Any new options after Xtandi(or Zytiga) and Cabazitaxel?

The most recent FDA-approvals of new drugs have been Erleada (apalutamide) for non-metastatic CRPC and Xtandi for the same indication. Keytruda was approved for men with a rare genetic abnormalities - MSI-i or dMMR. Estrogen patches (an old drug) have tested well in the UK in early trials.

After Zytiga, Xtandi, Dosetaxel, Jevtana, when these things all fail, as they all do at some point, Your MO will start to give you that blank look..They (and you) have run out of approved treatments ..If you are determined to hold off the grim reaper for a while longer, you will have to find an MO or other doctor willing to try things outside the "Standard Of Treatment"..In order to keep their malpractice insurance in place, few doctors are willing to work and prescribe drugs outside the accepted standard..And insurance companies usually balk at paying for them..

As you move into second line and third line treatments, you get less effective drugs that come with a greater side effect load...Finally the side effects are just too much to tolerate given the possible benifit..Some stage 4 patients can get some benefit from Radium 223 if most of the detectable mets are on bones.. But side effects can be rough..You will need to see an RO about the Xofigo treatment..The estrogen patch thing might be worth a try..At this point, anything is worth a try..Sometimes, a run of Dosetaxel will "reset" you cancer so it will respond to Zytiga again..Worth a try..Another simple treatment, BAT will also "reset" your cancer so Zytiga works again..

@Fairwind: I saw your post preview through my email notification, but now I am not able to see it here. What is wrong? Do you have any idea?

@142: Oh!Thanks! You were absolutely right. I don't know how it happened. It got fixed.

Farz53,

I did see your email but thought that it was something useful for others as well, so I checked the thread. I always try to reproduce the steps on my laptop so I can give a better answer.

Glad things are good now.

Fairwind:Do you think Chemo may ever fail? (Some say it is the most aggressive treatment and is supposed to work until the side effects wouldn't be tolerated anymore). Need your and other comment on this one. )

I had an attempt made by my onco team for the keytruda, but it turns out that actual specimens of prostate tissue are destroyed after seven years (by most, but not all labs), so mine are long gone. No genetic testing there. They suggest that if a met shows up in another, less risky area, they could biopsy them. But they do not want to do that to a vertebrae unless all else fails.

An argument for asking for your samples if there is a limit ....

They are keeping me on Taxotere, and added the RT on my T12 vertebrae. If the PSA starts back down, we will know that we are dealing with two independent types of PCa. If it does not, then we know Taxotere has failed, and we go to Jevtana. Problem there is that in cases similar to mine, they have seen that in Jevtana fails, even if Taxotere was "better", there are toxicities that increase greatly so that some (like me) should not retry Taxotere.

We are thinking about a retry of Xtandi, since it worked so well for 14 months.

I am still on Lupron and Prolia, and will be for life at this point.

142-

Have you discussed the Guardant 360 test with your oncologist? They are calling it "the liquid biopsy" because it a blood test. Unlike tests of circulating tumor cells that only look for whole tumor cells in systemic circulation, Guardant 360 looks at DNA fragments. They use next generation sequencing to make millions of copies for analysis. It's not the same as a pathological analysis where they can stain for certain characteristic biomarkers - ideally both would be used. Here's their website:

/www.guardanthealth.com/guardant360/

Why do they suspect that two different kinds of PC are going on? I read recently that two different PET scans (FDG and PSMA-based) were used to find different kinds of tumors that co-exist in the same patient.

apologies to Farz for kidnapping your thread

142-

Why are you getting Prolia, rather than Xgeva, when you have a known spine met? Are you trying to keep the dose low?

Celebrex, when added to Zometa conferred a 22% survival increase in men with mets. I imagine it would be similar for Prolia/Xgeva.

ascopubs.org/doi/10.1200/JCO.2016.69.0677

Hey Farz, sorry your thread got hijacked.. But back on topic, don't overlook clinical trials...This one holds promise and it might help your Dad. Depends if he is interested and where you live..

Look up NCT03511664, the "Vision" trial..

Farz,

I didn't mean to get your thread hijacked. I considered that, as I am in the same boat as your dad, my recent updates might offer something of value.