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Lutetium 177 treatment

User
Posted 17 Jul 2021 at 18:29

Hello everyone, not posted for a while but brief update:

OH diagnosed advanced Pca in July 2019, Been on hormone injections from outset, docetaxel, RT and Enzalutamide. Recent increased bone pain and PSA doubling monthly. Bone scan shows increase in existing lesions and new lesions in the bones (spine, pelvis, sacrum, hip and thigh) CT scan looks like Enzo has kept lymph nodes at bay. 
Offered cabazitaxel, radium 223 or investigation of Lututium 177. Off to London next week for PSMA PET scan and consultation. 
Need to discover costs and weigh up benefits/side effects/survivability across the three treatments. My husband is not keen on my chemo because of the side effects. He asked what his life expectancy would be if he had no treatment, million dollar question but best guess 4-9 months. So that made him realise that treatment was definitely the only way forward still. 

Has anyone else experienced the Lutetium treatment, looks like side effects not too bad but I suppose still early days on overall survivability? 

Any help or advice much appreciated 

Thanks 

SunnyJane 😊

User
Posted 29 Sep 2021 at 23:45

Thank you Norm and Elaine for your kind comments and wishes. With my husband having had hormone therapy, docetaxel, radiotherapy and Enzalutamide, like many others he is on a continual journey of hoping for the best outcome but the fear of the worst is never far away. 
We are lucky that we have amazing family and work to distract us from dwelling too long on any negative thoughts. 

My husband always says he lives in hope and remains optimistic because without that way of thinking the outlook and life would be pretty miserable. We both stay as strong as we can, we consciously do things to make wonderful future memories and we enjoy life as much as we can. But when either of us feel a bit down we accept that those feelings are normal and we allow any sad thoughts to wash over us, we do not fight them or bury them as we know tomorrow is another day and most importantly we have each other. 

Sending love and warm wishes to men suffering with PCa and their wives, girlfriends, partners and families. At the outset of our journey I underestimated the effect his disease would have on me and the ripple effect to the wider family. It is so important as a wife/partner to practise some self care and self-compassion, I know that I have to do this so that I can stay strong to keep looking after my husband. 

Best wishes 

SunnyJane 😊

User
Posted 30 Oct 2021 at 10:17

Quick update:

Second cycle of treatment went ahead at the Wellington Hospital in London on the 11th October. My OH has dealt with this second treatment really well. The radiotherapy he received for his jaw and back pain has definitely helped. 
He suffered some nausea in the first couple of weeks but this has subsided.

He is experiencing a lot of fatigue (to be expected) so we just try and plan his day so he can get rests in between his work.

He will have follow up bloods in a couple of weeks and then a scan to measure progress, at that point they will decide if he goes for another two cycles and we keep our fingers crossed that it will go ahead and the health insurers keep supporting him.

Lovely to see some sunshine this morning β˜€οΈ 

With love to all 

SunnyJane 😎 xx 

User
Posted 22 Oct 2022 at 00:07

Sunnyjane, I have been following your husbands treatment journey with interest particularly his Lu177.  My husband is hoping to start his Lu177 shortly.

In the course of my research into Lu177 I came across a new Tandem treatment using Lu177 and Ac225 (Actinium)  which is currently being used in Germany, Finland and India.   From what I understand the Ac225 is more targeted and is used where monotherapy of Lu177 has failed.  It can be used as a monotherapy or in tandem with Lu177.  You may want to check it out for your husband as an option after radium223.  Its not available in the UK.

https://www.inspire.com/groups/zero-prostate-cancer/discussion/lu-177-ac-225-psma-radioligand-therapy-homburg-germany/

https://www.primomedico.com/en/doctor/prof-ezziddin-nuclear-medicine-homburg/

https://www.docrates.com/en/en-new-experimental-radioactive-lutetium-treatment-may-significantly-aid-the-treatment-of-advanced-prostate-cancer/

https://www.itnonline.com/content/radiation-therapy-effective-patients-no-further-treatment-options

 

User
Posted 24 Jul 2021 at 21:00

Update: OH has had a PSMA PET/CT scan and is now having an FDG PET Scan this coming week in London. Referred by his consultant.  Luckily he has health insurance and they have agreed to fund the scans and two cycles of Lutetium. Then he will assessed as to responsive to the treatment and if he needs further cycles we hope to persuade the health insurers to keep funding. 

so many unknowns, fears, lots of travelling to get treatment but he feels it worth it to obtain innovative treatment and with less side effects than chemo. He really struggled with the docetaxel and one of his main choices for treatment going forward is quality of life. 

Will update once we have some results. 

Best wishes

SunnyJane 😊

User
Posted 05 Jan 2022 at 23:00

Update: My OH had follow up bloods and PET scans after first two cycles of PSMA and on the positive side it was showing no dramatic spread, some tiny new lesions in his cervical spine, left shoulder and greater activity in his left hip but generally the consultants were pleased. But PSA remained at 15 and his alkaline phosphatase was nearing 700 (normal range 40-130). 

The health insurance company agreed to fund another two cycles so he returned to London on the 14th December for the third cycle, his consultant that administers the infusion was a little despondent as the results so far were not entirely encouraging. As is normal his bloods were taken prior to the L177 infusion and the consultant returned to his hospital room to excitedly tell him “you’re a late starter” PSA had dropped to 10.3 and ALP had dropped to 550. Finally the news we wanted, the treatment is having a positive effect. 

So we head back to London on the 6th January to have more bloods and consultation to determine timings of fourth cycle. 

Currently he is feeling very, very fatigued. I have mentioned his fatigue previously but this is on a whole new level. His recent bloods at the local hospital are showing a steady decline in his haemoglobin, red and white blood cells. So we will wait and see whether they are happy to go ahead or wait a little while for these levels to recover a bit. 

He also suffers with nausea for the first couple of weeks post treatment and he has had significant increased bone pain in his left hip, lower back and left shoulder. So has had to increase his zomorph dose. 

He continues to work and most importantly he made it to Christmas lunch and New Year’s eve this year. He missed the last two years due to illness last year and chemo the year before, so that was a massive plus this year. 

The continued uncertainty and with practically no data on PSMA treatment in terms of its ability to prolong life, we are resigned to just taking each day as it comes and celebrate the fact we are still together and we are able to still spend quality time with our family and loved ones. 

It was sad to read tonight that NICE has not licensed Oliparib in England and Wales. His consultants have been keen to get next generation sequencing done on his original biopsies to see if it would be a future option. Currently we would have to find a way of funding this treatment if PSMA fails. The final options are now Cabazitaxel or Radium 223 unless further trials become available. 

Sorry for long post but if any of this helps anyone considering the PMSA route then that’s great πŸ˜€ 

With love SunnyJane β˜€οΈ Xx 

User
Posted 01 Sep 2022 at 23:04

Feeling very sad tonight after hearing the sad news about Bill Turnbull. My OH has felt very emotional all evening. 

Since I last posted we have been through a pretty rough time but things have settled in the last couple of weeks as OH has received some excellent additional care. 

After completing 6 cycles of L177 in May 2022 and then a one off blast of radiotherapy to sacrum and hip in July due to rising PSA and 9/10 pain my OH has been able to enjoy the summer and have a rest from treatment. 

He has seriously struggled mentally over last few weeks but our local hospital has set up a new service called Enhanced Supportive Care. This consists of a Palliative care consultant and an Occupational Therapist and a Physiotherapist. They are there to look at your disease and care from a more holistic viewpoint. It has really been amazing for my husband in thinking about his life now and in the future. It has helped him to figure out his life goals and think about his future wishes. He was avoiding this as he felt making such plans was admitting defeat and the end was nigh! 

What he has realised is it means these thoughts and worries are parked and he can spend his energy focusing on what he likes doing. He is very fatigued but has continued working usually 4-5 days a week. Again giving up work was a sign of defeat for my OH and he felt gave him a purpose to get out of bed every morning. He is now trying to redefine his purpose and again use his limited energy on doing what he enjoys. 

