repost - cancer progression - next steps?

[Juju0713]

I am reposting in the hope of receiving a response regarding best next steps. Please see my profile for history on my dad's condition. He went to the ER last weekend with severe flank pain and CT revealed left-sided hydronephrosis as likely cystic soft tissue mass obstructing the left ureter. An anterograde stent was placed after failure of retrograde stent. The cancer has progressed since his last CT in February. Since the cancer is showing radiographic progression on xtandi and eligard will his next option here most likely be another round of chemo (a different one such as cabazitaxel) or would lutetium Lu-177 be a possible option for him? Or what would potential other options be? He will be meeting with his MO tomorrow and I would just like to be as best prepared as I can for the meeting. Thank you.

[God_Loves_Me]

Here is one medicine, I think your dad should take.

Olaparib (Lynparza®) is a type of drug used to treat men who are known to have a BRCA1 or BRCA2 gene change (mutation), and whose prostate cancer has stopped responding to hormone therapy

Please read following links, i hope help you to make best decision for your dad

Why Lutetium-177-PSMA treatment sometimes may not help, and may even harm

prostatecancer.news/2019/12...

Pluvicto+Xtandi Delays Progression Better than Xtandi-alone in mCRPC

prostatecancer.news/2024/04...

[WisdomSeeking in reply to God_Loves_Me]

Even Olaparib can harm - see: healthunlocked.com/advanced...

[God_Loves_Me in reply to WisdomSeeking]

no medicine in the world has no side effect that's reason you work with your MO to understand the side effects and continue treatment.

[Doctorsceptic]

The story does not sound at all good. My approach would be to go with a clear understanding of your father’s wishes. Does he want embark on debilitating treatment (if it is offered) and the trade off between quality of life and a notional increase in longevity? Is he mentally and emotionally prepared for end of life care.

I would listen with an open mind to what the oncologist has to say but be prepared to challenge unrealistic options. Remember that good palliative care coupled with sensible medical intervention gives better results than just having more and more radical treatment.

[Hawk56]

Reading through the NCCN guidelines may help, sorry I can't be of more assistance but where I am in my journey is such that I don't have experience or have done literature searches on treatment considerations such that I could offer any comments.

nccn.org/guidelines/guideli...

[Juju0713]

Tall_Allen just wondering if you might comment here as I know you are very knowledgeable, thank you

[Cactus297]

I am sorry I can’t be of more help but to date my son hasn’t needed any chemo. You are clearly in a difficult place. Please keep us posted on what you choose.