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Posted 12/27/2016 4:44 AM (GMT 0)
just saw the urologist, he said that we have ran out of treatment options.
he doesn't recommend xofigo because of my dad's current bloodworks. xtandi is out because of the cross resistance issues with zytiga.
we are so lost!
Posted 12/27/2016 6:26 AM (GMT 0)
I'm sure some of the guys who really know the options will be on here soon, but I think you should be looking for a good Oncologist, preferably one who specialises in PCa.

Sounds like your Urologist is now out of his depth, and time to move on to an Oncologist who will be more aware of the latest treatment options.

I personally believe you should never ever give up and I would keep looking until you find someone who can offer some options.

Best of luck

Chas
Posted 12/27/2016 6:35 AM (GMT 0)
Cross resistance means that Xtandi will not work as long as it would if Zytiga had not be used before. But you can still use it for some time.

George
Posted 12/27/2016 6:39 AM (GMT 0)
hi George,

my dad was previously on zytiga and achieved control only for a year. hence the urologist make that remake.
Posted 12/27/2016 8:57 AM (GMT 0)
I agree you need an oncologist. Where are you located. Many here will recommend one near you. There ate still a lot of options for tx. You need to be proactive right now and go find a good medonc who can prescribe a tx plan that will be most beneficial, based upon current scans and blood work. Good luck and keep faith!
Beth
Posted 12/27/2016 10:18 AM (GMT 0)
hi celebrate life,

I follow your posts very closely. actually we do have a medonc, today's visit is only with the urologist.
but well, we will be seeing him tomorrow as my dad was admitted due to low blood counts. we are considering both xtandi and xofigo however the doctors just doesn't seems to believe that they may work.
we are from Singapore by the way.
Posted 12/27/2016 11:21 AM (GMT 0)
Xtandi is an option and you should just try it. This is the way to find out if it works or not. Unfortunately it will work less than a year if Zytiga has been used before.

George
Posted 12/27/2016 11:51 AM (GMT 0)
Hi George,

we wanted to try xtandi as well. this is because I have read about restoring the sensitivity towards zytiga and xtandi after chemo. my dad had done both taxotere and jevtana, hence I wanted to give xtandi a try. although the urologist discourage.
Posted 12/27/2016 1:17 PM (GMT 0)
Fuunit, sorry to hear the despair in your virtual voice, I have a feeling you are not t the end of the road, there are so many new treatments. I'm no expert but I'm guessing from your post, your dada has only scratched the service.as you probably know, look for a response by Tall Allen, there are others here who re very knowledgeable as well, about new treatments NS clinical trials.
Good luck.
Posted 12/27/2016 1:52 PM (GMT 0)
Fuunit,

I mentioned the LU177 PSMA treatment in the past. Did you ask for this treatment? You said it is available at your local hospital.

George
Posted 12/27/2016 2:31 PM (GMT 0)
George,

yes, my hospital does provide that treatment. however it slip my mind because we were focusing on xofigo which targets bone mets.. I will ask the oncologist tomorrow regarding lu177-psma..
I have read about it as well and attacks cancer cells in a different way from xofigo
Posted 12/27/2016 3:11 PM (GMT 0)
Fuunit,

I do not want to generate too much hope but want to motivate you to insist to talk to the doctors which provide this treatment and not to your urologist only. Here is an image how this treatment helped in ONE case:
VIEW IMAGE

The metastases return after some time though.

George
Posted 12/27/2016 3:26 PM (GMT 0)

Hello FUUNIT,

I agree with others who have stated that you need to rely heavily on a medical oncologist's recommendations at this point.

When I was first diagnosed, I simply consulted with my original urologist. When I added an oncologist to my medical team, many new doors opened, in terms of treatment options.

I realize you are dealing with a case with many complexities, so please make sure that you consult with a doctor who has expertise in treating cases of advanced prostate cancer, and who understands the complexities of the case you have described.

A close friend of mine did a series of chemotherapy treatments, then went on ZYTIGA. When ZYTIGA failed him, after a period of time, then he underwent a second series of chemotherapy treatments. After that second series of chemotherapy treatments, he just started XTANDI, which has now lowered his P.S.A. to the lowest level he has ever achieved since he was diagnosed.

My friend felt he was "out of options" --- but he and his doctors decided to try XTANDI after the second round of chemotherapy infusions, and he has had encouraging results so far.

His doctor has stated that in the future, yet another round of chemotherapy treatments can be considered.

I know it is helpful to hear from a wide range of people, so I hope that you will continue to seek out the expertise of an oncologist who specializes in prostate cancer cases with complexities.

Sent with my best,
"Cyclone Team Fan" ~ Iowa State University
Posted 12/28/2016 1:50 AM (GMT 0)
Hi George and Cyclone,

It's always very encouraging to hear great success stories from all around. It just makes you more motivated to try new treatments. Although we do know that there is always a time frame associated to each treatment and different people react differently.
Anyways, I just received the blood report, PSA is increased ( expected) but ALP has decreased. So there's a mixed results which I'm still happy because of the ALP reduction. I'm pressing the oncologist for newer treatments with radioligands etc. Hopefully they work for some time.
Posted 12/28/2016 5:00 AM (GMT 0)
I did several months of Zytiga, which worked really well (got me done to about 1.5 from over 5), but it shut down my liver. I was off for several months (PSA went up), then went on Xtandi. Xtandi worked very little (when any) for 8 months, with tiny PSA drops, but last month I went from 1.5 > 1.1. Crossed fingers for 16 January test.

