It seems I am turning CRPC. My PSA is still low at .42 but it has gone up 8 fold since January. I have been lucky to have stayed CSPC for six years. Time to think about the next steps. I talked to my MO yesterday. I am switching from prednisone to dexamethasone right away. Getting new scans in January to compare to the old ones. May switch to Xtandi. I asked about going on Enza for a couple months, doing docataxel and then resuming Enza, but she said that may not be allowed in our medical system(BC, Canada). Once I drop the Enza, I may not be allowed to go back on. She is making calls. I asked her if she was aware of the PRESIDE trial and she was. She said there may be a trial I can do. I’m really interested in an Actinium trial but I didn’t mention it. Will do that in January when I talk to her again.
Does anybody know if it’s OK to just switch cold turkey to Dexa ?
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Reading your bio, you seem to fit the definition of Oligometastatic disease. So my question to you, if you get new scans, is it possible to get MDT on the Mets that show up or are you now past that stage where MDT may be beneficial to you in regard to remaining on your current treatment.
It would be nice to have that Docetaxel tx between Zytiga and Xtandi. Even if you only get in around 3 out of 6 infusions. However too if Docetaxel was benefitting you and tolerable you could continue and save the Xtandi until you progressed again. IMHO.
Probably something you've already been aware of and I'm not a Oncology MO or scientist so I cant explain into detail lol but generally:
We know of the issue/possibility of "cross resistance" when going directly from Zytiga to Xtandi which can reduce the length of time Xtandi is of benefit or worse case no benefit.
A course of Docetaxel has apparently been shown or known to reduce this possibility. I had 3 of 6 Dox infusions between Zytiga and Xtandi. Only 3 infusions because I was still progressing so stopped chemo. I asked my MO if although I progressed on Docetaxel would those 3 infusions be enough to still give a chance of reducing the possibility of cross resistance. His answer was affirmative.
Anectodectly it didnt do much to give me much time on Xtandi in my case. Going Zytiga to chemo to Xtandi I got about a month and a half of or two of benefit from Xtandi.
That was a couple years ago. The story continues from there of course. Luckily ha.
If you look at my bio skip to the update 2024 and you get a pretty good look from October 2019 onward at my treatments, couple trials I've been in and my latest and greatest relief my recent blessings on about the best Pluvicto results a guy could have.
Actinium-225 (Ac-225) is being investigated in clinical trials as a targeted radiopharmaceutical, similar to Pluvicto, for the treatment of prostate cancer. While Pluvicto uses Lutetium-177, Actinium-225 is a more potent alpha emitter, which may provide stronger tumor-targeting potential. However, as you noted, some individuals in trials report more side effects, likely due to the increased potency of Ac-225 compared to Pluvicto.
If you're considering or looking into these trials, I'd recommend reaching out to the specific trial site for firsthand accounts from participants, as experiences can vary based on factors like dosage, treatment schedule, and individual health conditions.
The correct name of the institution you're referring to is Weill Cornell Medicine, located in New York City. It is the biomedical research unit and medical school of Cornell University.
The oncologist associated with clinical trials involving J591 PSMA is Dr. Scott T. Tagawa, who specializes in prostate cancer treatment and research at Weill Cornell Medicine. He has been involved in studies exploring the use of radiolabeled monoclonal antibodies targeting prostate-specific membrane antigen (PSMA) in metastatic castration-resistant prostate cancer (mCRPC).
Weill Cornell Medicine is currently recruiting participants for several clinical trials related to prostate cancer. Here are some of the active studies:
Pilot Study of PSMA-TRT Re-treatment Utilizing 225Ac-J591
This pilot study administers a single dose of 225Ac-J591 to men with progressive metastatic castration-resistant prostate cancer (mCRPC). The research aims to evaluate the safety and efficacy of this treatment.
17
**Pilot Study of PSMA-TRT Re-treatment Utilizing 225Ac-J591**
This pilot study administers a single dose of 225Ac-J591 to men with progressive metastatic castration-resistant prostate cancer (mCRPC). The research aims to evaluate the safety and efficacy of this treatment. 22Phase I/II Study of 225Ac-J591 Plus 177Lu-PSMA-I&T for Progressive mCRPC
This clinical trial investigates the combination of 225Ac-J591 and 177Lu-PSMA-I&T in treating progressive metastatic castration-resistant prostate cancer. The study aims to determine the optimal dosing and assess the treatment's safety and effectiveness.
23
**Phase I/II Study of 225Ac-J591 Plus 177Lu-PSMA-I&T for Progressive mCRPC**
This clinical trial investigates the combination of 225Ac-J591 and 177Lu-PSMA-I&T in treating progressive metastatic castration-resistant prostate cancer. The study aims to determine the optimal dosing and assess the treatment's safety and effectiveness. 28Radioimmunotherapy Phase I Dose-Escalation Studies in Prostate Cancer Using 177Lu-J591 Antibody
This study explores the use of 177Lu-J591, a radiolabeled monoclonal antibody, in treating metastatic prostate cancer. The trial focuses on determining the appropriate dosing regimen and evaluating potential side effects.
