My husband was diagnosed in Jan 2020 with stage 4 prostate cancer with bone metastasis. He is castrate-resistant. He is on Lupron every three months. Zytiga failed after about a year. He is now on his fourth chemo (cab) which the doctor thinks is not working. He mentioned four options that he thinks would be the next step. 1. Lu-177. 2. Clinical trial AR Degrader. 3. Modify chemo with the addition of another drug (may not be ideal because of increased neuropathy) I usually take good notes but I can't find the name of the drug 4. Stop all treatment. He has bone pain that is pretty extreme at times. He takes 4 mg of Dilaudid as needed for pain and Lyrica. The pain management nurse just added Cymbalta also for pain. He's still mobile (limited) but uses a cane and tires easily. I'm looking for any suggestions and information. Thank you.
Update-We saw the oncologist on Friday, Jan 13 when the above was discussed. The PSA result had not come back yet but the doctor was pretty sure that chemo was not working. He did schedule another chemo in three weeks. The result came on Jan 14. PSA 1,355.00
I am assuming that the oncologist will cancel the 5th chemo.
Past PSA results
10/7/22-338.643
10/31/22-535.906
12/20/22- 842.693
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margretrburns
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Margaret - Sorry to hear the treatment history has not provided more benefits. I'm not qualified to comment on your situation, but others who read and post here are. MateoBeach has done chemo and a flavor of Lu-177 that he got in AU, so I expect he will be your best resource here for #1 on your options list. Here is the link to his HU profile with his treatment history:
Margaret - Try to think of it as the darkness before the dawn; i.e., "pretty deflated" but far from being defeated. And while that is much, much easier said than done, a positive perspective is a fine emotional anchor when things seem to turn against us. I have 2 x cancers myself and have lost both parents & two siblings to various types of cancer. My two remaining siblings both have/had cancer, with one currently in treatment. By including my extended family, it seems I've lived most of my 60+ years since being a young teenager with cancer as the backdrop to family life. In spite (or maybe even, because of it), I do my utmost to look at every day as the gift it surely is - at least in an absolute sense, if not always in a relative one.
As the bone pain you mention is purported to be the type that is "hard to reach", you have my heartfelt sympathy for trying to quell that QOL-robbing condition. In looking for additional options, we have a number of people participating at this forum who are n=1 do-it-yourselfers, myself among them. Most are expanding on SOC by using treatment approaches still only available in CTs and/or combining/adjusting treatment regimes/dosing for best results for their specific circumstances. So, please give your post some time to see if any of them are able to provide personal patient experience to aid with your situation or offer some additional options/approaches for consideration.
In the meantime, Stay Positive, Be Safe, and Stay/Get Well! Ciao - Capt'n K9
Thank you for taking time to respond. I really needed to hear this from you. "Try to think of it as the darkness before the dawn; i.e., "pretty deflated" but far from being defeated".
I’m so sorry to hear that his status is dire now with the severe pain and chemo as well as ADT plus AAR drugs not providing control of the cancer. Terrible to be in pain so he should have whatever opiates regimen to control that.
Lu-PSMA treatment is worth considering and he can get it if he can get a prompt PSMA PET scan. The treatments are easy, just an infusion. But kidney function must be adequate. About 1/3 of patients get marked improvement, another 1/3 get modest improvement and around 1/3 no significant benefit. Only way to know is to try.
An appropriate clinical trial should also be under consideration. I don’t know which one you referred to in option 2. If a metastasis is accessible for biopsy for genetic and immuno-histology (IHS) analysis it could indicate the best choices or trials.
BAT is probably off the table with the painful bone mets that could be aggravated by high testosterone. Unfortunate as BAT can restore responsiveness to enzalutamide or similar. And can be combined with Olaparib.
Holding you both in my heart and thoughts. Paul / MateoBeach
Hi MateoBeach, Thank you for responding. I forgot to mention that my husband was accepted into the Splash trial in October. Unfortunately he was going to be put on Xtandi and not Lu-177 as we had hoped. He did have a PSMA PET scan in October. His oncologist suggested that he not do the trial because Zytiga stopped working previously and Xtandi is a cousin drug. So my husband decided on chemo because if it didn't work then he could get Lu-177. (He chose not to do chemo when he was diagnosed in Jan 2020).
This is his eGFR- 68 mL/min/1.73 m2 on Jan 13. (In December it was 85). I don't know if this is adequate kidney function.
He did have genetic testing done but it didn't offer any options.
I asked about BAT but the doctor said it wouldn't be helpful for him.
I don't know much about the AR Degrader clinical trial.
I have a message in to the doctor to see if he can meet with us sooner to go over these options in more detail. Since chemo doesn't seem to be working there's no reason to wait 3 weeks for the next appointment.
I know he said something about if he does one treatment he won't be eligible for the other. But it's all fuzzy right now. I feel like I'm underwater and everything is strange.
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