Any thoughts on treatments?

[Miccoman]

OK. I presented in 2014 with PC metastasized to the bone. PSA was 65.

Went on ADT without any treatment on my prostate and things have been under control until this year. My PSA has been very slowly rising for years.

In May I stopped Xtandi to do immunotherapy when my PSA had rising to over 2.0 (as recommended by my original oncologist in Florida).

Between 7/1 and 8/17 my PSA went from 3.23 to 8.0 and my urine stream has gotten worse (I had a TURP in April and was pissing like a horse, literally at first -- bladder would just dump out in a huge stream).

My oncologist allowed me to restart Xtandi since I have it on hand but he doesn't think it will do anything about my PSA (side effects have been more intense hot flashes -- still short duration, though -- and return of cold flashes).

So, urine stream faltering and PSA rising. Seems to me to indicate my prostate is growing. You don't have to be a rocket scientist, or even a doctor, to know what my urologist is going to recommend.

Surgery is the last thing I want right now (see my post on my orchiectomy) what other options are there?

Since most men with metastatic disease don't live as long as I have and since most men at my stage of the disease do not have prostates we're off in the weeds, so to speak.

All suggestions welcome.

Lee

[Tall_Allen]

Prostate radiation (not surgery, yet) has been found to prolong survival only if there have been fewer than 4 distant metastases. Talk to a radiation oncologist rather than a urologist.

Immunotherapy and radiation or chemotherapy work synergistically. If there is any bone pain, Xofigo is an option.

Chemo would be a good option now in preparation for the approval of LuPSMA by next year (hopefully).

[Miccoman in reply to Tall_Allen]

Thanks, Allen, I knew you'd have some solid advice.

Hard to tell on the distant mets as my father started trying to beat the queer out of me when I was 5 -- lots of stuff on my ribs that are probably healed breaks but there's no way to tell (according to my old oncologist). That aside there are more than 4 vertebrae and lots of pelvic spots that are definitely met.

No bone pain, I think because I learned to block it as a child. That's as good a reason as any, but I very seldom feel anything in my bones and then it's transient.

So I'll look more seriously at chemo. Sort of a Hobson's choice to be depressing my immune system going into flu season, to say nothing of Covid.

Thanks again for your solid input!

Lee

[Tall_Allen in reply to Miccoman]

Lee,

I'm so sorry to hear about the abuse you've suffered. It sounds like you are not a good candidate for prostate radiation or surgery.

If you think there is any bone pain at all, you can get Xofigo. You can combine Xofigo with chemo. Read the section in the following article about Xofigo entitled "Chemotherapy":

prostatecancer.news/2021/02...

When you get chemo, make sure you get Neulasta with it - it keeps your immune system functioning.