My brother has advanced prostate cancer

[rasher1]

Hi everyone. I hope all of you are doing well.

My brother diagnosed Aug 2022 with stage 4 prostate cancer at age 53. PSA was 44 and he had some mets in his bones(Pelvic). After that he had triplet therapy(every 3 month hormone therapy+ Docetaxol+ Nubeqa), but unfortunately his PSA rising right after he finished his chemotherapy.

He had an appointment with his MO and she told him he has not many options. She told him that he should have a blood test ( for DNA) first and depend on the results he may eligible for 2 clinical trial and if the result would not good then he just could have another chemotherapy!!

My brother lives in Vancouver. He never had any PSMA scan. He just did bone scan and CT scan. We are really confused now. If his DNA test would not be good then he is not eligible for any clinical trial??

Thanks in advance

[Tall_Allen]

They are probably looking to see if he is BRCA+ in which case a PARP inhibitor may be beneficial.

[rasher1 in reply to Tall_Allen]

He had genetic test and result came negative for BRCA 1 and 2 but ATM was suspicious.

[rasher1 in reply to Tall_Allen]

SCREENING FOR:

A PHASE I STUDY OF PALBOCICLIB, A CDK4/6 INHIBITOR, IN PATIENTS WITH

METASTATIC CASTRATION-RESISTANT PROSTATE CANCER

Trial CodeIND.223

OR FOR:

PROSTATE CANCER BIOMARKER ENRICHMENT AND TREATMENT

SELECTION (PC-BETS) STUDY

(IND.234)

Trial Code IND.234

[rasher1 in reply to Tall_Allen]

My question is in which case any body may not eligible for other clinical trial?

[Tall_Allen in reply to rasher1]

Every clinical trial is different

[MarkBC]

I am in Victoria, close to Vancouver, and was diagnosed at 55. Sorry to hear that his triplet therapy is not working. BC Cancer is an excellent facility for cancer treatment. Hopefully your brother likes and trusts his MO. There is very good research into prostate cancer happening in Vancouver.Once a man is diagnosed stage 4, a PSMA PET scan is not necessary unless there is a need to find a small met that is causing a specific problem.

I hope the MO is able to find a treatment plan that is effective for your brother. Best of luck to him.

[alohapickle in reply to MarkBC]

My spouse became castrate resistant and failed chemo. He had a PSMA PET to see if he was a candidate for Pluvicto. He was and it helped. Best to you.

[rasher1 in reply to alohapickle]

Thanks for replying. Wish you all the best.

[PHnerd in reply to alohapickle]

Hello, how much did the Pluvicto help?

[rasher1 in reply to PHnerd]

He didn't have any Pluvicto yet.

[rasher1 in reply to MarkBC]

Thanks very much. As I heard there are too many clinical trial available and I read here that maybe someone tried 3-4 trials or more but his MO told him depends on DNA test you may eligible for trials that I mentioned above. She told him otherwise you hav to do chemo and No other choice.

[spw1]

I am sorry to read this. Please check online for different trials. I did that in the UK for my husband. Check the eligibility criteria for exclusions - some do not want a person who has had a chemo etc. Some may be only available for certain mutations. The only trial that was constantly considered for my husband was a phase 1 trial called Crescendo. It was not dependent on DNA but his bloodwork would sometimes have a slightly smaller platelet count than required or lymphocyte count. We spent a lot of long journeys to consider options. In the end I could not understand why the initial blood check could not have been done in our local hospital to avoid driving 6 hours to be told that the bloods were not right this week or that. So do your own homework. The trial criteria are not too difficult to understand. I would still do PSMA scan to see if he has PSMA avid cells. Ideally also do a PET FDG scan alongside. You do not want too much discordance in those if pluvicto is to be really beneficial. Hope this helps. Good luck.

[rasher1 in reply to spw1]

Thanks for your time and information. I hope they could find a best option for him.

[Woodstock82]

When my PSA rose following six infusions of docetaxel, I was treated with six infusions of cabazitaxel, and got very good results.

There are also platinum-based chemotherapies that might be options for him.

[rasher1]

Thanks very much. Wish everything goes well for you.

[SeosamhM]

I'm confused why, in cases of metastatic PCa, MOs are now offering up darolutamide (Nubeqa) in lieu of abiraterone (Zytiga), apalutamide (Erleada), or enzalutamide (Xtandi). While all are anti-androgens, these medications are NOT the same and a switch to one of them from Nubeqa would be a simple course. If the MO balks, I would ask for the specific research paper - in mPCa - that says they are equivalent or that the risks of Nubeqa are so much lower that it isn't worth investigating a switch.

IMO, without checking into these 2nd line hormonal drugs, simply offering up a trial is ridiculous. I do agree that there are other effective chemos to try ( cabazitaxel, Xofigo), but l would start with the simpler choices first.