Cabazitaxel run its course, what happens next?

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User

Posted 24 Oct 2022 at 17:06

I've made it through 9 cycles of Cabazitaxel, but the cycle 10 got cancelled - the nurse thought I'd had enough, and the last cycle might do more harm than good. Whilst I feel I've done well not really suffering from any of the side effects, there has been increasing tiredness and lack of energy (although my hikes along short sections of the Oregon Coastal Trail two weeks ago show that I can still do stuff, if only for short periods when I've built myself up for the challenge).

PSA hit a low point of 84.6 on 5 September (down from 2314 at the end of May). I'd hoped to get down to single digits, but what can you do? PSA rising steadily: 143 by 26 September, and 238 on 19 Oct. Back of a fag packet calculation suggests a doubling time of about 6 weeks. Been here before, so no longer bothered about it - what would be the point. Doctor inadvertantly referred to Cabazitaxel as a "last resort". Well now that's gone I'm wondering what happens now... PSA continues to rise exponentially - will be interesting to see how high it goes.

Radium 223 has been mentioned, but not a certainty. Would appreciate any info on this - how it works / what it does, and potential side effects. Thanks for any info/advice.

User

Posted 25 Oct 2022 at 00:16

Your body thinks Radium is Calcium, so it gets routed to growing bone. Bone continuously regrows around bone mets, so the Radium is drawn to the bone mets. The Radium is radioactive, and delivers radiotherapy treatment very locally to the bone mets, but it's low energy so the radiation doesn't travel far through tissues. The half-life is 11.4 days. Radium only works on mets in bone, because it homes in on the regrowing bone rather than the prostate cancer cells directly.

There is a similar treatment Lutetium 177 which is newer and going through trials on the NHS. Prostate cancer cells have a molecule on the surface called PSMA. This is the molecule that PSMA PET scan tracers lock on to, to enable the location of prostate cancer cells to be seen in PSMA PET scans. For Lutetium 177 treatment, Lutetium 177 is included in the tracer molecule, and locks on to the PSMA molecule. Lutetium 177 is also low energy radioactive source and delivers radiotherapy to the cancer cell. Unlike the Radium, it directly targets prostate cancer cells, so it should work against mets in other places than just bone. A small percentage of prostate cancers don't produce PSMA, in which case it won't work. Also, PSMA does appear in low levels in salivary glands, so they can be affected by the treatment.

You may also be able to have chemo again after a while.

Edited by member 25 Oct 2022 at 00:18 | Reason: Not specified

User

Posted 27 Oct 2022 at 19:30

Thanks Andy, that's really useful info. I'm reposting my original post under a more appropriate title to hopefully get further info, especially on use and side effects.

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