At the end of L177 his PSA had risen to 15.3 but after the radiotherapy it reduced to 11.3 and then 10.9 mid August. We had an onco consultation mid August but our usual consultant was away so we saw a locum. He has scheduled us to come back to see our usual onco early October. If bloods are stable we presume my OH will continue on current regime until PSA starts rising again. We have been told then it will be remaining options of Cabazitaxel or Radium 223. 

We paid privately (£2000) to have his original biopsies screened for the BRCA gene but sadly he is negative so the drug Olaparib will not be an option. Only 10% of men are positive but we felt it was worth trying as options run out. 

He currently feels that he will not go down the chemo route again as personally he doesn’t feel the side effects are worth the expected additional months of life he will get, but who knows when the time comes to make that decision. 

He has also started some counselling sessions at our local FORCE, these have been offered to both of us and we go as a couple which has been very beneficial. My OH has always been a man with great mental resilience and a very positive outlook on life but he has accepted this additional support and help as he can see the benefit and he recommends anyone who gets offered extra help to take it. 

I will update you all once we know what his next steps will be after future bloods and consultations. We live in hope of possible new trials and we were told by the Prof who administered the L177 there is a chance this treatment can be repeated, if so we would have to have the support and agreement of our health insurance company. 

Much love to you all

SunnyJane xx 

User
Posted 17 Jul 2021 at 18:29

Hello everyone, not posted for a while but brief update:

OH diagnosed advanced Pca in July 2019, Been on hormone injections from outset, docetaxel, RT and Enzalutamide. Recent increased bone pain and PSA doubling monthly. Bone scan shows increase in existing lesions and new lesions in the bones (spine, pelvis, sacrum, hip and thigh) CT scan looks like Enzo has kept lymph nodes at bay. 
Offered cabazitaxel, radium 223 or investigation of Lututium 177. Off to London next week for PSMA PET scan and consultation. 
Need to discover costs and weigh up benefits/side effects/survivability across the three treatments. My husband is not keen on my chemo because of the side effects. He asked what his life expectancy would be if he had no treatment, million dollar question but best guess 4-9 months. So that made him realise that treatment was definitely the only way forward still. 

Has anyone else experienced the Lutetium treatment, looks like side effects not too bad but I suppose still early days on overall survivability? 

Any help or advice much appreciated 

Thanks 

SunnyJane 😊

User
Posted 18 Jul 2021 at 01:58

About 8% of men exhibit insufficient PSMA for the Lu 177 to work so a PSMA scan is a prerequisite to establish whether this is the case so having this scan will establish whether Lu 177 is viable in your OH's case.

You may find you can glean some interesting information from this thread. However, some of the early detail has since changed after it was started. It is now possible for suitable men to have the PSMA scan at a small number of centers on the NHS in the UK that do PSMA scans for example. Much of the earlier part of this thread dealt with the 68 Gal PSMA scan but later posts included those from user name 'Notabene' who had Lu 177 in Finland where it was more expensive than in Germany. Unfortunately, Notabene does not seem to have posted for quite a time. It should be remembered that the cost of cutting edge treatments can vary between centers and countries and go up and down. So one really needs to establish current costs if considering this treatment. https://community.prostatecanceruk.org/posts/t13262-Lutetium-177---PSMA-Treatment

DaveSt is another member who had Lu 177 but has not given an update since he posted in the above referenced thread back in Oct 2020.

 

 

 

 

 

 

i

Edited by member 18 Jul 2021 at 02:30  | Reason: to highlight link

Barry
User
Posted 18 Jul 2021 at 15:50

Hi Barry

thanks for your kind reply and link to the other thread. It still seems very variable dependent on where you live. Our consultant told us about PSMA treatment and has referred us to The Prostate Clinic in London. So we are embarking tomorrow on a bit of a discovery mission. 
Will my husband’s scan show that he is right for the treatment or not as the case may be? What will the treatment involve, frequency, travelling to London, cost etc. 
He has obtained three opinions on next steps. Reassuringly they have said our consultant in Devon is doing everything they would have done and whatever decision he makes going forward there is no one right decision. As we all know it seems to such depend on how each individual responds to the treatments. 
My husband didn’t respond very well in terms of shrinking cancer or stopping further spread to docetaxel or RT but Enzalutamide has been the most successful. He started last July but new symptoms started occurring in April hence where we find ourselves today. 

So hard for all going through this journey, especially when your decision on treatment in many ways is a bit of a gamble as you have no way of knowing how the body will react. 

I will update once I have more information. I don’t come on here that often but have been very appreciative of reading experiences of others. Do you think it would be helpful to move this conversation over to the other thread, for ease of others seeing the ongoing conversation? 

Thanks again for your reply. 

SunnyJane 😊

User
Posted 27 Sep 2021 at 23:36

Wishing your husband all the very best with his further treatment. Thank you for sharing your information. Hope you are ok too. We’re at the earlier stages of this journey and I know how difficult it can be already for him but also for us. Take care 

User
Posted 29 Sep 2021 at 21:28

Hi Sunny Jane,

Your self and husband are wished all the best of fortune in this high tec option you have decided on.

All of us in the APC community will in the long term benefit from the experiences  of pioneers like yourselves.Please keep us posted as treatment proceeds and stay strong!

Kind Regards

Norm

User
Posted 10 Oct 2021 at 23:40

Wow really tough week! 

My poor hubby has continued to feel really nauseous so naturally been off his food, exceptionally fatigued and very depressed. I keep reassuring him that this is a consequence of the RT and PSMA but it is so difficult when you are in the limbo stage of waiting to see if current treatment is working. He currently feels as if he is regressing, not progressing. Sadly only time will tell but this horrid disease leads to the darkest and most horrid corners of ones mind. He is very emotional and so down he says he can’t see any value he brings to anything anymore. 
This is very hard to watch, especially from someone who has always been so positive. I do remember when he was on chemo after the 3rd or 4th cycle he felt like this. 
I reminded him that he is currently having the book thrown at him in terms of treatment, he has just had his 3 monthly hormone injection, he is still taking Enzalutamide (as they feel there is still some benefit in terms of his lymph nodes) he is undergoing PSMA and he has had RT a week ago. Plus all the morphine and numerous other drugs. 
I keep telling him that it’s the treatment not the cancer making him feel this way and just offer as much love, support, kindness and care without smothering him. It’s a fine balance between supporting but not making him feel like he can’t do anything. I support him to do as much as he feels up to but if he needs to rest or sleep then reassure him that’s his body saying he needs to rest. 
I miss my husband, stupid thing to say when we are together all the time but any wife or partner watching their loved one going through this will know what I mean. 

I am hoping that this week may see some of his symptoms easing and then we head off to London on Wednesday for PSMA treatment and scans Thursday/Friday. We are hoping that bloods will all be ok to go ahead with treatment and fingers crossed he should start to see a drop in his PSA. 

Following this cycle he will be reviewed and if he is responding positively he will be offered another two cycles. 

Thank you for reading, I am not going to lie, life is tough at the moment πŸ˜”

With love to all

SunnyJane 😊 

User
Posted 11 Oct 2021 at 00:10

Thanks for the update, and wishing you both all the best for the next treatment.

User
Posted 11 Oct 2021 at 00:27

Sunnyjane, so sorry to read your post and hear that you’re having a really hard time at the moment. 

We are in the very early stages of diagnosis so I’m lucky that my hubby still doesn’t have any symptoms (apart from a couple of HT side effects) and is feeling fit and well….I still panic at every little ache or pain though πŸ˜’ 

You’ve obviously both been so strong and positive throughout this journey so far and it’s apparent just how much you have been there for him. 

I really hope he starts to improve very soon and will be feeling much better to go ahead and get his treatment later this week. 

Take care of yourself too and keep being strong. Wishing you both well and looking forward to hearing positive news from you soon xx

Edited by member 11 Oct 2021 at 00:28  | Reason: Not specified

User
Posted 11 Oct 2021 at 14:29

Hi,

Hopefully this will turn out to be just a bit of a blip in your husband's treatment which although tough at present ,with your evident loving support ,he will get through. 

