Advice for next steps for 82 year old dad

[Lynsi13]

Good morning,

I'm needing advice for my 82 year old dad. Dad has been fighting prostate for eight years. Upon diagnosis his PSA was 257 and he had a single lymph node found to be involved. He had chemo and started on lupron + bicalumatide. In 2020 the medicine began to fail and he had provenge and started on Xtandi. Now his Xtandi is failing. His PSA is presently 2.54, up from 1.17 three months ago.. which was about half of that the months prior.

To complicate things, in September 2021 he had to have a quadruple bypass which was complicated by AFib and the necessary medications for that (which he is still on).

Then in November 2021, he was diagnosed with a rare form of lymphoma in his brain. He went through a very difficult and rigorous chemo which demanded he stay in the hospital for two weeks at a time for each round. Fortunately, the chemo was very effective and he is about to celebrate 1.5 years in remission from the brain cancer. He is on no medication for this cancer presently.

Despite his age and his health battles, dad is far from a frail elderly man. He still preaches every Sunday at his church and leads Bible studies mid week. He says he feels fantastic! He has told me that he isn't ready to quit fighting.. he just doesn't want to have any more hospital admissions for treatments (like he had with the brain cancer).

Looking ahead to next steps, from what I understand pluvicto or another form of chemo is ahead. Is there anything else? And, between pluvicto and chemo, my assumption is that pluvicto will be more easily tolerated?

I've read that pluvicto is only affective about 30% of the time. How much more affective would chemo be and would the side effects be worth the pay out?

And if he were to decline either of these treatments, are there any other medications he could try?

I appreciate any help you could offer!

Lynsi

[MyDad76]

What a fighter your dad is! Another thing to consider is genomic testing - it might give additional treatment options in case of BRCA+ or MSI-hi/dMMR.

[Lynsi13 in reply to MyDad76]

Thanks for the reply! Yes, I should have added that we did genomic testing a few years ago and didn't find anything of importance!

[MyDad76 in reply to Lynsi13]

It is my understanding that sometimes during the course of the disease things can change and that biopsy of mets might give different results.

[Lynsi13 in reply to MyDad76]

I didn't realize that! Well dad didn't have any mets to biopsy. His lone met in his lymph node had been destroyed by chemo and otherwise, his cancer was well under control when they did the testing with his PSA being undetectable.

[witantric in reply to Lynsi13]

was the testing gremline (e.g saliva) or somatic (of the tumor)?

[Lynsi13 in reply to witantric]

It was done with saliva. For some reason they didn't have enough of the tumor specimen from his biopsy in 2015 to test and when they ran the test his PSA was undetectable and his lone met to his lymph node had been destroyed by chemo.

[witantric in reply to Lynsi13]

OK. He needs a somatic genetic test if possible. May be later. Lots of therapies (PARP) are based on somatic test I think. Tall_Allen can correct me.

[MyDad76]

And I guess that having both a PSMA PET/CT scan and an FDG PET/CT scan would give good impression as to if pluvicto would work.

[Lynsi13 in reply to MyDad76]

Yes, I imagine that will be the next step!

[Tall_Allen]

He can't get Pluvicto except on clinical trials unless he has had chemo first. Pluvicto after chemo and chemo add about the same to survival. Here are the clinical trials and their criteria in the US:

prostatecancer.news/2020/08...

[Lynsi13 in reply to Tall_Allen]

Yes, he actually did have chemo immediately upon his diagnosis in 2015. It was taxotere chemo.

[Tall_Allen in reply to Lynsi13]

Then he should definitely have Pluvicto now.

prostatecancer.news/2020/05...

[Lynsi13 in reply to Tall_Allen]

Thank you for your input. I'll have this article ready when we go to his oncologist on Tuesday.

[SupportP]

I would press to start Pluvicto ASAP. And yes, it is considerably more well-tolerated than chemo. Reading what you've written, I wonder that the oncologist hasn't already pursued it for your dad. But perhaps I'm just being cranky :). All best wishes to you all -- your dad sounds like quite a remarkable man, and you clearly are a blessing to him.

[j-o-h-n in reply to SupportP]

Cranky? No way.............

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/17/2023 5:06 PM DST

[j-o-h-n]

God Bless you and the 82 year old kid...........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/17/2023 5:05 PM DST

[ellie2211]

They should run a Psma scan and go from there. Pluvicto can damage kidneys if it had nothing to latch onto.

[ellie2211 in reply to ellie2211]

Has

[SuppWife]

Hope your dad is doing well. ❤️🙏