Treatment options

[TerryR123]

Hi- I have posted a few times about my brother who was diagnosed in March 2021. For 18 months he did really well on Abiterone. His PSA went from his initial diagnosis of 52 to under 0.03 for several months. He has Kaiser HMO and unfortunately his oncologist retired at the time his PSA starting trending upward. He was put on Docetaxel by the new oncologist and his PSA continued to rise. I continually questioned what other options were available since it did not appear to be working and he did not suggest anything except continuing the chemo. I paid out of pocket for a second opinion and the doctor realized the Lupron was stopped during chemo which he told us was making the chemo ineffective at best but was like adding fuel to the fire. His report was sent to my brother’s oncologist and he immediately received a Lupron shot and started taking Casodex per instructions from the other doctor. At this time the PET scan showed the cancer had moved to the sacrum area and now my brother can barely walk and has a catheter. The other doctor also recommended immediate radiation to the sacrum area which he has now completed as of 2 weeks ago. We were hoping to get Pluvicto but since he is so weak that isn’t an option. I’m so upset with his oncologist and wish I had gotten an outside opinion earlier. During this time his PSA went up to 48 and now after the Lupron it is at 22. My brother has learning disabilities so he doesn’t always understand what he should be concerned with. I’m sorry this is so long but I’m trying to explain his situation. Here are my questions- Is it an option that he could go back on Abiterone or another hormone once it stops working in the past? 2) Should he get a biopsy done to get DNA sequencing 3) Should he try another type of chemo? I am have another appointment with the other doctor but I am hoping to get information now since that appointment is a few weeks away. Because he has an HMO it is difficult to change oncologists although I am trying to do this. I appreciate any feedback! Thanks- Teresa

[Tall_Allen]

(1) Is it an option that he could go back on Abiraterone or another hormone once it stops working in the past?

Enzalutamide (Xtandi) may work for a short time. However, a recent clinical trial found that combining it with docetaxel may extend its effectiveness.

prostatecancer.news/2022/10...

(2) Should he get a biopsy done to get DNA sequencing

Not just for DNA sequencing, but also for histology and IHC.

(3) Should he try another type of chemo?

If docetaxel stopped working, he should try cabazitaxel (Jevtana)

[TerryR123 in reply to Tall_Allen]

Since he did not receive Lupron during the Docetaxel I’m wondering if he should do another session to see if it goes down before trying Jevtana? I was hoping he could try Abiraterone since I was told Xtandi can cause low blood pressure which he already has. I am going to request the biopsy you have mentioned. I was really hoping he would be strong enough for the Pluvicto but he is still very weak at this point and not very mobile. Many thanks for all of your helpful information! If there is anything else you think I should look into please let me know.

[SteveTheJ]

Kudos to you for taking this on. Your bother's situation doesn't match mine but he's very fortunate to have someone as conscientious looking after him.

[TerryR123 in reply to SteveTheJ]

Thanks you so much! I’m really trying to do everything I can.

[lcfcpolo]

Well done for supporting your brother. Hopefully the PSA trends lower again now that Lupron restarted.

[TerryR123 in reply to lcfcpolo]

Many thanks! I was very relieved to see that it has lowered his PSA quite a bit.

[j-o-h-n]

You make me want to cry......... You need a medal...........Hopefully there are other siblings or relatives that can help with all that you're doing.........God Bless you (and of course Good Bless your brother).

p.s. How old is he and where is he located?

j-o-h-n Thursday 11/09/2023 6:41 PM EST

[TerryR123 in reply to j-o-h-n]

Thanks John! I really appreciate it. He is only 59 and is in the Northern Virginia area.

[j-o-h-n]

Thank you Terry, I know you have your hands full..... but it's a good idea to update your brother's bio since it helps him and helps us too. All info is voluntary.....so don't make it a priority but a nice to have. Again Bless you both and keep posting here on HU.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/09/2023 10:28 PM EST