Stay Strong

Kind Regards Norm

 

 

 

 

User
Posted 05 Jan 2022 at 23:32
Thanks for the update, good to see figures are heading in the right direction and you had a good Christmas and New year...
User
Posted 06 Jan 2022 at 01:02
So pleased to see that the Lutetium is starting to have an impact and bravo to the insurance company for agreeing to fund further cycles. Having a relatively normal Christmas is a bonus and will be a happy memory for you all to hold in your hearts. Take care of yourself, SunnyJane x
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Jan 2022 at 08:03

Hi SunnyJane believe that Bill Turnbull has been receiving this treatment, stopped doing his radio program presume while having treatment, believe prior to that was having R223. May be if he can be contacted might give you more insight into long term.

User
Posted 06 Jan 2022 at 09:09

Originally Posted by: Online Community Member

Hi SunnyJane believe that Bill Turnbull has been receiving this treatment, stopped doing his radio program presume while having treatment, believe prior to that was having R223. May be if he can be contacted might give you more insight into long term.

Hi Jeanette, Yes I think I read that Bill was receiving PSMA, my OH is running a couple of years behind Bill in terms of his diagnosis but we feel they have followed a similar treatment regime. Let’s hope if Bill is receiving it, he is gaining benefit from it as well. πŸ™ 

Much love xx 

 

User
Posted 22 May 2022 at 19:50

Hi Sunny Jane,

Thank you for sharing the update on your husband's treatment with us.

He is obviously a strong character and I wish you both well on this uncharted journey. Moreover,hope he gets some deserved respite to build himself up before any other treatment becomes necessary.

Regards

Norm

User
Posted 23 May 2022 at 10:22

Hi SunnyJane, it is so helpful for us that you are sharing your difficult journey. I do hope that the treatments begin to work better soon. I really feel for you both. 
I am still learning about these less known treatments as I previously thought I’d got away with a cure , but alas not as my PCa has come straight back and may possibly be castrate resistant now as my PSA has risen after 4 doses of Zoladex. 
Keep on fighting and as I said, thank you for sharing this information. Much appreciated.

Good luck. 
Phil

User
Posted 23 May 2022 at 14:57
Hi Sunny Jane,

So very sorry that the relatively rare treatment your OH had has not worked better, particularly after good early response. I hope the pain can be dealt with which is the most pressing aspect but treatment now to slow progression needed. Just to clarify for the benefit of those that may be interested, PSMA is what is expressed by a patient that enables Lutetium 177 to work or to show location of mets. It is not a form of treatment. About 8% of patients express insufficient PSMA to work as a scan which is a prerequisite for having Lutetium 177. Like so many treatments, patients can respond differently.

Barry
User
Posted 24 May 2022 at 21:53

Originally Posted by: Online Community Member

Hi SunnyJane, it is so helpful for us that you are sharing your difficult journey. I do hope that the treatments begin to work better soon. I really feel for you both. 
I am still learning about these less known treatments as I previously thought I’d got away with a cure , but alas not as my PCa has come straight back and may possibly be castrate resistant now as my PSA has risen after 4 doses of Zoladex. 
Keep on fighting and as I said, thank you for sharing this information. Much appreciated.

Good luck. 
Phil

Hi Phil

I am so sorry to hear that your cancer has progressed. Like you say, keep fighting and keep asking lots of questions. I hope you manage to get some treatment to hopefully stop further progression. 
Take Care

SunnyJane 😊

User
Posted 02 Sep 2022 at 08:28

Originally Posted by: Online Community Member
Thank you for the update SunnyJane,

I can understand the metal side becomes increasingly important and it's good your OH has received additional support. There comes a point when one has to take a view on further treatment for more time as compared to less treatment for better quality of life. I am not suggesting that your OH is close to this yet and it may depend on what is offered. I note that he does not want further chemo so will carefully weigh up what is offered.

You are right Barry, my OH mindset is certainly about weighing up more treatment v quality of life at the moment. It is only a decision he can make and I will support whatever decision he makes. 

I think it’s a very brave decision to not have further treatment, it goes against the grain to turn down something that could give you more time with family. We are not yet at that point, we thought we were a few months ago but since then his bloods have been a bit more positive. What is interesting is it’s hard for the doctors to know whether the recent fall in his PSA is a delayed effect from the L177 or whether it is from the radiotherapy he received a couple of months ago to treat severe pain in his back or hip. 

To be honest we are not that concerned about the reasons why we are just relieved that he has not had to make that decision yet about whether to go for chemo or R223 or not and personally whatever his current thoughts or feelings are I don’t think he will finally make that decision until it’s right in front of him. 

We are focusing on making memories, we have managed to get away for a week in Spain with the family and my OH is focusing on living his life in the best way he can. 

Many thanks for your support and comments, this forum is so important in being able to hear from others who understand what we are going through. 

Much love

SunnyJane xx 

User
Posted 14 Sep 2022 at 22:34

My OH is at a similar stage with pain, brain fog from the morphine and the need for company, so I feel for you both. Cabazitaxel didn’t work for my OH, he has just had some radio for pain on his pelvis. We are also getting great support. Hope they manage to get on top of his pain. And thank heavens for dogs to make us get out! Sending hugs and best wishes. T’other Jane.

User
Posted 14 Sep 2022 at 22:48

Originally Posted by: Online Community Member

My OH is at a similar stage with pain, brain fog from the morphine and the need for company, so I feel for you both. Cabazitaxel didn’t work for my OH, he has just had some radio for pain on his pelvis. We are also getting great support. Hope they manage to get on top of his pain. And thank heavens for dogs to make us get out! Sending hugs and best wishes. T’other Jane.

Thanks T’other Jane πŸ˜ƒThis forum is so great that other half’s really do understand what you are going through.
Family and friends are wonderful but it is hard for them to truly understand the impact this horrid disease has on our husbands/partners and the impact their disease/condition has on their wives/partners. I have received some lovely messages from wives in a similar situation - we are not alone. 
Take care 😎 

User
Posted 19 Oct 2022 at 00:18

So today my OH started his Radium 223. His pain has continued to get worse over recent weeks so his zomorph had been increased to 100mg twice daily and he is taking too up oromorph 3-4 times daily. He has also started on a reducing dose of 6mg of dexamethasone daily. The steroid has definitely lifted his spirits so has been a good side effect for him.  

His latest PSA has risen from 15.3 to 17.7, Hb has dropped to 95 and ALP has risen to 585. If Hb drops over next couple of weeks post R223 treatment we have been told he will need a blood transfusion. 

So we are now just trying to take things easy and let the radium do its work. My husband is still working, not as much as before but he is still doing what he can. 

We are trying to remain strong and we are very grateful for all the support from the hospital and hospice care. They are amazing. 

Love to one and all

Sunnyjane ❀️ 

User
Posted 24 Jan 2023 at 17:53

Hi everyone 

Not been on here for a while, my OH completed his L177 in May 22 and started Radium 223 in October 22. He has had four cycles once a month and is due his 5th in February. 

However, he has had a real deterioration since October in terms of pain and mobility. After cycle 2 in November he started to swell around the face, lower back, stomach, lower legs and arms. This is a known side effect but is very uncomfortable for my husband. Between cycle 2 and 3 he gained 10kg in weight - purely fluid! 

He has also had a complete deterioration in his teeth, they have all decayed and he has had 6 fillings. But the worst issue is the pain. He started getting more pain after cycle 2 mainly in his lower back and hips and where he has significant bone mets in that area. 

The pain has resulted in a trip to Hospice care where the doctors are working hard to get the balance right in terms of pain relief v drowsiness and hallucinations. He is still working and work continued to be his therapy. 

