Prostate Cancer with Bone Met

steelheadfisherman

Hi Everyone,

My name is Charlie and I was diagnosed with Prostate Cancer with Bone Metasisis in Feb 2017 PSA @ 153 Gleason 6.  Has six doses of Taxotere Chemo  along with a six month Lupron Shot.  PSA went down to 23.  Began a regimen of ZYTIGA which lasted about 15 months along with Lupron.  PSA rose to 53 and was switched to XTANDI for about 6 months with no change to PSA.  Was introduced put on XOFIGO aka Radium 223 for 5 infusions.  PSA held steady at 65, but not much more.  My Oncologist put me back on Taxotere of which I have completed 3 Infusions.  Appointment is in two weeks to discuss, but our benchmark was 85 when I started Chemo.  My Oncologist thinking is that Taxotere worked in the beginning and with increased bone met activity that it would help again.  My big question is why won't my PSA ever go down to a manageable level?  I know PSA is what feeds bone met.  I am glad I am still here, but I feel there is something missing from the picture.  Is it feasible to have prostate radiation treatments or a prostate removal at this point?  Would that cut off the PSA at its source?  Or, worst case scenario is my Oncology team giving up and using Taxotere as a longer term solution?  Don't worry, all questions for my next Onco visit.  Anyone been down this road and can share the experience?   Thank you for listening.

VascodaGama

Consider Quality of Life too

Charlie,

Welcome to the board. I would like to know the details of your initial diagnosis. How many biopsy cores were positive to Gleason score 6? Have you done any MRI trying to locate extraprostatic extensions close to the gland? Is the bone metastasis located at one spot or are there several other places? Where are they located?

At the time of diagnosis were you asymptomatic? How old are you?

If I understand it well, the initial combination treatment (Taxotere plus Lupron) arrested the cancer into submission driving the PSA down (153 to 23 ng/ml). Can you tell for how long did the PSA keep steady before it started to increase?

The treatments you received are the traditional ones administered in advanced cases. Apart from the Taxotere and Xofigo that manage to kill cancerous cells, the others are palliative. Logically your doctor has decided to return to Taxotere. However, you must understand that the PSA has nothing to do with the treatment. PSA serum is produced by prostatic cells (not feeding them) and many of these cells do not produce PSA at all. The doctor uses the PSA as a marker to identify indolence or progression of the disease as there is no other marker to judge success (apart from symptoms). In fact you could have steady and low PSA levels in spite of cancer progression with no idea that the bandit is growing.

I have read here in the forum the story of patients with similar advanced cases and failed treatments that decided to try Lutetium-177 PSMA radionuclide therapy. This covers the whole body (like chemotherapy) but uses a radionuclide that targets only cells with PSMA (prostatic specific membrane antigen). The Xofigo treatment you have done  is a similar therapy but Xofigo only attacks lesions in bone. L177 has been in practice in Germany, Australia, China, etc (?). There are several articles on the therapy in the net. In this link you got some studies;

https://pubmed.ncbi.nlm.nih.gov/31595044/

Recently there have been clinical trials using “Antibody” (Mab’s) therapeutics for treating prostate cancer. You can investigate on the matter in here;

https://pubmed.ncbi.nlm.nih.gov/27817214/

https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCI-2019-01266&r=1

In any case, I wonder about the extent of your illness and about any influence that other health issues are or could prejudice in the choice of a treatment. I hope that the side effects from the several therapies are not affecting you much. You should consider quality of life too.

Best wishes and luck in your journey.

VGama

eonore

To answer your question about removal of the prostate, or radiation, these are localized treatments, aimed at removing or killing the cancer before it has spread.  Once the cancer has moved beyond the prostate and pelvic area, in other words become systemic, radiation or removal will not cure the cancer and will cause needless side effects and affect your quality of life.  This is why you doctors have only suggested systemic treatments.

 

Eric

Frank-1964

Dear Charlie,

Dear Charlie,

Have you had any pain in your bones and joints when you diagnosed with PCa? The reason I am asking since I had so much pain in my joints, knees, feet, arms and with moderate pain in my back. Have you had a bonescan or do you still experience pain in the bones after XOFIGO aka Radium 223 (usually there are no cancer cells on bones after)?  I hope you are doing well and wish you the best.

Frank

steelheadfisherman

VascodaGama said:

Consider Quality of Life too

Charlie,

Welcome to the board. I would like to know the details of your initial diagnosis. How many biopsy cores were positive to Gleason score 6? Have you done any MRI trying to locate extraprostatic extensions close to the gland? Is the bone metastasis located at one spot or are there several other places? Where are they located?

At the time of diagnosis were you asymptomatic? How old are you?

If I understand it well, the initial combination treatment (Taxotere plus Lupron) arrested the cancer into submission driving the PSA down (153 to 23 ng/ml). Can you tell for how long did the PSA keep steady before it started to increase?

The treatments you received are the traditional ones administered in advanced cases. Apart from the Taxotere and Xofigo that manage to kill cancerous cells, the others are palliative. Logically your doctor has decided to return to Taxotere. However, you must understand that the PSA has nothing to do with the treatment. PSA serum is produced by prostatic cells (not feeding them) and many of these cells do not produce PSA at all. The doctor uses the PSA as a marker to identify indolence or progression of the disease as there is no other marker to judge success (apart from symptoms). In fact you could have steady and low PSA levels in spite of cancer progression with no idea that the bandit is growing.

I have read here in the forum the story of patients with similar advanced cases and failed treatments that decided to try Lutetium-177 PSMA radionuclide therapy. This covers the whole body (like chemotherapy) but uses a radionuclide that targets only cells with PSMA (prostatic specific membrane antigen). The Xofigo treatment you have done  is a similar therapy but Xofigo only attacks lesions in bone. L177 has been in practice in Germany, Australia, China, etc (?). There are several articles on the therapy in the net. In this link you got some studies;

https://pubmed.ncbi.nlm.nih.gov/31595044/

Recently there have been clinical trials using “Antibody” (Mab’s) therapeutics for treating prostate cancer. You can investigate on the matter in here;

https://pubmed.ncbi.nlm.nih.gov/27817214/

https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCI-2019-01266&r=1

In any case, I wonder about the extent of your illness and about any influence that other health issues are or could prejudice in the choice of a treatment. I hope that the side effects from the several therapies are not affecting you much. You should consider quality of life too.

Best wishes and luck in your journey.

VGama

Your reply to me

Hi VGama,

 

Thank you for your detailed reply.  I appreciate it very much.  Will be reviewing all of the information and also preparing a reply to your questions.  You have shed a lot of light on questions I have had.  By the way, I am 70 years old and not suffering from any other ailments.  Will get back to you very soon.  Thanks again for your thoughts VGama.  Be safe and have a pleasant day.

Charlie