Sequence of treatment

[APK3]

Dx 11-1-23...GL 4+4.. PSA 139.. Bone mets , Ln involvement...Pten lose.. Did triplet therapy. 7 rds of chemo ..Nubeqa and Orgovyx . Slow decline to .08 nadr as of 1-8 -25. About 2 months ago my liver enzymes started to spike and my oncologist somehow missed the rise until my Alt was 790 and Ast was 820. He took me off Nubeqa for the last 3 weeks .They haven't returned to normal but have dropped to Alt 195 and Ast 178. My PSA rose to .1 as of the blood work today. I'm only on Orgovyx currently. Does this rise indicate I'm headed toward resistance ? After one becomes resistant Is there a sequence of therapy I should be looking into doing ? More chemo.. Pluvicto etc.. Thxs for any replies.

[Tall_Allen]

There is nothing worth doing until PSA reached 1.0 and doubling time is less than 9 months. After your liver enzymes normailize you could try slowly introducing a different second generation hormonal agent.

[APK3 in reply to Tall_Allen]

Thank you for your reply. Are there any advantages to what second generation agent to start next ?

[Pixicut in reply to APK3]

My dad was on Nubeqa and Lupron, became castrate resistant and switched to xtandi.

[speranza10 in reply to Pixicut]

What results are you getting from xtandi?

[God_Loves_Me in reply to Pixicut]

Did it work ?

[APK3 in reply to Pixicut]

Saw my MO today. He also says Xtandi once my liver enzymes get back in range.

[Tall_Allen in reply to APK3]

There is no randomized comparison to guide you.

[APK3 in reply to Tall_Allen]

TA by slowly, do you mean start with a pill for a few days then add a pill for a few days etc until full dose?

[Tall_Allen in reply to APK3]

Probably increase 1 pill for 30 days and check labs.

[APK3 in reply to Tall_Allen]

Appreciated