I will update further once he is out of Hospice and back home. 
Love to everyone 

SunnyJane xx 

User
Posted 24 Jan 2023 at 18:30
It is a rock and a hard place, isn't it. Radium 223 is supposed to reduce bone pain and improve quality of life but for a significant number of men, it actually makes the pain much worse and reduces mobility. Has the oncologist made any comment about stopping the Radium?

Remember to care for yourself while you are sorting out everyone else!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 18 Jul 2021 at 01:58

About 8% of men exhibit insufficient PSMA for the Lu 177 to work so a PSMA scan is a prerequisite to establish whether this is the case so having this scan will establish whether Lu 177 is viable in your OH's case.

You may find you can glean some interesting information from this thread. However, some of the early detail has since changed after it was started. It is now possible for suitable men to have the PSMA scan at a small number of centers on the NHS in the UK that do PSMA scans for example. Much of the earlier part of this thread dealt with the 68 Gal PSMA scan but later posts included those from user name 'Notabene' who had Lu 177 in Finland where it was more expensive than in Germany. Unfortunately, Notabene does not seem to have posted for quite a time. It should be remembered that the cost of cutting edge treatments can vary between centers and countries and go up and down. So one really needs to establish current costs if considering this treatment. https://community.prostatecanceruk.org/posts/t13262-Lutetium-177---PSMA-Treatment

DaveSt is another member who had Lu 177 but has not given an update since he posted in the above referenced thread back in Oct 2020.

 

 

 

 

 

 

i

Edited by member 18 Jul 2021 at 02:30  | Reason: to highlight link

Barry
User
Posted 18 Jul 2021 at 15:50

Hi Barry

thanks for your kind reply and link to the other thread. It still seems very variable dependent on where you live. Our consultant told us about PSMA treatment and has referred us to The Prostate Clinic in London. So we are embarking tomorrow on a bit of a discovery mission. 
Will my husband’s scan show that he is right for the treatment or not as the case may be? What will the treatment involve, frequency, travelling to London, cost etc. 
He has obtained three opinions on next steps. Reassuringly they have said our consultant in Devon is doing everything they would have done and whatever decision he makes going forward there is no one right decision. As we all know it seems to such depend on how each individual responds to the treatments. 
My husband didn’t respond very well in terms of shrinking cancer or stopping further spread to docetaxel or RT but Enzalutamide has been the most successful. He started last July but new symptoms started occurring in April hence where we find ourselves today. 

So hard for all going through this journey, especially when your decision on treatment in many ways is a bit of a gamble as you have no way of knowing how the body will react. 

I will update once I have more information. I don’t come on here that often but have been very appreciative of reading experiences of others. Do you think it would be helpful to move this conversation over to the other thread, for ease of others seeing the ongoing conversation? 

Thanks again for your reply. 

SunnyJane 😊

User
Posted 18 Jul 2021 at 22:54
Hi Sunny Jane,

The PSMA scan is generally used to try to establish whether a man has mets and how extensive these may be and sometimes this means that treatment may be directed specifically at what has been found rather than go to a systemic treatment. However, where it is already known that a man has mets, the PSMA scan is used for a different purpose. This is to establish that a man expresses sufficient PSMA so a Lu 177 treatment has a chance of working. So if the take up does not show sufficiently in the PSMA scan there is no point in proceding to Lu 177.

It matters not where the PSMA scan is done, although if the patient's consultant can get it done within the few centers that can do it within NHS this is better than having to pay for it. If you have to pay there can be a difference in the amount charged by providers. So the scan may show there is no point in having the rare and expensive Lu 177. However, if the scan shows suffient PSMA, a man could then go on to have the reccomended courses of Lu 177. Unfortunately, just as with any treatment and particularly with something that is fairly new, there is no assurance that Lu 177 will work well in any particular case. I don't know if the treatment is now available in the UK. Anybody who has got passed the proving PSMA test and seriously considering Lu 177 should investigate this aspect. (I am not sure whether 'The Prostate Center' only do the scan but also the Lu 177).

Certainly add to the link I gave with any substantive information as this can be of general interest but probably best if you keep detaited information to your thread for your ease of reference.

Barry
User
Posted 24 Jul 2021 at 21:00

Update: OH has had a PSMA PET/CT scan and is now having an FDG PET Scan this coming week in London. Referred by his consultant.  Luckily he has health insurance and they have agreed to fund the scans and two cycles of Lutetium. Then he will assessed as to responsive to the treatment and if he needs further cycles we hope to persuade the health insurers to keep funding. 

so many unknowns, fears, lots of travelling to get treatment but he feels it worth it to obtain innovative treatment and with less side effects than chemo. He really struggled with the docetaxel and one of his main choices for treatment going forward is quality of life. 

Will update once we have some results. 

Best wishes

SunnyJane 😊

User
Posted 24 Jul 2021 at 23:17
Hope for good response but please let us know regardless.
Barry
User
Posted 02 Aug 2021 at 16:39

Thank you for this post, it is very helpful. If you can advise of how the scans and treatment work, it will be a great help to many. The UK appears to be behind Germany, Australia and the USA on this. If your insurance company lets you see the cost of the scans and the treatments it would definitely be helpful to understand these for those of us without insurance.

Very best of luck. Your husband is blessed to have such a supportive wife. My prayers are for him to respond well. Take care.

User
Posted 27 Sep 2021 at 01:57

Sorry for not updating sooner. 
After a couple of trips to London to undergo PSMA PET scans my husband got the green light to undergo first cycle of Lutetium 177 in The Wellington Hospital, London. Went in for a day 1, usual screening bloods to check all ok, his PSA had risen to 10.3

He had to spend two days at the hospital, day 1 post bloods he received a saline drip to ensure his kidneys were well flushed through and then he received the Lutetium as an intravenous drip. This was then followed by another saline drip and monitoring and he was allowed to leave the hospital that evening. The drug is delivered as a targeted therapy via a radioisotope, he is radioactive following treatment and wears a wrist band for the next couple of weeks. We had to sleep in separate beds for 5 nights. 

Following treatment he has had less severe side effects than chemo but he has been very fatigued, a bit of nausea, initial urinary and bowel incontinence (lasted 2-3 days) increased bone pain and my husband started to suffer with teeth ache. Prior to treatment he had felt like he was brewing a tooth abscess but dentist couldn’t find any evidence of any dental issues on examination and X-ray. 

Day 2 in hospital was a scan to check that the Lutetium was where it should be and that his kidneys were well flushed and not harbouring excessive amounts of the radioactive isotope. All look good and we went home. 

My husband is due his second cycle mid October but had bloods last week (4 weeks after treatment) and a consultant appointment in London. His PSA has risen to 15.3 other bloods are ok apart from his Alkaline Phosphatase  which is 645 (normal range 40-130) This is indicative of the bone cancer activity. My husband mentioned the debilitating pain he is suffering in his jaw and increased bone pain especially in his lower back. 

Sadly on further examination of his last scan the consultant noticed a deposit of cancer in his right upper jaw. We were not expecting this news so a bit of a shock. 

He has now been referred back to our local hospital for a one off blast of radiotherapy to his back and jaw to help alleviate pain. Our local consultant has increased his Zomorph to 30mg twice daily to help with the worsening pain. He was told that the radioactivity could cause bone flare pain which it has. He is also taking intermittent oromorph, paracetamol and ibuprofen. 

Following second cycle he will be reviewed after this and that will determine whether he receives another two cycles depending on his response to the treatment. 

To date his health insurance company have funded the first two cycles. We were told the treatment is around £15,000 per cycle. And if you don’t live near London (we don’t) you have to remember travel and accommodation costs on top of treatment. 

I will update again after second cycle. 

Best wishes

SunnyJane 😊 

User
Posted 27 Sep 2021 at 14:48

Thank you for posting update. It's too early to know how effective the treatment will be but we hope it will be worthwhile. As you are aware, Lut 177 is a fairly rare treatment and learning about your husband's experience would be useful for anybody else here contemplating it.

