Dad with Stage 4 PCa - Need some words of wisdom...again please!

[kikinini]

Hi everyone.

Just got back from appointment with Dad's oncologist. To keep you up to speed - 3 months ago, his ADT injections stopped working and his PSA started to climb up slowly. Oncologist put Dad on Enzalutamide - been on it for 6 cycles - tolerated well but his PSA has gone from 76 to 87 in one week. So Enzalutamide has started to become 'ineffective'.

A liquid biopsy was carried out last week, waiting on results for BRCA2 (to see if he qualifies for olaparib (Lynparza®). In the meantime, no radiotherapy, in case he is BRCA2 (needing to presrve bone marrow quality for Olaparib)

In the meantime, they are exploring Radium 223 (Xofigo) as an option, but will only know after a full spine MRI.

Feels/sounds like we are running out of options. I guess it feels like that because Chemo got him admitted into ICU, so that's a no go. Lutetium 177 is not being funded anymore by NHS in UK. Each treatment seems to become ineffective quite rapidly

What I would like to pick all your brains with.....is there a drug/a combo I should be asking his Oncologist about? If he does qualify for Radium 223, is this a good treatment? I'm not naive as to the severity of his disease, but I always try and look for the light at the end of the tunnel....but if Radium 223 does not help, are there many other options?

Would love some information I could propose to his oncologist... or at least ask the question.

Thanks so much in advance

Omer

[Tall_Allen]

Here are some combinations with Ra223 that have been tried:

prostatecancer.news/2021/02...

[kikinini in reply to Tall_Allen]

Thanks so much Tall_Allen,

So interesting reading all the combinations in one place. I'll make sure to save that page.

At the risk of sounding stupid....am I right in thinking that the combination of Xtandi+Xofigo seems to be the one that has the most preferable outcomes re. fractures and overall survival? Because the Onc mentioned something about keeping him on Xtandi whilst on Xofigo. Even though it's efficacy (Xtandi) is reducing?

[Tall_Allen in reply to kikinini]

What they learned about fractures was that Xofigo combined with abiraterone or enzalutamide increased the rate of crippling fractures. They found that adding Zometa or Xgeva could mitigate that effect. If he has already become Xtandi-resistant, he would probably do better by switching to abiraterone and combining it with Xofigo and Zometa.

[kikinini in reply to Tall_Allen]

Thanks Tall_Allen,

You are a saving grace

It is the first time today I've really been able to clear the decks and read the studies you sent. So I do appreciate your suggestion of the combo. Dads Oncologist is due to call me tomorrow, so will definitely request this. Just been trying to keep Dad's head above water - he's been in a dark place for the last couple of days. So fingers corssed he qualifies for Xofigo .Thanks again

[GP24]

You could ask your oncologist if your Dad can get into this trial. This drug shall work if everything else fails. There are several sites in the UK where your Dad could join.

clinicaltrials.gov/study/NC...

[j-o-h-n]

Hello kikinini,

It appears that you (the offspring) are 27 years old. That would lead me to believe your Dear Father is a young gentleman. Would you be kind enough to tell us his age? (and if you would add it to his bio). Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/22/2023 10:23 PM EST

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

Hi John,

Lovely hearing from you. Thank-you for taking the time to stop by

I thought I had in one of my previous threads, but anyway, he is 55. I shall amend his bio accordingly

[NecessarilySo]

You might consider heat therapy in conjunction with his other treatments.

cancer.org/cancer/managing-...

[kikinini in reply to NecessarilySo]

Hi NecessarilySo

Thank you. So grateful to have so many suggestions. This place really does feel like a community. I know, for myself, each time Ive felt desperate, this is the first place I come to.

I have briefly looked at it after reading your reply,, and will go deeper into it. Looks interesting and the premise seems to make sense.

[TwilightZone]

Mike Milken (Junk Bond king) was diagnosed with late stage prostate cancer in 1993, given 12 - 18 months to live. He's still alive and attributes his success to cancer fighting diet, exercise, advanced (sometimes experimental) treatments. He helped establish the Prostate Cancer Foundation to foster prostate cancer research (along with diet and exercise).

I'm nine years into my battle, have stage 4, and about to start Milken's diet - what do I have to lose. Suggest the same for your Dad.

Just GOOGLE Mike's name and multiple references appear. Good luck to both of us!

[kikinini in reply to TwilightZone]

Thanks so much for that. Will delve into it. I feel, at least with researching about this awful disease, I at least get a little bit of control...knowledge is power and all that!

You keep fighting the fight - 9 years is a great feat. I wish you continued good health and be strong. As you say, nothing to lose at all.