Radium-223 + Xtandi?

[MechD]

I’ve been on chemo (cabazitaxel + carboplatin) since Jan 2022 and also on Zometa and Lupron. PSA went from 1.3 in Jan 2023 to 11.7 this month. CT and Bone scans show bone mets somewhat stable but with activity, all bone no soft tissue. PET PSMA earlier this year did not show enough tracer activity to indicate Lutetium-177 (available at UC Davis, CA with long lead time).

So we are in the process of changing treatment to Radium-223. When asked if I should stay on Xtandi, both my MOs said it’s ok to continue and pretty much left it up to me as there’s no indication it’s affective since PSA is rising.

Any thoughts on staying on Xtandi in which case treatment would be:

Radium-223, Lupron, Xtandi, Zometa.

I appreciate your input,

Blessings to you.

[Tall_Allen]

It might be a good time for Provenge, too.

[MechD in reply to Tall_Allen]

I had Provenge treatments in June/July of 2021.

[GP24]

You can use both Ra223 and Xtandi, but it is important to get Zometa during that time. This study states: "Bone health agents should be administered and bone health should be closely monitored following treatment with radium-223 and enzalutamide."

ncbi.nlm.nih.gov/pmc/articl...

This study covers the safety of this combination:

ascopubs.org/doi/abs/10.120...

[MechD in reply to GP24]

Thanks yes I will continue the Zometa.

[MechD in reply to GP24]

Very relevant articles, thanks for the links.

[Kevinski65]

Are u taking Xtandi with lupron… try that. Also add aspirin after running by doctor.

[MechD in reply to Kevinski65]

Yes I am. Add aspirin strictly for pain or is there another benefit?

[Foldem]

when I did Radium 223, I had no side effects. But was only on Lupron. Good luck.

[MechD in reply to Foldem]

That’s good to hear, thanks.

[Tinuriel]

My husband just did what you are doing - Ra223, Lupron, Xtandi, Xgeva instead of Zometa (bone strength). Even though your PSA is rising, the thought expressed is that ADT is still providing some benefit, putting on the breaks for some of the cancer cells.

[MechD in reply to Tinuriel]

Yes, I agree there may be some benefit so I’ll continue the Xtandi with Ra223. Thank you.