Edited by member 30 Sep 2021 at 01:18  | Reason: word omission

Barry
User
Posted 27 Sep 2021 at 18:45

Hi Barry, you are completely right too early for any opinion yet on its effectiveness but I hope my updates may provide a bit of insight and understanding to a still new and innovative treatment in this country. 

Will update again after second cycle 😊

User
Posted 27 Sep 2021 at 23:36

Wishing your husband all the very best with his further treatment. Thank you for sharing your information. Hope you are ok too. We’re at the earlier stages of this journey and I know how difficult it can be already for him but also for us. Take care 

User
Posted 29 Sep 2021 at 21:28

Hi Sunny Jane,

Your self and husband are wished all the best of fortune in this high tec option you have decided on.

All of us in the APC community will in the long term benefit from the experiences  of pioneers like yourselves.Please keep us posted as treatment proceeds and stay strong!

Kind Regards

Norm

User
Posted 29 Sep 2021 at 23:45

Thank you Norm and Elaine for your kind comments and wishes. With my husband having had hormone therapy, docetaxel, radiotherapy and Enzalutamide, like many others he is on a continual journey of hoping for the best outcome but the fear of the worst is never far away. 
We are lucky that we have amazing family and work to distract us from dwelling too long on any negative thoughts. 

My husband always says he lives in hope and remains optimistic because without that way of thinking the outlook and life would be pretty miserable. We both stay as strong as we can, we consciously do things to make wonderful future memories and we enjoy life as much as we can. But when either of us feel a bit down we accept that those feelings are normal and we allow any sad thoughts to wash over us, we do not fight them or bury them as we know tomorrow is another day and most importantly we have each other. 

Sending love and warm wishes to men suffering with PCa and their wives, girlfriends, partners and families. At the outset of our journey I underestimated the effect his disease would have on me and the ripple effect to the wider family. It is so important as a wife/partner to practise some self care and self-compassion, I know that I have to do this so that I can stay strong to keep looking after my husband. 

Best wishes 

SunnyJane 😊

User
Posted 04 Oct 2021 at 19:30

My husband has received his radiotherapy treatment to his jaw and lower back today. Last time this treatment did not seem to have such a significant impact. On this occasion he is feeling like he has done 10 rounds in the boxing ring. 
His upper right jaw is very sore, feels bruised and swollen to touch and his back is also very sore. He is feeling nauseous and looks very pale and unwell. 
We are both hoping this will ease over next few days as he has to travel to London next week for his second Lutetium cycle. 

If anyone has experienced this one off radiotherapy treatment for bone pain has any advice it would be much appreciated. Does the pain get worse before it gets better? 

Many thanks as always

SunnyJane 😁

 

User
Posted 10 Oct 2021 at 23:40

Wow really tough week! 

My poor hubby has continued to feel really nauseous so naturally been off his food, exceptionally fatigued and very depressed. I keep reassuring him that this is a consequence of the RT and PSMA but it is so difficult when you are in the limbo stage of waiting to see if current treatment is working. He currently feels as if he is regressing, not progressing. Sadly only time will tell but this horrid disease leads to the darkest and most horrid corners of ones mind. He is very emotional and so down he says he can’t see any value he brings to anything anymore. 
This is very hard to watch, especially from someone who has always been so positive. I do remember when he was on chemo after the 3rd or 4th cycle he felt like this. 
I reminded him that he is currently having the book thrown at him in terms of treatment, he has just had his 3 monthly hormone injection, he is still taking Enzalutamide (as they feel there is still some benefit in terms of his lymph nodes) he is undergoing PSMA and he has had RT a week ago. Plus all the morphine and numerous other drugs. 
I keep telling him that it’s the treatment not the cancer making him feel this way and just offer as much love, support, kindness and care without smothering him. It’s a fine balance between supporting but not making him feel like he can’t do anything. I support him to do as much as he feels up to but if he needs to rest or sleep then reassure him that’s his body saying he needs to rest. 
I miss my husband, stupid thing to say when we are together all the time but any wife or partner watching their loved one going through this will know what I mean. 

I am hoping that this week may see some of his symptoms easing and then we head off to London on Wednesday for PSMA treatment and scans Thursday/Friday. We are hoping that bloods will all be ok to go ahead with treatment and fingers crossed he should start to see a drop in his PSA. 

Following this cycle he will be reviewed and if he is responding positively he will be offered another two cycles. 

Thank you for reading, I am not going to lie, life is tough at the moment πŸ˜”

With love to all

SunnyJane 😊 

User
Posted 11 Oct 2021 at 00:10

Thanks for the update, and wishing you both all the best for the next treatment.

User
Posted 11 Oct 2021 at 00:27

Sunnyjane, so sorry to read your post and hear that you’re having a really hard time at the moment. 

We are in the very early stages of diagnosis so I’m lucky that my hubby still doesn’t have any symptoms (apart from a couple of HT side effects) and is feeling fit and well….I still panic at every little ache or pain though πŸ˜’ 

You’ve obviously both been so strong and positive throughout this journey so far and it’s apparent just how much you have been there for him. 

I really hope he starts to improve very soon and will be feeling much better to go ahead and get his treatment later this week. 

Take care of yourself too and keep being strong. Wishing you both well and looking forward to hearing positive news from you soon xx

Edited by member 11 Oct 2021 at 00:28  | Reason: Not specified

User
Posted 11 Oct 2021 at 14:29

Hi,

Hopefully this will turn out to be just a bit of a blip in your husband's treatment which although tough at present ,with your evident loving support ,he will get through. 

Stay Strong

Kind Regards Norm

 

 

 

 

User
Posted 30 Oct 2021 at 10:17

Quick update:

Second cycle of treatment went ahead at the Wellington Hospital in London on the 11th October. My OH has dealt with this second treatment really well. The radiotherapy he received for his jaw and back pain has definitely helped. 
He suffered some nausea in the first couple of weeks but this has subsided.

He is experiencing a lot of fatigue (to be expected) so we just try and plan his day so he can get rests in between his work.

He will have follow up bloods in a couple of weeks and then a scan to measure progress, at that point they will decide if he goes for another two cycles and we keep our fingers crossed that it will go ahead and the health insurers keep supporting him.

Lovely to see some sunshine this morning β˜€οΈ 

With love to all 

SunnyJane 😎 xx 

User
Posted 05 Jan 2022 at 23:00

Update: My OH had follow up bloods and PET scans after first two cycles of PSMA and on the positive side it was showing no dramatic spread, some tiny new lesions in his cervical spine, left shoulder and greater activity in his left hip but generally the consultants were pleased. But PSA remained at 15 and his alkaline phosphatase was nearing 700 (normal range 40-130). 

The health insurance company agreed to fund another two cycles so he returned to London on the 14th December for the third cycle, his consultant that administers the infusion was a little despondent as the results so far were not entirely encouraging. As is normal his bloods were taken prior to the L177 infusion and the consultant returned to his hospital room to excitedly tell him “you’re a late starter” PSA had dropped to 10.3 and ALP had dropped to 550. Finally the news we wanted, the treatment is having a positive effect. 

So we head back to London on the 6th January to have more bloods and consultation to determine timings of fourth cycle. 

Currently he is feeling very, very fatigued. I have mentioned his fatigue previously but this is on a whole new level. His recent bloods at the local hospital are showing a steady decline in his haemoglobin, red and white blood cells. So we will wait and see whether they are happy to go ahead or wait a little while for these levels to recover a bit. 

He also suffers with nausea for the first couple of weeks post treatment and he has had significant increased bone pain in his left hip, lower back and left shoulder. So has had to increase his zomorph dose. 

He continues to work and most importantly he made it to Christmas lunch and New Year’s eve this year. He missed the last two years due to illness last year and chemo the year before, so that was a massive plus this year. 

The continued uncertainty and with practically no data on PSMA treatment in terms of its ability to prolong life, we are resigned to just taking each day as it comes and celebrate the fact we are still together and we are able to still spend quality time with our family and loved ones. 

