread to my bones so far and this treatment works in damaging tumor cells in the bones. Also this treatment has the least side effects. I would like to continue working while having this treatment.

3. Trial for LU - 177. The only way to receive LU - 177 is in a clinical trial or pay for it yourself here in BC. The trial is complicated and you cannot be sure what arm you will be on. Apparently I can pay for Pluvicto at a private clinic. I have been told the cost could be $25000.00, not sure if this is correct. I will need to follow up with this.

I will also be adding Xgeva to the mix.

Any advise or comments on these options would be appreciated. I am very grateful for having this site available for real life experiences and information. I wish I new about this site back when I was diagnosed in 2017.

Thanks,

[Tall_Allen]

Discuss combinations/trials with Xofigo:

prostatecancer.news/2021/02...

[Willydad]

Hi Islandboy. I’m assuming the private clinic is Initio. Is it $25000 per treatment?

[RyderLake2]

Hello Islandboy,

Greetings from the Fraser Valley. We have "talked" before. I am currently on the SPLASH clinical trial being run by the BC Cancer Agency. Although I am not on the Lutetium arm, I have been assured by my clinical care team that I am eligible for a crossover to Lutetium should my PSA start to rise. There is nothing complicated about this trial although I am being watched very closely with monthly blood work and CT scans and Nuclear Bone Scans every second month. I recommend you check into what trials you might be eligible to participate.

[Islandboy2021]

Hi Ryderlake2,

I have been contacted by BC Cancer and apparently I am eligible for a trial GUPR21/PR.21 that is 177 LuPSMA-617 versus Docetaxel.

[Benkaymel in reply to Islandboy2021]

Can you choose which arm you go on? You've said you don't want chemo right now.

[tango65]

Consider to request direct biopsies of the met to do histological, IHC and genomic studies.

The cancer may have mutations making it susceptible to olaparib, rucaparib, combination of these drugs with zytiga, keytruda, or chemo with platinum compounds or BAT if there is a P53 mutation.

These studies may also help to select clinical trials if the cancer is evolving into NEPC.

[Peace-to-you]

consult a radiation oncologist…there may be more options

[AlvinSD]

I know you said you don't want chemo. However, I wanted to share my experience with it. It is chemo but (relative to what friends have gone through with chemo for breast cancer or colon cancer) it's not so horrible. I would do six more cycles of chemo in a hot second if it meant I could get off of ADT.

I had six cycles of docetaxel last summer with an infusion every three weeks. I got my infusions on Mondays. (I was given dexamethasone premedication which I started Sunday AMs.) I felt kind of lousy Tuesday-Wed-Thursday but perked up on Fridays. I still had energy to walk 5-7 miles a day in the mornings every day throughout chemo...even when I felt "lousy". I didn't have much in the way of nausea or diarrhea. Lousy for me was just being kind of tired and a little achy. (I found radiation to be much worse in terms of side effects like nausea and diarrhea.)

I am glad that I went for the route of aggressive Triplet Therapy with chemo on the encouragement of Tall_Allen .

Best wishes for your decision!

[Islandboy2021 in reply to AlvinSD]

I have had chemo at the beginning of initial treatment. I know I will be having it again at some point. I wanted to try some other treatment first if available. The ADT will never end either way.