PSA increase nearly one year after triplet therapy (mHSPC), what's next?

[Sissel25]

Hello everyone, thank you for all your help for a year. My dad went from a high of 3103 PSA to a nadir of 44. He unfortunately couldn't reach a <1 result but it had stabilized for a few months after his docetaxel + zytiga + prednisone. Unfortunately his new result is 67 PSA exactly a year since diagnosis.

His doctor had ordered a bone scan and bone scintigraphy before it increased because he still had pain on his right hip and we're meeting her on the 30.

What should we ask her and what would be some options to explore? He doesn't have BRCA mutation. All it says (might not be legible as it was in french) is variant "c.530C>G / p.(Pro177Arg) in exon 5 of the gene TP53( NM_000546.5)" if that means anything to you all

I've researched a bit but I don't know how to take a PSA increase like his considering his initial PSA diagnosis was so high.

It was also a very weird shift in PSA over the months. He started Docetaxel on February and his PSA had stayed around 99 for several months under chemo and then very slowly went down to 44 in August *after* his chemo.

Thank you for any tips and questions I could ask to his doctor. Maybe trials to consider? Thank you!

Edit: If that is any interest, he couldn't handle monthly injections of Degarelix (Firmagon) so he switched to Decaptetyl (Triptorelin) every 3 months and his PSA actually dropped further. Not sure if it's related though.

[Sissel25]

Widespread bone mets unfortunately. I'll still ask to be sure

[Tall_Allen]

Can he get Xofigo?

[Sissel25 in reply to Tall_Allen]

I think he can and might be reimbursed by our healthcare system in France. I will ask about that, thank you.

[Sissel25]

Thank you, but we are in France. Still, I will search and see our options around this topic.

[Benkaymel]

Given that he has pain from the bone mets, I wouldn't think BAT is a viable option for him is it?

[Aldo62]

I have been doing Orgovyx (ADT) along with Nubeqa (Darolutamide) and it seems to be a very effective combo, with fewer side effects than ADT drugs like Lupron. Orgovyx lowers the T, and Nubeqa blocks the T receptors inside the cancer cell. They are both very expensive drugs, but I have been able to get them for free through the hospital.