Recent PSAM revealed 3 small spots on my ribs and my MO has given me several options and I am seeking help with that.

[TEXAS_dan2022]

My PSA has been relatively flat, in the .26 to .36 range for 2 years but has now started rising to .71. My MO gave me several options from radiation therapy:

A: switching from my Abiraterone & Prednisone (which I have been on for over 4 years now) to Extandi which I can not afford the $3600 monthly cost

B: consider radiation therapy if approved by the UTSW radiation department.

C: consider doing a session of injections of Docataxel wich he advised has several not so pleasant side affects.

D: trying something called Sipuleucel -T which I am unfamiliar with.

He said that most of these options , aside from the radiation, only have a promise of a 20% chance of any major changes but they are best options.

what do you guys think?

[FormulaRob]

I always believe to go aggressive is best. So radiation in my opinion .. not a doctor and I don’t know anything of course .. but ask what your best odds of success are with each. If radiation has the highest success rate I would opt for that for sure and just deal with the side effects

[Tall_Allen]

Are you on Medicare? The maximum out-of-pocket cost of drugs is $2,000 per year in 2025.

Radiation of the metastases if they are in places that are safe to irradiate is a no-brainer - why not? It will reduce your PSA, but you still have to treat the underlying cancer. Doing it at the same time as Provenge (sipuleucel-T) may increase the antigen presentation for the immunotherapy so that it works better.

Switching to Xtandi may help for a time, but not for long because there is cross-resistance with the Zytiga you have been taking. It has been found that docetaxel keeps Xtandi working longer.

[TEXAS_dan2022 in reply to Tall_Allen]

Thanks Tall_Allen. I have been reading up on many clinical trials , double and triple legged therapies, PRESIDE, (ACIS RCT), and MAGNITUDE RCT. among others. Spme used cabazitaxel instead of Docetaxel and lots of confusing data for someone in my condition. Reading data sheets on Docetaxel, Enzalutimide and Provenge is depressing to say the least. If I went on the triplet therapy of Enzalutimide, Docetaxel and ADT (Lupron now), it looks like treatment could be worse than doing nothing. I told my MO that I do not want to end up feeling like an invalid or shut-in to extend my survival by 8-10 months.

[TEXAS_dan2022 in reply to Tall_Allen]

So if Medicare cuts off out of pocket @ $2,000 how is that handled. I have been on Lupron for over 6 years now and using my Medicare Part D I have been paying out between 7,000 to $10,000 per year but it has been going down a lot (cost of Lupron) recently. My MO has not yet prescribed Xtandi yet so I have no way of knowing what it will actually cost me.

I do thank you for all of your inputs as you are 'The Man' when I want to get some good feedback.

[Tall_Allen in reply to TEXAS_dan2022]

After $2000 out-of-pocket on Part D, Medicare picks up the rest in 2025. It was about $3500 in 2024. Lupron is covered by Part B, not Part D. If you have a supplemental plan, Lupron is 100% covered.

[dhccpa]

I just did the Sep-T, or Provenge. See my recent posts and those of others. Don't know what it did yet but was easy to do. Make sure it's covered before leaping, since it's pricey.

[Leaffan57]

that sounds like my story… I got the radiation right away and then went in Lupron and Erleada. >.01 PSA and T at 50 for 13 months now. Good luck

[TEXAS_dan2022 in reply to Leaffan57]

Thank you for the encouragement