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Provenge vs Radium 223

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Posted 3/26/2016 3:34 AM (GMT 0)
My father who is 95 has asymptomatic metastatic castrate – resistant (hormone – refractory) prostate cancer. Apparently, Lupron Depot is no longer controlling his prostate cancer. His PSA increased from 1.8 to 15.8 and the CT scan shows a spot on his right hip. The spot has been there since 2012 and was the initial reason for taking Lupron Depot. The scans did not show any new metastatic spots. However, there has been an interval change to the spot.

His urologist is sending him to his group’s practice that treats advanced prostate cancer. They have called me up and said that he will be getting Provenge. There is no discussion. I asked about Radium 223. They told me that it is only used for pain management. Is the decision this cut and dry? Is Provenge the more effective treatment as compared to Radium 223? It seems to be complex for a 95 year old.
Posted 3/26/2016 4:13 AM (GMT 0)
Greenred,

So sorry you have to be here, but welcome to our corner of the world. This is the best place to be to support, we're like brothers. A few months ago, I ask my Onc if and when my present ADT2 treatments went refractory, what next? She told me she would put me on Radium 223! I've search a few times on 223, but will need to do more as I just can't remember all the information. I have a hard remembering what I read!!

Soon, others will be coming in and I know they can help you with the information you're wanting.

Keeping you and your father in my thoughts and prayers!

Dave in Bartlett, TN
Posted 3/26/2016 5:37 AM (GMT 0)
Greenred,
Welcome to the forum. Gary had radium 233, and yes it was supposedly for pain control, but it also seemed to reduce the bone mets. But he had widespread mets. But if your Dad has only one spot, why not spot radiation? I haven't been convinced that Provenge is all that effective, but some members say they are. Seems like an unlikely choice to me, but I'm certainly no expert.
Beth
Posted 3/26/2016 7:16 AM (GMT 0)
I agree with Beth - if it's only a single bone met, SBRT to the one spot (3-5 treatments) seems a more effective and safer solution than Xofigo. Xofigo is great if there are multiple mets. It's downside is that it can reduce the bone marrow's production of all kinds of blood cells (myelosuppression) which can be life threatening. That can be very tough on a 95 year old man. He can also add one of the second line hormonals (Zytiga or Xtandi). I think Provenge might work especially well with the spot radiation.

- Allen
Posted 3/26/2016 4:04 PM (GMT 0)
I would try for spot radiation to treat the bone met combined with Zytiga before I would try Provenge. This path put me in remission, PSA dropping quickly to 0.04 from 1.8 The Zytiga / Xtandi drugs have a better response than Provenge and have fewer and less severe side-effects...Might be worth a try or maybe not...
Posted 3/26/2016 5:27 PM (GMT 0)
Greenred,
I agree with the consensus here. I've had Provenge, Xofigo, and most other treatments available. Firstly get a second opinion from an oncologist that is well immersed in the current options available for advanced PCa. The benefits of Provenge are still largely unknown. The delivery process is time and energy intensive for a 95 year old man. Xofigo is a much easier treatment. It is not just for pain management. It has been shown to significantly extend survival and because it employs alpha particle technology it is kinder to bone structures. There are usually no side effects, but as Allen suggested it can suppress blood cell production to some degree. I'm pretty sure that Xofigo was instrumental in forcing my first remission. The best path in this setting however, given your dad's age, would seem to be spot radiation with a second line hormonal drug. Again, seek another opinion. Best of luck to you and your dad.

Jim
Posted 3/26/2016 8:31 PM (GMT 0)
I had Provenge but view it as more of a complementary treatment as opposed to a mono therapy.

Not sure the two (Provenge and Xofigo/Radium 223) are mutually exclusive.

While hsi PSA is rising he could qualify for Provenge with two consecutive PSA increases at least 14 days apart and then do Provenge and SBRT concurrently as I did.

Have one Provenge cycle before the SBRT, one at about the same time and one after the SBRT.

Provenge itself will not necessarily reduce his PSA so no way to know for sure if it is working but in theory it makes all future treatments more effective. I measured the combined effect rather than Provenge solo.
Posted 3/26/2016 9:46 PM (GMT 0)
Frankly, I think the Radium 223, with its SE profile, is too tough.

Why not wait until he is symptomatic and then do the SBRT.

Mel
Posted 3/29/2016 2:38 AM (GMT 0)
I want to thank you all for your help and support. Your feedback gets me up to speed and will enable me to focus my questions to my father's caregivers.
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