PSA up to 150 on Olaprib, any insight on what’s next?

[StayingSTRNG]

Hi all,

my dads history is mostly in my profile but in short he started on Zytiga a year ago. Zytiga worked well but had major side effects and lead to a switch to Erleada. Erleada failed at the time shown in the picture with the orange circle and he switched to Olaprib by the time he got the PSA results circled in purple.

Olaprib I presume was working initially however we saw a slight increase on August 1st and that continued. Following that date on August 16th my dad underwent what we THOUGHT was a standard nephrostomy run change (bilateral), but unbeknownst to my mom and I, they had actually done a capping procedure. This was a procedure my dad did not want done but they didn’t explain thoroughly to him the plan and he agreed/consented. They sent us home with no after care instructions and not informing us (the family) of what they had done. By the time my dad arrived home he was in severe pain, unable to urinate, and therefor couldn’t communicate with us. He ended up in septic shock and in ICU for the following days, thus suspending Olaprib until September 5th.

Since restarting Olaprib, his PSA has gone from 83 to 150. These results came in long after his MO appointment yesterday so we have no direction quite yet.

Any advice on other treatments to may be effective assuming this one has failed for him? Do you think maybe the inconsistent use of it could be a reason for it? He is having his 3rd or 4th blood transfusion due to the Olaprib, did anyone have similar? Any advice or insight is so much appreciated!

[Nfler]

have you looked into this at all, may well be worth it…

Pub meds recommendation of looking into ivm as an anti cancer drug

[Tall_Allen]

PARP inhibitors work better with BRCA2+ than BRCA1+, so maybe that's all he can get from it. They are very toxic to the blood. It may be time to try something else.

Have they done a biopsy - histology and IHC on a metastasis? That might provide clues as to the next treatment (docetaxel, Provenge, Xofigo, Pluvicto) or clinical trial.

[StayingSTRNG in reply to Tall_Allen]

That makes sense. I don’t think he has had that done as I have not heard of it before. We won’t see them again for 2 more weeks.

Are any of the treatments you mentioned harsh on the kidneys? Because his kidneys are certainly compromised

[Tall_Allen in reply to StayingSTRNG]

Kidney function should certainly be considered by his MO.

[StayingSTRNG in reply to Tall_Allen]

Ok! I just noticed they made an appointment on the portal in the systemic therapy unit for an oncology infusion. Multiple appointments. I don’t know if that may mean chemo is next (I don’t want to assume), but it looks that way