Hello. Am now in year 10. Details in profile.
For 2+ years have been taking Zoladex, Zytiga and Prednisolone. The CT bone scans and Nuclear medicine full body scans every 6 months show no radiographic progression and I feel ok, apart from fatigue when not active. Recently have some discomfort in left hip when climbing stairs. PSA has steadily risen to 41 but stable for last 3 months. Testosterone is stable and low (0.4). ALP normal.
I recently had a PET choline scan done abroad, to get another view. It showed that all my mets are in the bones.
PET Choline summary
- absence of residual lesion at the level of the prostatic compartment or seminal vesicles
- absence of pelvic or distant lymph node lesion
- multifocal secondary bone damage involving the posterior arches of the tenth ribs on right and left (SUV max 11.8), the left ischiopubic branch (SUV max 15), the posterior pillar of the left acetabulum (SUV max 12.6), and the right edge of the hyoid bone.
First time I see the hyoid bone show up.
Docetaxel is being suggested back home. Not my first choice as I think there might be interim steps which could be effective, eg:
1/ zap (SABR) the left hip joint to get rid of the discomfort, also zap the hyoid.
2/ change from Prednisolone to Dexamethasone to get more out of Zytiga.
3/ if (2) fails, move to Xtandi. Zoladex seems to be working, not sure whether to change.(?)
4/ if Xtandi begins to fail, start Docetaxel. Per the PRESIDE trial, this could also have the effect of prolonging Xtandi effectiveness.
I would much appreciate your thoughts on the above interim steps. Am ready to do chemo but not right away if there are valid alternatives.