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Looking for hope

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User
Posted 06 Jan 2022 at 19:27

Hi, first time posting. My 80yo dad was diagnosed with stage IV prostate cancer 1.5 years ago. Course as follows: 


 


June 2020: diagnosis made, adenocarcinoma, Gleason 8, multiple bone Mets (around 10), PSA 67. 6 cycles docetaxel commenced along with Lupron every 3 months. 


December 2020: completed chemo. PSA down to <1. Continue Lupron alone. 


June 2021: PSA nadir at 0.08. Continue Lupron alone. 


September 2021: PSA up to 0.240. 


October 2021: PSA continues to rise, 0.480. Bone scan + CT scans show no new disease, decreased conspicuity of precious bone Mets. 


November 2021: Start Erleada (apalutamide).


December 2021: unfortunately PSA up to 0.680 on Apa for 3 weeks at this point. 


January 2021: on Erleada 1.5 months. Unfortunately PSA up to 0.750.


 


I am devastated that he became hormone refractory so quickly, and did not respond to apalutamide. We do not see his oncologist for another 2 weeks. 


can anyone offer advice as to what might come next, what to expect, or any hope to offer??? 


he feels great, has no pain/symptoms, and no one even knows he has this diagnosis. Still working part time at 80 years old. 


thank you so much. 

User
Posted 07 Jan 2022 at 00:47
Are you in the UK? Lupron is a US drug - its nearest relative in England is Prostap?

I think it is too soon to say that he has not responded to Apalutimide and it is hard to be sure that he did become hormone independent that quickly - do you happen to have his testosterone readings for Sept / Oct 2021? Although it is disappointing to see a rise on a new drug, the rate of rise does seem to be slowing and it is often said by oncologists that at your grandad's stage of the disease, PSA is less important than how he is feeling. The scan data is also reassuring here. We have had members whose PSA rose to 1000 and above but they remained well for sustained periods of time. Also, if the onco does believe that Apalutimide has failed already, grandad may just sneak into the NICE rule that a man can change to enzalutimide or abiraterone within 3 months.

If the onco feels that Apalutimide is not working and grandad coped well the first time round, he might suggest docetaxel again or another chemo drug, cabazitaxel. Alternative treatments might also include swapping Prostap for Stilboestrol, an oestrogen based HT which works in a different way. Stilboestrol is an old fashioned treatment now but has been very effective for some men on this forum when normal HTs have failed quickly.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 07 Jan 2022 at 17:38

Thank you so much for reply. Has not had testosterone checked in over a year! Will definitely ask his onc to check this. I can only assume he must be castrate though esp with combination of lupron+Apa? Yes he is being treated in US. 

User
Posted 07 Jan 2022 at 19:53
Ah okay - lupron then, sorry. I am not sure if stilboestrol is still used in the US.

Anyway, hope is not yet lost.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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