Rising PSA - no clinical trial of PARP inhibitors yet

I just wanted to give a quick update. The day I was going in to enroll in a clinical trial for PARP inhibitor's the Cancer Institute of New Jersey gives me a call and announces they found a trial that is not randomized and I will be guaranteed to get PARP. The downside is that I won't be getting Zytiga as part of the trial. I will be on PARP alone with my on-going Lupron depot.

I was a bit torn. I did want to get the PARP/Zytiga combo, but if I had enrolled, there would only be a 50% chance I'd get the combo. With the new clinical trial, I will be on PARP alone, and since it is a dose escalation trial, that means that I will start off with a small dose and work upwards.

A bit alarming since my PSA has climbed up to 8.6. Now I'm waiting for the phone call to see when I can enroll in the second trial.

My local onco seemed alarmed I was not going to get Zytiga and he encouraged me to take the combo, even if it means not getting the PARP. But my second onco, who is more of a clinician, had nothing but good things to say about PARP and encouraged me to get it whenever I can, wherever I can. It's several years away from FDA approval.

I'm very nervous. This is my first time in between therapies and the first rise in my PSA since I started hormone therapy a year and a half ago. I'm also going against my primary onco's advice.

There's a clinical trial of both Zytiga and Xtandi together that you may be eligible for. It's Phase II, so you are guaranteed to get both:
A Study to Determine Safety and Tolerability of Enzalutamide (MDV3100) in Combination With Abiraterone Acetate in Bone Metastatic Castration-Resistant Prostate Cancer Patients
These are both proven to increase survival.

The other clinical trial I'd be eager to get into would be for Cabozantanib. It's had spectacular results so far:
Trial of Cabozantinib (XL184) in Castrate-Resistant Prostate Cancer Metastatic to Bone
Cabozantinib-S-Malate in Treating Patients With Hormone-Resistant Metastatic Prostate Cancer
Magnetic Resonance Imaging in Measuring the Effect of Cabozantinib on Bone Metastases in Patients With Castrate Resistant Prostate Cancer
Cabozantinib Plus Docetaxel and Prednisone for Advanced Prostate Cancer

They are all Phase I or Phase II studies, which means you are guaranteed to get the drug.

Thanks for the info and support.

I'm tending towards the PARP trial first, since one of my major problems is having the BRCA mutation. They believe this how I got the cancer in the first place. My genes couldn't stop the growth.

It's a trial for 6 months, and at the end, if I'm benefiting from the drug, I'll continue.

I'm excited about the other trials, XTandi/Zytiga combo, etc. But perhaps I can pursue those after the PARP trial. If the PARP trial works for a long time, I won't complain.

I now fully feel the weight of having to make these decisions. My heart goes out to all who have been in tougher spots than this.

John, tough choices to make but thank god we have these options.