When treatment stops working

User

Posted 18 Jan 2023 at 21:12

Hi all

My Dad - diagnosed 2010, Gleason 8 (contained) had prostatectomy 2011. Since then when levels rose he went on casodex and then changed to the zoladex implant in 2017.

The cancer has now been confirmed as spread to the lung and rib. His levels started to rise to 4.9. At this point (October 2022) he was put back on casodex alongside the zoladex.

Unfortunately he ended up in hospital yesterday with a chest infection (2nd lot of antibiotics not quite got rid of it. Inflammatory markers up so is now on IV antibiotics)

whilst there I asked for his psa results taken from last week and they have come back at 8.9. From 4.3 (over 3 months) I assume this means neither hormone therapy is now working against the prostate cancer in his lung.

He’s 82, not brilliant health (heart issues, peripheral neuropathy) and I’m wondering what if anything will be offered next.

If anyone has had a similar spread (I know it’s more rare) could you let me know how the consultant tackled it.

Thanks
Tracey

User

Posted 19 Jan 2023 at 01:25

They will probably take him off the Casodex if it's not working, and ironically, that might lower his PSA for a while, because when Casodex fails, it can be because the cancer cells learn to use it instead of Testosterone.

Is he on, or has he had any of Abiraterone, Enzalutamide, Daralutamide, Apalutamide?
If not, one of these might be added, providing they're not incompatible with any other health conditions.

User

Posted 19 Jan 2023 at 18:05

Hi - thanks for coming back.

He originally started on casodex in 2011 and eventually it stopped working. He then went on the zoladex implant for about 4 years until his levels starting creeping up again. Last year they started to rise quicker so in October they added casodex back in. Originally it brought his psa down but in 3 months it has now doubled. He has never had any other treatment apart from the prostatectomy.

He’s now being treated for an infection in his left lung, yet the lesion is on his right lung. Today whilst in hospital he is now producing complete red urine (I’m assuming it’s blood). His phlegm is frothy white, was brown earlier in the week. He has atrial fibrillation, heart disease/failure and peripheral neuropathy so quite a complex case. They struggled to regulate his blood pressure, pulse and oxygen so he’s definitely not the fittest bloke to tolerate or probably be given chemo or radiotherapy.
😢

User

Posted 21 Jan 2023 at 10:55

If he'd already stopped responding to Casodex in the past, it's perhaps not surprising it didn't work for long with the injections as a combined blockade.

They probably need to concentrate on stabilising the more immediate issues first. When they've done that, it will depend on his situation at that point what further medication they can give and assessing the risk of them doing more harm than good.

Red urine can be caused by medications, including an antibiotic occasionally used for lung/airways.

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When treatment stops working

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