4th line palliative systemic options?

[Docker53]

Oncologist phone call today was not the news we were hoping for.PSA had been at 20 past 4 months and hubby was diagnosed as stable.

Monthly PSA blood work is done and this month PSA jumped to 29.

Oncologist is sending hubby for another Bone and CT scan.

She has suggested either abiraterone, clinical trials or cabazitaxel.

He was on Xtandi for 15 months, then Chemo and last treatment was Radium 223. He handled side effects well.

Any suggestions on what should be next with the 3 options offered?

We are in Kawartha Lakes, north of Toronto, Ontario

[tango65]

He could have Lu 177 PSMA treatment after Xofigo and then get into chemo with cabazitaxel or look for clinical trials.

There are clinical trials with Protacs , a new form of anti androgens. At this time there are at least 4 trials going on with these drugs and they may be effective depending in the mutations of the androgen receptor.

It is important to have a biopsy and do genomic studies to determine if the cancer may respond to PARP inhibitors or combinations Olaparib plus abi, talazoparib plus enza etc. The cancer may show MSI instability high and respond to keytruda. Many possibilities.

[Docker53 in reply to tango65]

Thank you for your response. I rely on this forum daily and appreciate all the feedback on what our options are in the future. It has been a roller coaster ride to say the least and having all your opinions and support has meant the world to us.

[tango65 in reply to Docker53]

Best of luck!

[Ramp7]

After Lupron and Zytiga failed, I enrolled at Dana Farber's LuPSMA177 trial in 2022. Completed all 6 infusion. Good response but not durable, PSA slowly increased. Met with Sam Denmeade ay John's Hopkins. Presently doing BAT with the assistance of my local MO. I was a responder, PSA stable presently. urotoday.com/video-lectures...

[NewGame in reply to Ramp7]

When you say the LuPSMA177 trial in 2022 was not durable - how long were you stable after you finished?

[Ramp7 in reply to NewGame]

6 months

[Woodstock82]

I had good initial results from Lupron and docetaxel, but they didn't last. Seven months later my PSA had doubled from nadir. Continued the quarterly Lupron, started on daily abiraterone, and had a set of six infusions of cabazitaxel. I got excellent results from that. Last chemo was almost three years ago. Lupron and abiraterone still on the same schedule. PSA has been at or near 0.01 for almost two years.

I found that the side effects for docetaxel and cabazitaxel were pretty much the same, but with cabazitaxel they hit quicker and harder.

[Docker53 in reply to Woodstock82]

Thank you for your response. What was you're PSA at it's highest? Your results from your current treatment look promising.

[Woodstock82 in reply to Docker53]

Details are in my profile, but the short answer is: I was diagnosed late, so surgery and/or radiation were not options for me. PSA at diagnosis was 11,201.7. Lupron and docetaxel brought that down to 1.54. Lupron and abiraterone and cabazitaxel brought my PSA down from 4.5 to <0.01. I am enrolled in the CHAARTED2 clinical trial, so I have labs every six weeks and scans every twelve weeks. So far the Lupron and abiraterone continue to do a good job of keeping my mets from growing or spreading.

[Docker53 in reply to Woodstock82]

Excellent to hear. Thank you.