My brother was diagnosed with stage 4 prostate cancer in April of 2021. His PSA was 52 at the time of his diagnosis. He went on Lupron and Abiraterone which took his PSA to .03 and kept it low until Oct 2022. It went to 8.9 and his doctor put him on Docetaxel chemo. His PSA has continued to rise and his oncologist has kept him on this chemo. His PSA is now 48. He was told he could go on Pluvicto but after his PET Scan he was told he is not a candidate. My question is what other options may be available? He has done 14 sessions of the Docetaxel and does not want anymore. He is very weak. I am not sure why the doctor would want to keep him on Docetaxel when it does not appear to be working. Many thanks for any information!
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TerryR123
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Lots of therapies are approved for patients in his situation: Xofigo (if bone metastases), Provenge, Cabazitaxel, PARP inhibitors (if BRCA+), Keytruda (if MSI-hi/dMMR), and various combinations of those.
There are also many clinical trials he might qualify for.
I thought that was a lot and questioned the oncologist. My brother has an HMO so I’m trying to get as much information on different options before his appointment next week. He is scheduled for another chemo so I want to figure out before that. I will research all the things you listed. He does have bone metastases. I don’t have much time to figure this out. Many thanks for the information!
Sorry to hear of your brother's condition. There aren't that many HMOs to my knowledge.....perhaps Kaiser? I have no idea of your brother's finances, but would it be feasible to seek a 2nd opinion. Nowadays, a phone or virtual consult is common. Just need to forward his latest test results and treatments to date. You could proceed with scheduling that 2nd opinion, and then keep or cancel that appointment ...dependent on satisfaction with the results of your HMO appointment next week? I'm sure a 2nd post here, asking for 2nd opinion MO suggestions, would elicit a good list of top MOs.
What is your brother's age? If he is with a Medicare Advantage HMO, then that HMO must provide /cover all current SOC treatments that traditional Medicare is required to cover.
Your brother should inform the HMO MO that you want his best suggestions without regard to his knowledge of what the HMO would or wouldn't cover!!! How the treatment is covered is the patient's concern....the Doc's concern is to provide the best in advice with regard to any and all relevant treatment options!!!
Yes, he has Kaiser. His oncologist retired and the replacement oncologist does not seem very knowledgeable about prostate cancer. When I told him that my brother cannot tolerate anymore of the Docetaxel he just said we can hold off. That does not sound like a good idea with his PSA rapidly rising. I am looking for a doctor to pay out of pocket. Great idea to post asking for recommendations. Thanks for your reply!
Yes, write a new post and I'm sure you'll quickly receive many suggestion .....Tanya Dorff at City of Hope is oft mentioned!! Just a guess...probably $500-$1000 these days? First, I suggest you go to TA's separately published blog site and see what you find there re your brother's current status and suggested treatments and success rates. Also pubmed.com is an alternative to Google for finding studies of different treatments. Kaiser has many positives IMO, but this high level expertise for PCa may be hard to find there.....their providers seems to mostly be generalists in their specialties.....kudos to that new MO if he/she admitted to less than top-expert status!! You could ask where you might find such expertise closest to you/your brother, and if an answer is volunteered, ask for a referral.....all they can do is say "no" ? In a way, that would be wise for Kaiser, as the liability for your care would then be shared!!!!! Most of us would never think of suing, but these organizations are constantly on alert for such possibilities IMO.
Unanswered questions from a wonderful member (maley2711-see above post)
What is your brother's age? If he is with a Medicare Advantage HMO, then that HMO must provide /cover all current SOC treatments that traditional Medicare is required to cover.
Your brother should inform the HMO MO that you want his best suggestions without regard to his knowledge of what the HMO would or wouldn't cover!!! How the treatment is covered is the patient's concern....the Doc's concern is to provide the best in advice with regard to any and all relevant treatment options!!!
Well, as an old softball (originally baseball) pitcher, I always wanted the plate umpire "to call em as they see em" ............ you deserve the thanks....
He just got on Medicare so I’m assuming Kaiser is part of Medicare Advantage HMO? I have made so many phone calls trying to find out about getting second opinions. I couldn’t get anywhere so have decided to pay out of pocket. Thanks for the reply! This site has been very helpful.
For palliative care, try daily cannibis use to see if discomfort is reduced. Also energy, if he uses sativa brand. Worked for me during chemo. I wonder if TA might suggest the new PARP approved by FDA?
Similar situation with me. At 52, I came down with prostate cancer and had it removed after a few months. I'm Stage 4 and have been through many treatments. I was a candidate for Pluvicto but it didn't work and doubled my PSA from 1.56 to 20. I stopped Pluvicto and now am back on Jevtana. It worked before and they took me off of it to try Pluvicto. Jevtana is a milder chemo that targets prostate cancer cells. My hair didn't fall out but just got a little thinner and It's usually tolerated by many. It's taken with Prednisone. I just started again and hopefully after 3 cycles my PSA will start to trend downward. Remember it's not the number itself, it's the rising and falling. If it stabilizes that's a good thing. I've been battling this disease for 10 years now and they have thrown everything at me. The disease has been metastasized to the bones and not any of my organs. The bone things have been treatable and I guess that's the lesser of 2 evils. That's the quick story. Good luck!
Hi-From your experience do you think Jevtana would be an option after Docetaxel stops being effective? We are meeting with the oncologist tomorrow and so far he hasn’t mentioned any options.
Hi Robert. I can see some similarities in our cases although you have experienced a greater variety of medication. My details in profile
You’re right about the PSA number. My MO is mostly ignoring it (stable around 24 now) and is using 6 monthly scan comparisons to check for progression. Am wondering if you’re getting scanned and what it is telling you.
I'm getting scans yearly and will be getting more soon, I imagine. I will have to wait and see and when I find out I will post the results. I'm an open book and will answer questions to the best of my ability.
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