Adding second line hormonal therapy?

[gio2x]

Hello everyone. My father's treatment from diagnosis consisted of ADT (Zoladex, 3-month injections as of now) and 6 courses of Docetaxel chemotherapy. PSA nadir was 0.89 after 7 months of treatment but after that the last 3 PSA tests show increase (PSA 2.310 on 24 Oct. 2023, PSA 6.81 on 24 Nov. 2023 and PSA 8.22 on 13 Dec. 2023).

It's time for his 3 month Zoladex injection and a PSA test. We are expecting from Medical Oncologist to add something to the treatment regimen as PSA is increasing. It will most probably be Zytiga but I have read that sometimes in the past Bicalutamide (Casodex) was added to Zoladex for certain time in similar cases. What's the general opinion about that nowadays? I suppose adding newer drugs (such as Zytiga, Xtandi, ...) will be better as they are newer and more efficient.

Also, how concerned should we be about PSA rise? I think the earlier second line hormonal therapy is added, the better, cause PSA is clearly increasing and waiting doesn't seem reasonable to me.

I would appreciate any suggestion or thought. I apologize for the possible mistakes, English is not my native language.

[GP24]

As the cancer has spread to the bones, he should not be treated with ADT only. Add Zytiga if covered by insurance. Bicalutamide is much less effective than Zytiga or Xtandi.

[Tall_Allen]

Bicalutamide is added for a couple of weeks when starting Lupron to prevent a testosterone flare. It has nothing to do with his situation.

Zytiga or Xtandi is a good next step.

[gio2x in reply to Tall_Allen]

Thank you once again for advice, sir. I really appreciate it. I know that hormone therapy including newer drugs works for certain time (we hope it will be a long time), but when that time comes (when they will no longer keep PSA and cancer at bay), what options will be there as the possible treatment routes? I mean - where can I see information about optimal treatment routes/sequences to be somewhat better prepared.

[MyWifeMyLife]

Hi there, my husband Jeff was on all kinds of things I’m sorry but I don’t know which one really worked. I lost him back in OCt of 2021. So my memory is fading. He did have a shot every 3 months though, and I do remember in the beginning he had casodex & actually went into remission! Then they took him off casodex and then his PSA went up. Then he started double dose (2 combined chemo drugs) of chemo. He went down hill from there. I remember asking myself, why take him off what’s clearly working and take him off? Found out through my. Research that the double dose chemo was actually in clinical trials & not approved There’s the answer! Money for the doctor . My background is I. Clinical Trials. He was treated like a rat. And it showed. Sorry this is long, but you can always check ClinicalTrials.com. To see if the drugs are listed. Also PubMed for information too.

I wish I had an answer for you, I’m sure your dad is very proud of you!

One more thing, Jeff my former hubby had tachycardia from a common side affect of these brand new meds, The doc had no clue! So Jeff had ablation Surgery on his heart. Ridiculous, then he couldn’t get out of bed due to his b/p dropping so fast!

That’s when he then refused all Meds or chemo. He told me many times they killed him doing that surgery. I think he’s right. He had prostate bone malignancy it never moved to any organ or lymph gland. They wouldn’t let me come in the office due to covid at the time.

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

I am so glad to see you're still with us...Thank you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 01/17/2024 7:54 PM EST

[gio2x in reply to MyWifeMyLife]

Thank you for sharing. I am very sorry for your loss.