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[Roxy1968]

My husband has advanced prostate cancer, psa was 325 at diagnosis, has had one round of chemo, psa never got to single figures, we were told, don’t emphasise on the figures, two months after chemo, things not great, put on Abiraterone …, psa doubled every 2 weeks, last count was over 500, suggesting another round of chemo, it is in his bones but not organs however it is lymph nodes, I have tried to push for radium but they say because in lymph nodes this may not be an option, anyone else in this situ ? we appear to have very little options, any body have any suggestions, my husband is only 58 and diagnosed in December 21, feeling quite desperate 😥

[Tall_Allen]

Xofigo is approved for painful bone metastases as long as it's not in visceral organs (e.g., liver, lungs). Cancer in lymph nodes does not contraindicate its use. If insurance refuses - appeal! It also combines well with many other medicines. He may also qualify for Pluvicto. Cabazitaxel (Jevtana) may work when docetaxel doesn't.

A biopsy of a current metastasis may provide clues for further therapy and clinical trials.

[Roxy1968 in reply to Tall_Allen]

thank you

[tango65]

Consider to request direct biopsies of the mets to do histological, IHC and genomic studies. If direct biopsy is not an option they could get a liquid biopsy to study ctDNA.

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.

They could also show PSMA expression indicating the cancer may respond to Pluvicto treatment.

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

Xofigo is also an option but it will not treat soft tissue mets.