What happens next

[Bongoed]

My 68 year old husband was diagnosed with metastatic prostate cancer to the bones Oct 22 with PSA at 220. Since then he has been on Zoladex, Enzalutamide and has just finished 8 rounds of Docetaxel. Apart from this cancer he is very healthy - but what happens now when the PSA starts rising again. He is starting to get quite depressed and I have noticed a big change in him. Please advise.

[God_Loves_Me]

What's his current PSA ? Please add all PSA informations and other informations under bio so other member can help you. He is currently doing triplet therapy. It is one of the best treatment and great results as well.

Have you requested PSMA PET Scan ?

[Bongoed in reply to God_Loves_Me]

Hi -thank you for the reply. His PSA was 18 before Chemo - then 6 after cycle 4,5,6 but had risen to 10 on the last test, which has worried us, however the last test was done at a 4wk interval and not the normal 3 wk - so not sure if that would make a difference as we were not comparing like for like . All bloods are and have been normal and otherwise he’s always been very fit and active. PSMA Pet Scan - no apologies but we are by no means experts in this - is that available in the UK? The Enzalutimide was stopped as although the response was good at the beginning - almost undetectable after 12 months it started to rise quite rapidly, hence the chemo. I think going off the posts on here we need to be researching more and having the correct and direct questions to ask the Oncologist at the next apptmt - thank you for taking the time out to reply, much appreciated.

[God_Loves_Me in reply to Bongoed]

Under the profile, there is a section called "Bio." Add everything from beginning to date.

Most users here will go through your BIO and share their experience. It is not medical advice. They are sharing what they did when they had similar situations like yours.

I would say Please do not get depressed or nervous. We all have the same boat. It is good time to educate yourself and your husband as well.

Yes PSMA Pet scan is common in UK and around the world.

Source : cancer.gov/news-events/canc...

Probably your dr will order PSMA PET Scan. Also free to ask for the scan.

If you have cancer spots than may be options to go for radiations as well.

Here is PCa Abbreviation List

healthunlocked.com/advanced...

You will hear soon from Tall_Allen

[Bongoed in reply to God_Loves_Me]

Thank you once again, the abbreviation list is a god send.

[WisdomSeeking in reply to Bongoed]

It's good that his blood tests are normal and that he's always been fit and active.

He could try enzalutamide again after chemo. Docetaxel sometimes reverses enzalutamide resistance. See a post on Tall Allen's blog "Docetaxel Extends Enzalutamide Effectiveness": prostatecancer.news/2022/10...

[Bongoed in reply to WisdomSeeking]

Thank you, that’s good to know about the enzalutamide - he did tolerate that really well. That’s now on the list for the next apptmt with the oncologist.

[Proflac in reply to Bongoed]

Hi. You can ask about PSMA scan but availability on NHS is very limited. Depends where you are being treated. Also it depends on what scans he has had previously as you need to compare like for like to see progression. PSMA is much more sensitive and will likely show stuff which might have been there all along. Plus it's most used where tx with LU 177 (pluvicto) might be a tx option and again this is not available on NHS at current time though you can pay privately in UK or abroad. There maybe some trials in UK where you can access it however. Do then ask consultant about PSMA scan and Pluvicto and see what they say. If you have the means they may recommend this course of action. In my experience of the NHS they don't discuss what they can't offer so it's always good to ask. Best wishes.

[Bongoed in reply to Proflac]

Thank you very much. Gt Manchester so quite near the Christies hospital. Initially they mentioned/asked if he would consider trials - is that usually a last resort when the standard treatment fails though, - not sure. He’s had Pet scans and bone as he has several mets on his spine, hips and 1 in his skull. Not sure what a PSMA scan would tell us as it is aggressive - which makes us so angry as apart from the increase in trips to the bathroom through the night he had no other symptoms- anyway no point in going there now. I do appreciate all the advice from yourself and all the other gents - Best wishes to you all also.

[Concerned-wife in reply to Bongoed]

Trials in England have helped add years to the lives of many men around the world. You can study, then decide if worth it to your husband. Please understand that the non experimental part is not just a placebo sugar pill but rather standard of care. And he might get extra tests.,or a wonderful new treatment.

[Bongoed in reply to Concerned-wife]

Thank you - this is all good advice.

[Proflac]

Hi. I'm a wife too! Given the bone mets has anyone mentioned xofigo? If you get an opinion at Christies you are likely to get best possible advice for tx going forward.

[Bongoed in reply to Proflac]

I do apologise. No, no mention of Xofigo yet - but thank you, again something that we can mention at the next apptmt..

[Proflac]

Forgot to mention if he has considered tx for the depression? Talking therapy or antidepressants might help. Your GP should help.

[Bongoed]

Not yet, he is usually a very upbeat guy, but I’m monitoring it closely - thank you for your concern.

[Concerned-wife]

he should have a bone density test. I believe Standard of care is not to give those drugs if he is not osteoporotic while still hormone sensitive.

[j-o-h-n]

Greetings Bongoed,

I second the request. Please update your dear Husbands bio. It will help him and help us too. All info is voluntary. Thank you!

(age, location, meds, doctor(s) names, treatment center(s). age, psa scores, gleason score and etc.)

Good Luck, Good Health and Good Humor.

j-o-h-n