It was sad to read tonight that NICE has not licensed Oliparib in England and Wales. His consultants have been keen to get next generation sequencing done on his original biopsies to see if it would be a future option. Currently we would have to find a way of funding this treatment if PSMA fails. The final options are now Cabazitaxel or Radium 223 unless further trials become available. 

Sorry for long post but if any of this helps anyone considering the PMSA route then that’s great πŸ˜€ 

With love SunnyJane β˜€οΈ Xx 

User
Posted 05 Jan 2022 at 23:32
Thanks for the update, good to see figures are heading in the right direction and you had a good Christmas and New year...
User
Posted 06 Jan 2022 at 00:51
Always so much 'wait and see' so constantly on the rack. Pleased for you both that there have been some good indications and hope you have favourable news in your next update.
Barry
User
Posted 06 Jan 2022 at 01:02
So pleased to see that the Lutetium is starting to have an impact and bravo to the insurance company for agreeing to fund further cycles. Having a relatively normal Christmas is a bonus and will be a happy memory for you all to hold in your hearts. Take care of yourself, SunnyJane x
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Jan 2022 at 08:03

Hi SunnyJane believe that Bill Turnbull has been receiving this treatment, stopped doing his radio program presume while having treatment, believe prior to that was having R223. May be if he can be contacted might give you more insight into long term.

User
Posted 06 Jan 2022 at 08:58

Originally Posted by: Online Community Member
Always so much 'wait and see' so constantly on the rack. Pleased for you both that there have been some good indications and hope you have favourable news in your next update.

You are absolutely right Barry, I think we all generally become good at the wait and see but it certainly gets a bit harder when new treatments are being carried out. I suppose when it gets harder we all focus on the positives to help us through these trickier times. 
best wishes for positive 2022 Barry

Much love x 

User
Posted 06 Jan 2022 at 09:05

Originally Posted by: Online Community Member
So pleased to see that the Lutetium is starting to have an impact and bravo to the insurance company for agreeing to fund further cycles. Having a relatively normal Christmas is a bonus and will be a happy memory for you all to hold in your hearts. Take care of yourself, SunnyJane x

Thanks Lyn, you can imagine our excitement when we finally started to see an improvement. I suppose it will now be the balancing act between timings of next treatment versus his blood results and hoping the insurance company will keep supporting him. The costs of travelling to London, accommodation, taxis, let alone the treatment itself, follow up appointments, scans pre and post treatment, blood work etc would be impossible without the amazing support of the insurance company. 

Let’s hope if PSMA becomes a success then it will become available to all men as it so much less invasive than chemo. 

Much love xx 

User
Posted 06 Jan 2022 at 09:09

Originally Posted by: Online Community Member

Hi SunnyJane believe that Bill Turnbull has been receiving this treatment, stopped doing his radio program presume while having treatment, believe prior to that was having R223. May be if he can be contacted might give you more insight into long term.

Hi Jeanette, Yes I think I read that Bill was receiving PSMA, my OH is running a couple of years behind Bill in terms of his diagnosis but we feel they have followed a similar treatment regime. Let’s hope if Bill is receiving it, he is gaining benefit from it as well. πŸ™ 

Much love xx 

 

User
Posted 22 May 2022 at 16:55

Update on OH’s progress of the L177 treatment. 

During the first week of May he finished 6 cycles of L177. Approx two weeks prior to this last cycle he was experiencing a lot of lower back pain. He started the regime with a PSA of around 15 this dropped by cycle 3-4 to 10.5 then by cycle 5 was up again to 13.5 and by cycle 6 was back to 15.3. Bloods were showing some detriment to bone marrow and ALP up to 656 again. 

Post cycle 6 the London consultant did the routine scan to ensure PSMA uptake was in the right places and reported that there was some new bone mets and activity in the lumbar spine, sacrum and hip. This was obviously causing the increase in pain. 

He has now had X-ray, MRI and CT at the local hospital, received a one off blast of radiotherapy to his back and hip, is having to use a crutch to aid his walking. Is on significant increases in amounts of zomorph, oromorph, taking paracetamol, naproxen, amytriptaline daily, omeprazole and is now on 2mg dexamethasone daily. He is having his teeth all checked as they also want to start alendronic acid and he will be seen again in a couple of weeks by the consultant to talk about starting Cabazitaxel. 

We asked about Radium 223 but currently the consultant is not optimistic as too similar to PSMA? The professor in London has said that PSMA is not ruled out for further future treatments (health insurance company permitting) 

It does feel like he has shifted quite quickly from finishing PSMA to needing to start next treatment asap and our current fear is what is left after Cabazitaxel?

My OH has worked all through his treatment since diagnosis but this is the first time he has been unable to work due to the pain. He has not had the best reaction to his latest radiotherapy session but overall the PSMA has not been too difficult to deal with. 

As always we remain stoic and as optimistic as possible, we are enjoying life with the kids and having as much quality time with family as we can. 

Interested to hear others experience, I did ask our local consultant if he thought the PSMA had been worth it seeing as OH is already undergoing some significant spread but he felt it has kept cancer stable for at least 6 months so that is a positive 😊 

with love SunnyJane xx 

User
Posted 22 May 2022 at 19:50

Hi Sunny Jane,

Thank you for sharing the update on your husband's treatment with us.

He is obviously a strong character and I wish you both well on this uncharted journey. Moreover,hope he gets some deserved respite to build himself up before any other treatment becomes necessary.

Regards

Norm

User
Posted 23 May 2022 at 10:22

Hi SunnyJane, it is so helpful for us that you are sharing your difficult journey. I do hope that the treatments begin to work better soon. I really feel for you both. 
I am still learning about these less known treatments as I previously thought I’d got away with a cure , but alas not as my PCa has come straight back and may possibly be castrate resistant now as my PSA has risen after 4 doses of Zoladex. 
Keep on fighting and as I said, thank you for sharing this information. Much appreciated.

Good luck. 
Phil

User
Posted 23 May 2022 at 14:57
Hi Sunny Jane,

So very sorry that the relatively rare treatment your OH had has not worked better, particularly after good early response. I hope the pain can be dealt with which is the most pressing aspect but treatment now to slow progression needed. Just to clarify for the benefit of those that may be interested, PSMA is what is expressed by a patient that enables Lutetium 177 to work or to show location of mets. It is not a form of treatment. About 8% of patients express insufficient PSMA to work as a scan which is a prerequisite for having Lutetium 177. Like so many treatments, patients can respond differently.

Barry
User
Posted 24 May 2022 at 21:41

Originally Posted by: Online Community Member

Hi Sunny Jane,

Thank you for sharing the update on your husband's treatment with us.

He is obviously a strong character and I wish you both well on this uncharted journey. Moreover,hope he gets some deserved respite to build himself up before any other treatment becomes necessary.

Regards

Norm

Thanks Norm

Your kind words are really appreciated. 

Best wishes

SunnyJane 😊

User
Posted 24 May 2022 at 21:49

Originally Posted by: Online Community Member
Hi Sunny Jane,

So very sorry that the relatively rare treatment your OH had has not worked better, particularly after good early response. I hope the pain can be dealt with which is the most pressing aspect but treatment now to slow progression needed. Just to clarify for the benefit of those that may be interested, PSMA is what is expressed by a patient that enables Lutetium 177 to work or to show location of mets. It is not a form of treatment. About 8% of patients express insufficient PSMA to work as a scan which is a prerequisite for having Lutetium 177. Like so many treatments, patients can respond differently.

Hi Barry

Thanks for clarification, it is really helpful, like you say, for those thinking of embarking on this journey. It’s funny because the consultants often refer to the treatment as PSMA (probably because they think for lay people it is an easier name than Lutetium 177 🀷‍♀️) 

Despite the quick recurrence of bone mets, we genuinely feel that it has given my OH more time. But like you say it’s all about dealing with the pain (which happily after a rough weekend is now improving) and then starting another treatment to try and stabilise the ongoing spread. 

He has managed to work today so a definite improvement on the last 2-3 weeks. 

