8/4/23 Update questions for MO

[alperk]

To review, after 19 months on Lupron, Zytiga, prednisone, PSA increased on 1/23 to 0.253, then 0.309 on 2/21. Plarify scan showed only one active site in hip which was radiated. 4/4 PSA dropped to 0.24 which indicated the lesion was knocked out and I would be hormone sensitive and stay on Zytiga. Yea ! HOWEVER, 5/23 PSA went UP to 0.343 and 8/4/23 now 1.46 at my PCP physical. Have MO appt 8/16 which includes another PSA check but looks to me like another PET scan and/or Xtandi. Thanks for all you thoughts which I have boiled down, I think, to the following :

1. Get a scan first

2. Switching from prednisone to dexamethasone before you give up on abiraterone

3. Choose from and possibly combine: Taxotere, Xtandi, Xofigo, and Provenge.

4. Switch to xtandi or Casodex

5. Try docetaxel, which works by directly killing cancer cells, but can have substantial side effects,

6. Try Cabazitaxel chemo used together with prednisoneto other parts of the body (metastatic). Cabazitaxel is given after other cancer medicines have stopped working

7. Try relugolix (Orgovyx), daily pill to replace Eligard

8. Erleada or Nubeqa

9. Prostate cancer is found among people who take Vitamin b12, especially for people who are 60+ old, have been taking the drug for 2 - 5 years. I have been on it for 6 months

I don't want to overwhelm my MO so which of these above do you think are worth discussing with him?

[RyderLake2]

Hello,

I think start with the scan. Something is causing your PSA to go up and a PET scan should explain what this is. In my humble opinion (and I am not a doctor) scans are not just one option, they are the MOST important option. Second, if you haven't already done so, talk to your medical oncologist (MO) about your concerns taking Vitamin B12. Finally see what he (or she) has to say about your PSA going up based on your scan results. I would seek their medical opinion and ask them why they are recommending this option as the best one for you. I would definitely do this before offering all kinds of alternative therapies. Where I live Casodex is prescribed only before starting a regimen of first tier ADT drugs so as to prevent a testosterone flare. It is normally not prescribed after beginning hormone therapy and certainly not as a replacement for second tier hormone therapy drugs like Zytiga (abiraterone) and Xtandi (enzalutamide). Hope this helps!

[dhccpa]

Taxotere and docetaxel are the same thing, aren't they? Verify that, though.

[alperk in reply to dhccpa]

Yes. Thanks for that. Docetaxal looks like a rough choice for me at this point

[dhccpa in reply to alperk]

Yes, I haven't had it yet.