Rising PSA last Lutetium 177 December 2022

[Janhpr]

My husband finished his 6th treatment of Lutetium 177, December 2022 PSA 1, PSA starting to rise May 4.6 September 8.4, the Oncologist can only offer Chemo, can refer him for R223 to another hospital, what are his choices now, chemo nearly killed him in 2010

Got COVID at Easter had 7 vaccinations, nearly killed him temp 40.1, refused hospital admission as brother died previous year in hospital with COVID. With the help of District Nurses twice a week to dress a leg ulcer which has now healed and Shropshire Doc ringing everyday and antibiotics eventually got him back on his feet and joined a Cancer Rehabilitation exercise group, so thrown the all the walking aids away.

We had to cancel the cruise in May but did go 24th September 15 days around the Balearic Islands, but my husband had a fall on the ship 2nd day, which spoilt it a bit badly bruised( on Warfarin) but overall did enjoy, taxi pick up, drinks, good food, caring staff and entertainment, although no casino which we did miss, life is still worth living, both 80 in January 2024, want as much time as we can possibly get, but little treatment choices and want some QOL as well

[GP24]

Ra223 will fight the bone mets but usually the PSA value will not get lower. You can get chemo at a reduced dose every two weeks. This has fewer side effects.

The Pluvicto therapy may have resensitized your husband to Xtandi. You could try this again.

[Janhpr in reply to GP24]

thanks for your reply NHS not flexible and don’t think they will agree

[Tall_Allen]

Xofigo+Xtandi+Zometa might be a good choice.

[Janhpr in reply to Tall_Allen]

Thank you for your very valued reply and will ask about this combination. Have asked for Xtandi before but told not eligible because had Abiraterone for 6 years which gave remission and good QOL. The logic is if Abiraterone failed Xtandi will as well, keep on saying it did not fail stopped because became toxic to the Liver. The NHS is great as long as standard treatment but anything different can be very inflexible. Did discuss with Oncologist who is Indian buying Xtandi privately from India, much cheaper than UK which is £2500 per month, but need someone to monitor bloods and our Oncologist said not ethically able to do that.

[Benkaymel in reply to Janhpr]

Yes, the inflexibility of the NHS is very frustrating. I'm hoping that Pluvicto will be approved soon.

[Janhpr in reply to Benkaymel]

Not optimistic about think that Novartis have withdrawn completely from UK