Will let you know how he progresses 

Thanks for all your help

SunnyJane 😊 

User
Posted 24 May 2022 at 21:53

Originally Posted by: Online Community Member

Hi SunnyJane, it is so helpful for us that you are sharing your difficult journey. I do hope that the treatments begin to work better soon. I really feel for you both. 
I am still learning about these less known treatments as I previously thought I’d got away with a cure , but alas not as my PCa has come straight back and may possibly be castrate resistant now as my PSA has risen after 4 doses of Zoladex. 
Keep on fighting and as I said, thank you for sharing this information. Much appreciated.

Good luck. 
Phil

Hi Phil

I am so sorry to hear that your cancer has progressed. Like you say, keep fighting and keep asking lots of questions. I hope you manage to get some treatment to hopefully stop further progression. 
Take Care

SunnyJane 😊

User
Posted 01 Sep 2022 at 23:04

Feeling very sad tonight after hearing the sad news about Bill Turnbull. My OH has felt very emotional all evening. 

Since I last posted we have been through a pretty rough time but things have settled in the last couple of weeks as OH has received some excellent additional care. 

After completing 6 cycles of L177 in May 2022 and then a one off blast of radiotherapy to sacrum and hip in July due to rising PSA and 9/10 pain my OH has been able to enjoy the summer and have a rest from treatment. 

He has seriously struggled mentally over last few weeks but our local hospital has set up a new service called Enhanced Supportive Care. This consists of a Palliative care consultant and an Occupational Therapist and a Physiotherapist. They are there to look at your disease and care from a more holistic viewpoint. It has really been amazing for my husband in thinking about his life now and in the future. It has helped him to figure out his life goals and think about his future wishes. He was avoiding this as he felt making such plans was admitting defeat and the end was nigh! 

What he has realised is it means these thoughts and worries are parked and he can spend his energy focusing on what he likes doing. He is very fatigued but has continued working usually 4-5 days a week. Again giving up work was a sign of defeat for my OH and he felt gave him a purpose to get out of bed every morning. He is now trying to redefine his purpose and again use his limited energy on doing what he enjoys. 

At the end of L177 his PSA had risen to 15.3 but after the radiotherapy it reduced to 11.3 and then 10.9 mid August. We had an onco consultation mid August but our usual consultant was away so we saw a locum. He has scheduled us to come back to see our usual onco early October. If bloods are stable we presume my OH will continue on current regime until PSA starts rising again. We have been told then it will be remaining options of Cabazitaxel or Radium 223. 

We paid privately (£2000) to have his original biopsies screened for the BRCA gene but sadly he is negative so the drug Olaparib will not be an option. Only 10% of men are positive but we felt it was worth trying as options run out. 

He currently feels that he will not go down the chemo route again as personally he doesn’t feel the side effects are worth the expected additional months of life he will get, but who knows when the time comes to make that decision. 

He has also started some counselling sessions at our local FORCE, these have been offered to both of us and we go as a couple which has been very beneficial. My OH has always been a man with great mental resilience and a very positive outlook on life but he has accepted this additional support and help as he can see the benefit and he recommends anyone who gets offered extra help to take it. 

I will update you all once we know what his next steps will be after future bloods and consultations. We live in hope of possible new trials and we were told by the Prof who administered the L177 there is a chance this treatment can be repeated, if so we would have to have the support and agreement of our health insurance company. 

Much love to you all

SunnyJane xx 

User
Posted 02 Sep 2022 at 01:08

Thank you for the update SunnyJane,

I can understand the mental side becomes increasingly important and it's good your OH has received additional support. There comes a point when one has to take a view on further treatment for more time as compared to less treatment for better quality of life. I am not suggesting that your OH is close to this yet and it may depend on what is offered. I note that he does not want further chemo so will carefully weigh up what is offered.

Edited by member 02 Sep 2022 at 17:56  | Reason: spelling

Barry
User
Posted 02 Sep 2022 at 08:28

Originally Posted by: Online Community Member
Thank you for the update SunnyJane,

I can understand the metal side becomes increasingly important and it's good your OH has received additional support. There comes a point when one has to take a view on further treatment for more time as compared to less treatment for better quality of life. I am not suggesting that your OH is close to this yet and it may depend on what is offered. I note that he does not want further chemo so will carefully weigh up what is offered.

You are right Barry, my OH mindset is certainly about weighing up more treatment v quality of life at the moment. It is only a decision he can make and I will support whatever decision he makes. 

I think it’s a very brave decision to not have further treatment, it goes against the grain to turn down something that could give you more time with family. We are not yet at that point, we thought we were a few months ago but since then his bloods have been a bit more positive. What is interesting is it’s hard for the doctors to know whether the recent fall in his PSA is a delayed effect from the L177 or whether it is from the radiotherapy he received a couple of months ago to treat severe pain in his back or hip. 

To be honest we are not that concerned about the reasons why we are just relieved that he has not had to make that decision yet about whether to go for chemo or R223 or not and personally whatever his current thoughts or feelings are I don’t think he will finally make that decision until it’s right in front of him. 

We are focusing on making memories, we have managed to get away for a week in Spain with the family and my OH is focusing on living his life in the best way he can. 

Many thanks for your support and comments, this forum is so important in being able to hear from others who understand what we are going through. 

Much love

SunnyJane xx 

User
Posted 14 Sep 2022 at 22:22

Since posting last my OH has had another set of bloods and PSA has risen from 10.9 to 15.3 in 4 weeks. He has been feeling increasing unwell, poor appetite, sleeping a lot and bone pain getting worse in his left hip, sacrum and lumbar spine. He is also experiencing thigh pain and pain in his chest and left shoulder. 

On Monday this week his pain was so bad he had a home visit by the hospice nurse who gave him I/m morphine and he has had his zomorph increased to 80mg twice daily along with top up oromorph. He is feeling a bit nauseous from the increased dose rate and is struggling now to feel cognitively sharp enough to continue his work. 

Today he was referred to see his onco at the hospital, this appointment was brought forward 3 weeks due to the increased pain. He had a CT scan to mark him up for one off blasts of radiotherapy to his shoulder, lumbar spine and hip which will be done on Friday. He is booked to receive a bone scan and the onco has referred him to another hospital for Radium 223. 

He has opted not to have Cabazitaxel, mainly a quality of life decision and he has been told that the chemo and R223 are currently his only remaining options. 

The onco also mentioned there may be a possibility that they won’t let him have R223 yet as too close to having received L177. They are concerned about effect of the R223 on his bloods, the side effects we are told are not as invasive as chemo but can have similar effects on lowering red and white blood cell production and sadly these have never really recovered since L177 so it will be a waiting game. 

From what I have read on the forum R223 seems a bit of a mixed bag so firstly we wait to see if they will agree to go ahead with the treatment and secondly how he responds if he does receive it. 

We are both still receiving excellent treatment, support and care from the Enhanced Supportive Care team at our local cottage hospital, it has made such a difference to my OH’s mindset. 

Our onco is such a kind and calm man who takes each stage one step at a time. He respects hubby’s decision to opt out of chemo but stressed that it is still on the table and an option after R223 if he wants to reconsider at anytime. 

Difficult times for both of us and the family, really hard to watch the deterioration in my husband’s mobility and general ability to keep living a normal a life as possible. So hard to see him in so much pain yet still trying to do his best and contribute to the home, family and work. He has to deal with all of this on his terms and I just try and do my best to support him. However, we are all only human and I recognise that sometimes I need a break, so I ensure however tired I am I get out with my dogs and catch up with family and friends. If I think I will be away from the house for more than a couple of hours I ensure that someone is popping round. My husband finds being alone for too long without the distraction of others will make him start to dwell on the negative, it’s only natural but is so destructive for him mentally. 

So tough times again but we live in constant hope as you never know what is around the corner.

