My PSA has been going up steadily for a couple of years. In Jan. of this year it was 0.052 and now is 0.25. It went up 25% in the last month. I am on Lupron and Abi. Seems like they are failing. I know, it is still low, but I am looking at my next options. I am not one to prolong life at any cost. I have an appt with my MO in a month as well as another PSA test.
I'm not a fan of chemo. It seems to only give an extra few months and the side effects are not great. My mets are in my bones so RAD 223 may be possible.
Asking for advice, as well as comments from you who have been through chemo and/or RAD 223.
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gsun
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Hello, Here is my experience. When I went to my MO @ dx, he laid out a path of treatment. (It was right before triplet therapy.) At the time I was on Lupron and Casodex (Started by my urologist.). He said if I do chemo early, he thought that I would have some years to live, not just months. He did not know how many. I have extensive bone Mets. I started chemo the end of Aug 2021. It will be 3 years this August. It wasn't all fun. But I am glad that I did it. . You can see detail in my profile. I did not do RAD 223--I have no clue. My Urologist thought that I should start with RAD-223. But MO did not. Again, just my experience
Greetings from the Whack! Although your PSA is still very low, when the Androgen Receptor Pathway Inhibitor (ARPI) drugs like Xtandi (enzalutamide) and Zytiga (abiraterone) start to fail you need to move to drugs that kill the cancer rather than just putting it to sleep. The number one option is chemotherapy but there are others. As you know, I am on a clinical trial investigating the use of Lutetium (a radioligand therapy or RLT) pre-chemotherapy. RLT is a precise targeting of cancer cells that emit PSMA with radiation given intravenously. The problem with Lutetium (a beta emitter) is that while it is good with tumors greater than .5cm it is not very effective at micrometastatic tumours which are energy sheltered and receive low absorbed radiation with Lutetium due to its short path length of approximately of 0.77 mms.
A better option might be Actinium (an alpha emitter) that has proven better outcomes than Lutetium. The BC Cancer Agency has a clinical trial involving Actinium that might still be open to participants. There is also a number of immunotherapy drugs being investigated by the Agency. Have a look on-line and see what is available. If you see something that might benefit you then talk to your oncologist. If you have questions, give me a call. Good luck!
You said "... when... drugs like Xtandi (enzalutamide) and Zytiga (abiraterone) start to fail you need to move to drugs that kill the cancer rather than just putting it to sleep. The number one option is chemotherapy..."
But chemo Taxotere (docetaxel) should be used before, not after, hormone therapy fails. "You can't do chemo after Zytiga helps. You have to start them at around the same time (called "triplet therapy"). The reason is that cancer cells that are not killed by Zytiga go into an impervious state called senescence. Chemo only kills rapidly duplicating cells." -Tall Allen in Healthunlocked: healthunlocked.com/advanced...
I recently started Orgovyx and Zytiga doublet ADT last winter, and chose not to add chemo because I was 81 and did not want to add more side effects. As it has turned out, the side effects of my doublet are insignificant, and I might have been able to tolerate chemo. But that early window has passed, and I am not about to drop the ADT for awhile to try chemo.
One of the reasons why historically chemo has appeared to only provided small benefit is that it has been used at late stage advanced cancer where there are no good options, not just chemo. So called Triplet Therapy is showing that in the right circumstances chemo applied earlier can provide larger benefit.
Your cancer has not been aggressive so far and I think you still have a lot of options. I would definitely ask for a genomics workup which may provide information on selecting treatments matched to your cancer mutations.
Traditionally cancer was treated on a step by step basis. Enforced by insurance companies.
Somebody published some mathematical research.
They found when you are fighting any self replicating biological organism, hitting it hard and early with everything you have slows it down more than staging and escalating your attacks as it grows.
These equations apply as much to a covid epidemic as to prostate cancer.
That mathematical theory has been proven out with countless clinical trials to apply to prostate cancer.
Best practice is to hit it hard early.
It's staged to some extent because of the peculiarities and nuances of the specific treatments.
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