29
**Radioimmunotherapy Phase I Dose-Escalation Studies in Prostate Cancer Using 177Lu-J591 Antibody**
This study explores the use of 177Lu-J591, a radiolabeled monoclonal antibody, in treating metastatic prostate cancer. The trial focuses on determining the appropriate dosing regimen and evaluating potential side effects. 34Randomized Phase II Trial of 177Lu-J591 and Ketoconazole in High-Risk Castrate Biochemically Relapsed Prostate Cancer
This trial examines the combination of 177Lu-J591 and ketoconazole in patients with high-risk, castrate-resistant, biochemically relapsed prostate cancer following local therapy. The study aims to assess the treatment's efficacy in delaying disease progression.
35
**Randomized Phase II Trial of 177Lu-J591 and Ketoconazole in High-Risk Castrate Biochemically Relapsed Prostate Cancer**
This trial examines the combination of 177Lu-J591 and ketoconazole in patients with high-risk, castrate-resistant, biochemically relapsed prostate cancer following local therapy. The study aims to assess the treatment's efficacy in delaying disease progression. 40Phase I Trial of Docetaxel/Prednisone Plus Fractionated 177Lu-J591 in Metastatic Castrate-Resistant Prostate Cancer
This study evaluates the safety and effectiveness of combining docetaxel/prednisone chemotherapy with fractionated doses of 177Lu-J591 in patients with metastatic castrate-resistant prostate cancer. The goal is to determine the maximum tolerated dose and observe any potential therapeutic benefits.
41
**Phase I Trial of Docetaxel/Prednisone Plus Fractionated 177Lu-J591 in Metastatic Castrate-Resistant Prostate Cancer**
This study evaluates the safety and effectiveness of combining docetaxel/prednisone chemotherapy with fractionated doses of 177Lu-J591 in patients with metastatic castrate-resistant prostate cancer. The goal is to determine the maximum tolerated dose and observe any potential therapeutic benefits. 46For a comprehensive and up-to-date list of clinical trials currently recruiting at Weill Cornell Medicine, you can visit their Joint Clinical Trials Office website.
Please note that clinical trial availability and eligibility criteria are subject to change. It's advisable to consult directly with Weill Cornell Medicine or visit their official website for the most current information.
The PRESIDE trial (Prolongation of Response with Enzalutamide in Patients with mCRPC) was a clinical study that evaluated the efficacy and safety of continuing enzalutamide (an androgen receptor inhibitor) in combination with docetaxel and prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC) who had shown disease progression on enzalutamide alone.
Key Points:
1. Objective:
To determine whether continuing enzalutamide during treatment with docetaxel improves outcomes compared to discontinuing enzalutamide when docetaxel is initiated.
2. Study Design:
Phase: IIIb
Participants: Patients with mCRPC who progressed after initial treatment with enzalutamide.
Progression-Free Survival (PFS), combining radiographic and PSA progression.
4. Secondary Endpoints:
Overall survival (OS).
PSA response.
Safety and tolerability.
Results:
The trial demonstrated that continuing enzalutamide along with docetaxel provided a statistically significant improvement in progression-free survival compared to discontinuing enzalutamide. However, it did not show a marked benefit in overall survival.
Clinical Implication:
The findings support the idea that simultaneous targeting of the androgen receptor axis and using chemotherapy may delay disease progression in patients with mCRPC, even after initial resistance to enzalutamide develops.
That is interesting. Maybe if I go on enza and do not discontinue it during chemo, that would solve the issue of not being eligible to go back on it after chemo.
Good point and idea, just double check it with your doctor and insurance because you don't want to end up paying 3.5 K dollars per months or lose your treatment.
I have not tried it. Abiraterone causes to the adrenal glands to stop producing testosterone but it also shuts down the production of cortisol. The prednisone mimics cortisol so you don’t feel like crap.
Most important is actually to avoid high blood pressure with the proper dosing of prednisolone. If the dosing is not correct high blood pressure is the result.
I might be worth considering Bipolar androgen therapy (BAT). 'Bipolar androgen therapy (BAT) is a new treatment concept for men whose prostate cancer has become resistant to standard hormone‐blocking therapy. Over the past decade, we have performed a series of clinical studies testing BAT in asymptomatic men with castration‐resistant prostate cancer. The key findings from these clinical studies are that BAT (a) can be safely administered to asymptomatic patients with metastatic castrate‐resistant prostate cancer; (b) does not produce symptomatic disease progression; (c) produces sustained prostate‐specific antigen and objective responses in 30%–40% of patients; and (d) can resensitize and prolong response to subsequent antiandrogen therapy. '
Yes, that has been on my list for a couple of years now. My old MO said he would not do it because of the lack of Phase 3 trials. Cover you butt syndrome. I am going to discuss it in January with my new MO,
I can’t find that post. the search comes up blank. I have read a lot of Russ Holyer’s book. BAT doesn’t always work but maybe I could feel good for a bit of time.
I have no idea whether you would be a candidate nor whether Zthe Canadian system covers it/ but depending upon what the scans show- maybe you could be a candidate for “whack-a-mole” radiation. I had my hip radiated more than 2 yrs ago and will be getting my vertebrae radiated in a few weeks since they were the respective culprits for my rising PSA , then and now- again.
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Interesting Thought....maybe it's the Lupron.
intermittent ADT+Abiraterone
Worrying study on long-term ADT (esp Enza)
Abiraterone - alternatives
Gatenby's Adaptive Therapy
