Any coming back from this?

[Worriedson9]

Here’s a summary of my father’s situation since he was diagnosed last year in May 2022. I used all of his clinical reports to create this, but you can see my previous posts as well. He’s only 60 years old today - 59 at the time of diagnosis.

May 2022:

Diagnosed with high burden prostate cancer (Gleason 9), with initial PSA of 8.7.

Started on androgen deprivation therapy (ADT) with bicalutamide.

June 2022:

Prostatic biopsy confirmed invasive prostatic adenocarcinoma.

Started on goserelin.

PSA: 8.7.

August 2022:

Considered for enrollment in a clinical trial but found ineligible due to the absence of HRD mutation.

September 2022:

Started abiraterone.

PSA: 12.6.

CT scan showed some decrease in prostatic mass but progression in other areas.

October 2022:

PSA: 24.

November 2022:

Started docetaxel chemotherapy in addition to abiraterone.

PSA: 53.6.

CT scan showed mixed response.

December 2022:

PSA: 57.6.

CT scan showed mixed response with progression in some areas.

January 2023:

PSA: 51.9.

February 2023:

PSA: 58.6.

Reassessed for clinical trial eligibility but considered unsuitable due to poor functional status.

MRI spine revealed diffuse bone metastases throughout the spine.

March 2023:

Started cabazitaxel chemotherapy.

Experienced increasing pain, especially in the right leg.

Admitted to the hospital for Pseudomonas bacteremia and E. coli bacteriuria.

Delayed chemotherapy due to complications.

Liver biopsy confirmed metastatic adenocarcinoma.

PSA: 38.6.

April 2023:

Received second cycle of cabazitaxel chemotherapy with a dose reduction.

MRI spine showed mild posterior epidural tumor at L2 and soft tissue masses in the right ilium.

Progression in some areas observed on CT scan.

May 2023:

Admitted to the hospital with fever, confusion, and increased pain.

CT scan showed significant diffuse bony metastatic disease, liver and lung metastases, and retroperitoneal and soft tissue disease.

MRI of the brain showed no metastatic disease.

ECOG performance status declined to 4.

Seen in the radiation oncology clinic:

Drowsy with decreased mental status due to pain medication.

Recommended palliative radiotherapy for pain control.

Prognosis considered very poor.

Single fraction radiotherapy (800 cGy) with Ondansetron prescribed for symptom relief.

Summary: My father has lost the use of his legs due to muscle atrophy. He’s been seeing a physiotherapist who has been helping him - some progress has been made on that front but he is still largely bedridden. Two weeks ago, he ended up in the ER due to a suspected infection; none was found but they had to run the full course of antibiotics. He’s being discharged tomorrow. He’s been doing better in terms of the pain after radiation. He’s also been okay on most days I’ve seen him. I understand that his prognosis is poor - his prostate cancer is VERY aggressive, with an almost-unparalleled rate of progression.

My question… is anyone else here in the same boat? Has ANYONE come back from this? There is the larger matter of coming to terms with this - and believe me, I’m not in denial - however, if there is any option… ANY stone to unturn, I’d love to know. We were in discussion with a hospital in India for Lutetium, but even that seems unlikely to work in his case. The team is also a little concerned with how he will make the flight. We are situated in Toronto, Canada.

I don't want to lose my father.

My pre-emptive gratitude for your responses.

[NickJoy]

I am sorry to hear about this situation. I am hoping that some of the more knowledgeable members will reply but, in the meantime, I just wanted to check whether your father has had a PSMA scan which may help with the decision about India? If he has very PSMA avid cancer then Dr Sen's team maybe in a better position to decide if they can help. Also, I understand that LU177 can be obtained in Mexico and this would be a shorter flight for you. However, I don't have any knowledge about how good or bad the clinics in Mexico are whereas Dr Sen seems to be very well respected by those who have received treatment from her.

[Worriedson9 in reply to NickJoy]

Thank you for your answer.

We're in touch with Dr. Sen and her team is exceptionally professional. We haven't been able to arrange a PSMA scan yet but we're trying. Locality, wait times, etc. all are a factor and we're planning to streamline it so it all feeds into the next step.

[Djangler in reply to Worriedson9]

There's a facility in Vancouver that recently began offering LU177. They can also do the PSMA scan. They're more expensive than India, but much closer to you. Their name is INITIO nuclear medicine.