75M, Castrate resistant metastatic prostat cancer. Need help on treatment strategy

[TravisCooper]

Hello Everyone,

Need some help for my father. Age 75 years. Porstate cancer was detected in 2017. Has been on some form of ADT treatment since (Lupride, Enzalutamide etc). It has now turned castrate-resistant.

The latest PSMA scan showed multiple lesions in lungs, liver etc. Which is kind of surprising. The scan did last year had no such lesions The PSA though was rising steadily, but was around 2 for most part of the year and then moving to 5 two months back and finally to 9 now.

The doctor suggested doinga BRCA germline mutation testing along with MSI/PD-LI. He thinks it is a small chance but if the results are positive can lead to a more targeted therapy. it will be approx 3 weeks before I get these test results. Till then he has started my father on Abiraterone.

My worry is that in those three weeks the cancer may spread real fast. Will it make sense to start with Docetaxel and then if needed pivot to targetted therapy if needed ? Would it make sense to start with Lutieum (Pluvicto) instead ?

Is there any alternative treatment I can pursue ?

Would be really grateful for your suggestions.

[Tall_Allen]

Docetaxel, definitely.

[TravisCooper in reply to Tall_Allen]

Thanks brother.

[GP24]

Switching from Abiraterone to Enzalutamide is often done but works for just a few months. Better to get Docetaxel now and also get a genetic test. This test may take a while and he may be able to start with the drugs designed for BRCA or MSI mutations after Docetaxel. After that Pluvicto is an alternative.

[TravisCooper in reply to GP24]

Thanks brot. The shift here is from Enzalutamide to Abiraterone. Hope that works.

Have already started on genetic test. Will take three weeks for the result. I wish the doctors had asked me to get the genetic testing early in the process.

[VictoryPC]

There is a path. Hang in there and educate yourself. You'll find it as I did.

[petrig]

Maybe Nubeqa(darolutamide) +Orgovyx..

[petrig in reply to petrig]

Orgovyx (relugolix).

[TravisCooper in reply to petrig]

Thanks Bro. He is already on relugolix. Sorry should have mentioned it in my initial note

[j-o-h-n]

Greetings TC,

You've come to right place for help and information. Would you please update your dear Dad's bio. You may want to glean some of your post (above) and add it to his bio. All info is voluntary but it will help him/you and help us too. Thank you and hopefully the new year will be brighter for him and for you.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Miccoman]

Hang in there, Travis.

I'm 75, been through it all since diagnoses in 2014 as stage 4.

Tall Allen is right, of course, since you have to have had chemo in order to qualify for Pluvicto.

And then, if the DNA shows anything actionable, you can talk about options. I have mutations but I'm doing well and my MOs (I now have 4 in various institutes -- lots of opinions, lots of options) all agree that right now a clinical trail would be best, with the standard of care options as fall back, if I get sicker.

Don't forget about quality of life issues, like lowering stress, keeping active -- especially exercise and doing things he enjoys. There has to be more to life than going to doctors! I've found Qi Gong, an exercise routine based on Tai Chi and acupressure, to be helpful in balance and lowering stress.

Having looked at a number of clinical trials there are lots of very exciting treatments on the horizon, so keep a positive outlook.

[TravisCooper in reply to Miccoman]

Thanks friend. Appreciate the help.

One interesting information. The consulting doctor was saying that one rising opinion among medical fraternity was to try with Pluvicto early on on the process. Folks are waiting for a five+ year data to update guidelines.

The doctor has put us Abiterone for now, till the results of genetic testing come in. Based on the inputs received here, I am thinking of going back to the doctor and asking him to start on chemo right away.

Wish you all the health and the best of luck!

[speranza10]

Abiraterone after enzalutamide works poorly there is a strong cross resistance. It is better to alternate them with chemo, if now you do chemo and then do abiraterone the latter will work longer.

[speranza10]

In Europe they have recently approved the combination of abiraterone plus olaparib, even though there are no BRCA mutations. Maybe it could work for your father given the presence of metastases in the soft tissues.

[VictoryPC]

There a far better paths. Just educate yourself on the options as I did. It will save his quality of life.