Docetaxel treatment failure, running out of options.

[MarylandGuy]

Diagnosed in early 2023 with a PSA of around 200. Was in bad enough shape where I needed a transfusion and a hospital stay. Started on Lupron, Nubeqa and Zometa. That worked very well and over six months brought PSA under 1 and felt pretty good. Then in January 2024 that started to fail and PSA started rising. Did three treatments of Provenge and started on Lynparza/abiraterone which slowed progression for a few months into mid 2024. Then switched to Talzanna and xtandi which only slowed progression a bit. At this time my PSA is around 6 and it is November 2024.

My recent PSMA pet scans show six bone mets and almost no cancer in prostate. This cancer is now basically entirely in my bones and in no other soft tissue.

We then started chemotherapy with docetaxel (and prednisone) and PSA stayed the same then slowly rises till January PSA 17. Now in February my PSA came back at 34.

I am BRCA2 positive and therefore that is why we tried the PARP inhibitors.

So I have never done radiation. I have been told I have too many spots for traditional radiation but my doctor is now talking about Pluvicto or Xofigo next. What other options?

[Tall_Allen]

I'm a fan of Xofigo combined with other therapies. Perhaps discuss these with your oncologist:

prostatecancer.news/2021/02...

[MarylandGuy in reply to Tall_Allen]

Thanks for this information!

[MarylandGuy in reply to Tall_Allen]

Xofigo it is, that is what the doctor has prescribed.

[Tonyliv]

I switched from docetaxel to cabazitaxel. Worked for 30 weeks, ten sessions. Now looking at LU 177.

I was on abiraterone for years; apparently, enzalutimide still works in about 15% of cases, so going to try that.

[profsailor in reply to Tonyliv]

I did great with apalutamide for two years! When that failed, Docetaxal was next that was pretty awful and not really beneficial for me. I responded to Lu-177, first treatment in London, before available here as Pluvicto. 4 treatments so far and PSA is under 1.0.

[MarylandGuy in reply to Tonyliv]

So docetaxel failed and cabazitaxel worked?

[Tonyliv in reply to MarylandGuy]

Yes. I did 7 infusions of docetaxel and my PSA was growing as I became resistant. I switched to cabazitaxel for 10 infusions and finished last month, but that was failing too towards the end. Even a losing rearguard action is better than letting the cancer run away though.

[profsailor]

I had a horrible 8 months with docetaxal every 3 weeks and it only provided some benefit of lower PSA for about 6 months. As my PSA climbed again, I had my first Pluvicto treatment and responded well. I have now had a total of 4 and we are holding off until PSA climbs again and we’ll repeat the PSMA-PET. I only had some fatigue for a couple of days following Pluvicto treatments. No other side-effects. All the best to you with treatments.

[Tonyliv in reply to profsailor]

👍💪👏

[MarylandGuy in reply to profsailor]

Ok, that is one option I hope my doctor considers.

[RyderLake2]

Hello,

Pluvicto (lutetium) is a good start but for roughly one-third of the men taking this treatment, it doesn’t work. Actinium-225 might give you a better response. Far more powerful. Good luck!

[MarylandGuy in reply to RyderLake2]

I was hoping for actininium-225 as an option.

[God_Loves_Me]

I am NOT doctor and I am NOT Medical Advisor. I will address your last line "What other options?"

Trying other options would be a good idea, and Pluvicto and Oxifigo should be kept in the future.

Please see if you get enrollment in clinical trials.

Example :

 177Lu-TLX591 (Much better results than Pluvicto)

clinicaltrials.gov/study/NC...

67Cu-SAR-bisPSMA  (Much better results than Pluvicto)

urologytimes.com/view/fda-g...

[Professorgary]

I think your brca2 positive mutation is one of the mutations that respond well to BAT. Also, you are still on prednisone. Dr. Samuel Denmeade at JHU told me that in time prednisone is converted to androgens that feed the cancer. It is converted by certain gut bacteria. This bacteria increases with the lack of T. If you in fact live in Maryland, a consult with him might be beneficial. God bless.

[raoulmaher]

Hello Maryland Guy - NXP800 trial ? any chance of getting on one soon ? kindest Raoul

Obviously as well as all of the above !!!!!