Treatment options for paralysis due to spinal cord compression

[jeetu_g27]

Dear All,

My father who is battling advanced prostate cancer is bed ridden past two months . He was undergoing radiation treatment in October 2024 while this spinal compression had occurred . we continued the radiation to treat it (5 sessions) but it didn't help . He got high dose of dexamethasone(24mg/day for 7 days ,then 18mg/day for next 7 days also for two weeks , it didn't help.

Then we get him admitted to hospital and they again ordered MRI and planned a surgery to decompress the spine but after getting him admitted for 10 days, finally they said No to surgery due to overall weakness and life risk due to Anesthesia .

He started chemotherapy (cabazitaxel 35 mg) and got 3 infusions till 24th December 2024 . His PSA is responding to chemo and is 22 after third chemo , it was 40 before starting chemo .

We are not getting any hope for getting the leg movement back , any suggestion from respected members will be helpful.

Thanks all.

[God_Loves_Me]

may be pluvicto can help ?

[jeetu_g27 in reply to God_Loves_Me]

Thanks a lot , will explore the options

[JohnInTheMiddle]

Be careful with random suggestions to try this treatment or that treatment. However I have a question.

How long is your Dad been on leuprolide ("Lupron")? When did the cord compromise occur? Leuprolide is a common ADT GnRh "agonist" drug. I also had very serious spinal cord risk due to metastases. I was put on Degarelix, which is a ADT GnRH "antagonist". This prescription for me was a deliberate choice because Degarelix ("Firmagon") does not cause a testosterone flare at the beginning of treatment. An ADT agonist in the other hand causes an initial flare. My doctors did not want to make my spinal situation worse during the initial period treatment.

Both drugs deliver ADT, which is the foundation of prostate cancer therapy. Either way eventually you end up with low testosterone. No doubt your doctor's had reasons for their decisions; the whole thing is so complex.

[jeetu_g27]

Thanks John🙏

He started Lupron on 26 th March 2024 . He was going well till 14th August 2024 , going for long walk , doing cycling and experienced no pain . Mild pain started from 15th Aug and doctors gave morphin and gabapentin for pain relief. Pain was relieved but again started in October. we have done PSMA PET scan and it shows multiple lesions in spine ,Pelvic and ribs with no evidence of soft tissue or compression risk .

we started radiation to pelvic area and lower back on 20th ocober 2024 .On 25th october after radiation, he felt difficulty in walking , immediately I informed radiation oncologist , he suspected some fracture and ordered X-ray , it was done on 21st and shown no fracture .

On 23rd october MRI was done and it shown spinal compression and pressence of soft tissue at D9 , we continued radiation for 5 more session with radiation to spine , but things didn't improved . Also from 23rd october we started dexa 24mg/day for 7 day and then 18mg/day as per prescription from Neurologist but that too didn't work.

At present , there is no movement in his legs and no sensation , His bowl and bladder control was zero , but a week back his bowl control is back and he started feeling when there is an urge to go to loo.

PSA trend

[WisdomSeeking in reply to jeetu_g27]

Hello,

it's good that the bowl and bladder control improved.

In previous posts you wrote that abiraterone was no longer working. Has your father switched to Xtandi (enzalutamide) or to another ARSi different than abiraterone?

The dosage of cabazitaxel was 35 mg? I think normal is 20 or 25 mg.

Is the spine decompression surgery still an option if chemotherapy works out?

[jeetu_g27 in reply to WisdomSeeking]

Yes , after abiraterone failure he tried enzalutamide for approx 20 days but PSA continued to rise despite being on enza , so we stopped it after oncologist told to stop it and do radiation before chemo Yes , they prescribed 35mg cabazitaxel, don't know about the standard dose , here we get the vial of 60mg out of box .

Don't know if they will do the decompression, oncologist is not in favour of surgery .

[WisdomSeeking in reply to jeetu_g27]

Is he currently on any ARSi?

Tall_Allen often recommends Xtandi during chemotherapy even if Xtandi no longer works. Chemotherapy can make Xtandi work again. It maybe may work similarly for abiraterone.

See a blogpost on Tall_Allen's blog: prostatecancer.news/2022/10...

The dosage of cabazitaxel is calculated on mg/m2 so i guess his Body Surface Area (BSA) is around 1.75, so I think it's OK.

[jeetu_g27 in reply to WisdomSeeking]

No, he not on any ARSI as of today ...Thanks for sharing the article, will discuss this with oncologist and add it afterwards

[Doctorsceptic]

I am very sorry to hear of your father’s condition. The situation he is in is very serious and any improvement is only going to be temporary.. I am going to be blunt not because I want to be hurtful but because I don’t want to make suggestions based on false hope.

The single most important question is what does your father really want? Does he want to be left in peace and given as much comfort as possible or does he want to continue with active medical interventions and all the hassle that goes with it. It is time to have a very honest talk with him and the medical staff about what can and cannot be achieved. You obviously love him very much but I am sure you realise his prognosis is poor and he might not have much time left. So make the best use of what time he has left.

I wish you well.

[jeetu_g27]

Thanks Doctorsceptic ,

Yes , this is bitter truth that things are not good but we keep trying and pray to God for best .

Regarding my father wish : He was the most active person in our family tree till December -23 , more energetic and active than a youngster . Now he only want to stand on his own feet . He is experiencing no pain while lying on bed .

Being bed ridden is breaking him from inside .

[Cactus297 in reply to jeetu_g27]

🙏🏻from our family as well. Your Dad is going through what we all fear and pray our loved ones won’t experience and you are right there for him. You’re a wonderful son.

[jeetu_g27 in reply to Cactus297]

Thank you for your prayers 🙏

[Cactus297 in reply to jeetu_g27]

We are all going dealing with this monster of a disease and are all there for you🙏🏻🤗

[APK3]

🙏 for your father and you as well.

[jeetu_g27 in reply to APK3]

Thank you for your kind wishes and prayers 🙏

[God_Loves_Me]

Phase II study of cabazitaxel (CAB) plus enzalutamide (ENZ) in metastatic castration-resistant prostate cancer (mCRPC)

ascopubs.org/doi/10.1200/JC...

[Har036]

Praying for you🙏

[jeetu_g27 in reply to Har036]

Thank you 🙏

[j-o-h-n]

Remember, God is on your dear Father's side....May 2025 be a joyful year for him and for you.

Jeetu = always a winner!!!

Good Luck, Good health and Good Humor.

j-o-h-n

[Cactus297 in reply to j-o-h-n]

🙏🏻Spot on John!

[jeetu_g27 in reply to j-o-h-n]

Thanks John for your kind words and wishes 🙏