Any ideas as to what the next step should be

[Twig4]

My husband was diagnosed with a Gleason 9 score in 2017. After surgery, radiation, three rounds of chemo and now on Xtandi we just found out his PSA has risen to 417. Are suggestions, words of wisdom or help you can give to us we would certainly appreciate. Not ready to throw in the towel yet!

[Tall_Allen]

Metastases in lymph nodes, bones, or organs? Any biopsies of metastases? If you're in US, there is Provenge, Jevtana, Xofigo (if in bone and not organs), and many trials of PSMA-targeted therapies.

[Twig4 in reply to Tall_Allen]

Yes, it has spread to bones but not organs. We live in Indy and we have an appointment with his oncologist tomorrow. I believe Xofigo has been mentioned as a possibility and I am going to ask about Provenge. . We have already gone the Jevtana route. Dr Kwon is our dr at Mayo and he has mentioned LU 177 in Germany. That too may have to be a consideration. Just feeling extremely overwhelmed. PSA went up almost 80 points in 3 weeks. Thank you for your post.

[Tall_Allen in reply to Twig4]

If you get a chance, could you please enter all that in his profile- it helps when you ask for advice if we know what he's already had.

Combining Xofigo and Provenge seems to be synergistic:

prostatecancer.news/2021/02...

There are Lu177PSMA trials in the US. You may want to particularly discuss the Th227 trial in Omaha tomorrow (always email before the meeting if you can):

prostatecancer.news/2020/08...

[Twig4 in reply to Tall_Allen]

Thank you for the info. I will update my husbands profile today and mention the TH277 trial when we speak to his dr. Thank you so much.

[Grumpyswife]

I highly recommend a visit to Omaha to get Dr. Luke Nordquist’s opinion. Like TA said he may have a clinical trial that will fit.

We’ve been to Mayo and Omaha and the Omaha experience was excellent. We felt like herded cattle at Mayo. Like Dr Kwon, Dr. Luke thinks outside of the box. I believe Dr Luke is collaborating for a clinic in Illinois as well.

[Twig4 in reply to Grumpyswife]

Thank you for the info about visiting Dr Nordquist in Omaha. I am going to look into this today. I appreciate so much your reply.