Sending love to one and all ❀️ 

SunnyJane xx 

User
Posted 14 Sep 2022 at 22:34

My OH is at a similar stage with pain, brain fog from the morphine and the need for company, so I feel for you both. Cabazitaxel didn’t work for my OH, he has just had some radio for pain on his pelvis. We are also getting great support. Hope they manage to get on top of his pain. And thank heavens for dogs to make us get out! Sending hugs and best wishes. T’other Jane.

User
Posted 14 Sep 2022 at 22:48

Originally Posted by: Online Community Member

My OH is at a similar stage with pain, brain fog from the morphine and the need for company, so I feel for you both. Cabazitaxel didn’t work for my OH, he has just had some radio for pain on his pelvis. We are also getting great support. Hope they manage to get on top of his pain. And thank heavens for dogs to make us get out! Sending hugs and best wishes. T’other Jane.

Thanks T’other Jane πŸ˜ƒThis forum is so great that other half’s really do understand what you are going through.
Family and friends are wonderful but it is hard for them to truly understand the impact this horrid disease has on our husbands/partners and the impact their disease/condition has on their wives/partners. I have received some lovely messages from wives in a similar situation - we are not alone. 
Take care 😎 

User
Posted 19 Oct 2022 at 00:18

So today my OH started his Radium 223. His pain has continued to get worse over recent weeks so his zomorph had been increased to 100mg twice daily and he is taking too up oromorph 3-4 times daily. He has also started on a reducing dose of 6mg of dexamethasone daily. The steroid has definitely lifted his spirits so has been a good side effect for him.  

His latest PSA has risen from 15.3 to 17.7, Hb has dropped to 95 and ALP has risen to 585. If Hb drops over next couple of weeks post R223 treatment we have been told he will need a blood transfusion. 

So we are now just trying to take things easy and let the radium do its work. My husband is still working, not as much as before but he is still doing what he can. 

We are trying to remain strong and we are very grateful for all the support from the hospital and hospice care. They are amazing. 

Love to one and all

Sunnyjane ❀️ 

User
Posted 19 Oct 2022 at 08:13
Sunnyjane you and your OH are amazing. Fingers crossed the Radium does it's thing...
User
Posted 22 Oct 2022 at 00:07

Sunnyjane, I have been following your husbands treatment journey with interest particularly his Lu177.  My husband is hoping to start his Lu177 shortly.

In the course of my research into Lu177 I came across a new Tandem treatment using Lu177 and Ac225 (Actinium)  which is currently being used in Germany, Finland and India.   From what I understand the Ac225 is more targeted and is used where monotherapy of Lu177 has failed.  It can be used as a monotherapy or in tandem with Lu177.  You may want to check it out for your husband as an option after radium223.  Its not available in the UK.

https://www.inspire.com/groups/zero-prostate-cancer/discussion/lu-177-ac-225-psma-radioligand-therapy-homburg-germany/

https://www.primomedico.com/en/doctor/prof-ezziddin-nuclear-medicine-homburg/

https://www.docrates.com/en/en-new-experimental-radioactive-lutetium-treatment-may-significantly-aid-the-treatment-of-advanced-prostate-cancer/

https://www.itnonline.com/content/radiation-therapy-effective-patients-no-further-treatment-options

 

User
Posted 22 Oct 2022 at 12:43

Hi,

Is your husband planning to pay privately for L177 overseas or to get it on the NHS?

The last I heard this drug has not been approved by Nice for England.Also there have been quality issues  at the manufacturer that have interupted supply.

Regards

Norm 

User
Posted 22 Oct 2022 at 14:12

Hi Norm - he is hoping to get it on the NHS.  It was approved by NICE in September, and now awaiting roll out pending marketing negotiations with the pharmaceutical company ie. price.  I understand it is expected to be rolled out from early '23.  In the meantime he has had a PSMA PET Scan privately to verify if he is PSMA positive, a prerequisite for the treatment and he is, and his oncologist will refer him on. Hospitals that currently provide Radium 223 will be providing Lu177.  You can get a PSMA PET Scan on the NHS but his oncologist said that it would be a minimum of a 10 week wait......  Fingers crossed!

User
Posted 22 Oct 2022 at 17:51

Many thanks for the information. Asked the staff in Nuclear Medicine Dept during the week where I am having R233 treatment and nobody had the info. about Nice approval being given!

Fingers crossed the treatment works for your husband .

Stay Strong

Norm

User
Posted 24 Jan 2023 at 17:53

Hi everyone 

Not been on here for a while, my OH completed his L177 in May 22 and started Radium 223 in October 22. He has had four cycles once a month and is due his 5th in February. 

However, he has had a real deterioration since October in terms of pain and mobility. After cycle 2 in November he started to swell around the face, lower back, stomach, lower legs and arms. This is a known side effect but is very uncomfortable for my husband. Between cycle 2 and 3 he gained 10kg in weight - purely fluid! 

He has also had a complete deterioration in his teeth, they have all decayed and he has had 6 fillings. But the worst issue is the pain. He started getting more pain after cycle 2 mainly in his lower back and hips and where he has significant bone mets in that area. 

The pain has resulted in a trip to Hospice care where the doctors are working hard to get the balance right in terms of pain relief v drowsiness and hallucinations. He is still working and work continued to be his therapy. 

I will update further once he is out of Hospice and back home. 
Love to everyone 

SunnyJane xx 

User
Posted 24 Jan 2023 at 18:30
It is a rock and a hard place, isn't it. Radium 223 is supposed to reduce bone pain and improve quality of life but for a significant number of men, it actually makes the pain much worse and reduces mobility. Has the oncologist made any comment about stopping the Radium?

Remember to care for yourself while you are sorting out everyone else!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Feb 2023 at 22:46

Hi Lyn

My OH is now home after a 12 day stay in Hospiscare. The doctors have been amazing trying to juggle his meds to control the pain. He has been discharged with a syringe driver for his morphine and fentanyl patches as well as naproxen, paracetamol, pregabalin, amytriptaline, clonazepam, mirtazipan, dexamethasone, fentanyl tablets and oromorph. 

We have had completely opposing views from our oncologist who has known us since 2019 and the oncologist from a different hospital who administers the Radium 223. Our regular oncologist felt that after 4 cycles Phil had probably got the best of the benefit from the treatment, as his ALP had reduced from 650 to 130 and his PSA had reduced to 16 (from 18) in October. And the side effects were seriously affecting his quality of life. 

The oncologist administering the R223 wanted him to continue, he readily admitted he is a numbers man and in his eyes he felt the treatment was having a positive effect on his bloods. My OH has decided to stop the treatment. As I mentioned his pain and mobility is so poor he can no longer get upstairs to our bedroom so he is sleeping on a hospital bed downstairs. I have to help him with all his personal care and dressing etc. He has been amazing at adapting to this new way of us living together but it’s tough for both of us. 

His 5th cycle would have been this coming week so our best hope is that he will start to show some signs of recovery in terms of his bone marrow function and pain in the next 4-6 weeks. Currently in limbo just hoping he will improve, he began this treatment last October able to walk unaided to the Nuclear Medicine Dept and by the 4th cycle I was pushing him in a wheelchair. He was still lucid, alert and working but he is now in constant pain and often hallucinating with the levels of pain killers, especially on bad days! 

I am trying hard to ensure I take care of him but also myself. This week my sister who supports me massively has been diagnosed with cancer so life is pretty tough. But I can’t praise the care of our CNS, hospice nurses and doctors, OT’s, Physio’s and district nurses, we have been blessed with great people around us. 

So all we can do now is hope for some recovery, watch his bloods and again Hope he has some respite before the next spread of the disease as currently last options are now for him to consider Cabazitaxel but we are definitely having to think about quality of life v treatment. 

Love to you all xx 

User
Posted 05 Feb 2023 at 23:25
Sorry to lean that despite all efforts and what has been thrown at it, OH is so severely affected. It seems that whatever is proposed the improvement in his PCa is quite small and not long lasting and this is being heavily offset by increased side effects. Appreciate it is really hard for you both and your sister having been diagnosed is another concern.
Barry
 
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