(keep in mind I am a G4+5, and never had the PSA to go with my extensive involvement)

I don't know that Xtandi after Zytiga is supposed to quit after a year. If it does, I had best get busy spending my retirement money devil

But remember, each one of us is different, or they would have cured this by now.
Posted 12/28/2016 8:20 AM (GMT 0)
What is it in the bloodwork the precludes Xofigo? Myelosuppression from docetaxel? If so, you do have to wait before adding any radiopharmaceuticals or more chemo.Which immunotherapies are available there?
Posted 12/29/2016 1:46 AM (GMT 0)
Hi Allen,

his recent months blood works showed that he's anemic from docetaxel and cabazitaxel. hence the oncologist does not recommend any radiopharmaceuticals drug. as for immunotherapies, I have checked with him before and he said it's not available in Singapore.
Posted 12/29/2016 5:39 PM (GMT 0)
Makes sense. You have to wait until his bone marrow function recovers, certainly.
Posted 12/29/2016 9:13 PM (GMT 0)
What I meant was the Lutetium-177 therapy. The Singapor General Hospital offers this treatment: Peptide receptor radionuclide therapy (PRRT)
They write:

Singapor General Hospital said...
Peptide receptor radionuclide therapy (PRRT) is a molecular targeted therapy for inoperable metastatic well- or moderately-differentiated neuroendocrine tumours. It can also be used for other tumours with high somatostatin receptors expression. The treatment is performed with intravenous administration of radioactive somatostatin analogue (e.g. Lutetium-177 or Yttrium-90-labeled radiopeptide).

In several countries this is used to treat metastatic prostate cancer after chemo failed. See the image I posted.

George
Posted 12/31/2016 2:09 AM (GMT 0)
Hi George and Allen,

Indeed we will have to wait for the blood works to be "good" before commencing on any forms of treatment that may potentially cause myleosuppression.
So far both his PSA and ALP had decreased by quite a bit (few hundreds) even though he is only on Casodex (50mg). But i will bring up the idea of using Lu177-PSMA or DES for future treatments.
Posted 1/3/2017 2:43 AM (GMT 0)
Just a little update in 2017.

First of all, Happy 2017 to all brothers and sisters here!

Something happy to share, a recent blood test revealed falling PSA and ALP (both reduced by around 500!). So that's something worth cheering about. My father's appetite has improved after his Hgb went up and so far so good.
However he was admitted yesterday because of hypokalemia. It wasn't intended for as we went to doctor for calf pain. There wasn't a clear diagnosis of could have caused the pain. So the MedOnc ordered Xrays to be taken and we are waiting for the findings.
Oh well, apparently Singapore doesn't have Lu177-PSMA as a therapeutic option for now. According to the Medonc, they are trying to get the trial in Singapore but not sure when it will start. So meanwhile with the falling PSA and ALP, we will just remain on casodex and probably add Diethlystilbestrol to the current plan.
Posted 1/3/2017 3:40 AM (GMT 0)
I would like to point out that 40% of men do not experience a cross resistance with Zytiga/Xtandi. Also, a round of chemo
Can reset the effectiveness of Zytiga.
Posted 1/3/2017 3:46 PM (GMT 0)
Hello fuunit, my husband and I are from Singapore too. We see Dr Toh Chee Keong at national cancer centre. You can see our progression in the signature line. Have you done any of the more advanced scans to determine where the Mets are? Eg. We are now on GA68-PSMA scan every six months which is supposed to be more accurate and because that's been stable, we are also considering a round of radiotherapy including possibly even going to Japan to try out carbon ion therapy... If yourdad just has two sites of bone Mets don't know if you would consider that? Wish your father all the best -- this journey is not easy!
Posted 1/4/2017 5:40 AM (GMT 0)
Hi Ansty,

It's such an coincidence, we share the same MedOnc. We didn't consider the scan because his mets are kinda widespread as of now.
We are considering adding xofigo into the plan after his blood counts stabilised.
How is your husband doing so far?
Posted 1/4/2017 12:59 PM (GMT 0)
Hi fuunit,

I see. Sorry to hear that your father's mets are quite widespread... My husband is doing okay so far. PSA plummetted but the latest one was a slight rise -- we don't know if that's fluctuation or a trend of increase just yet. The doctor has told us that perhaps we should start to consider some form of radiotherapy as his mets also appear to be quite stable - just one met to left ischium and nothing else has come up so far. So if we zap it now, there may be 'curative intent' is the thinking, hopefully nothing else spreads in meantime...

Great that you are also with Dr. Toh. We quite like him. At the same time, i do agree with you we have to push medical providers to try different approaches. we have discovered that our insurance covers overseas treatment as well so we are starting to make enquiries about treatment in Japan with carbon ion therapy. (https://prostatecancerinfolink.net/2015/10/10/carbon-ion-radiation-therapy-for-prostate-cancer/)

Please keep me posted on how your father is doing, will pray for him too!
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