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Advanced PCa, that psychological thriller

User
Posted 14 Mar 2023 at 14:51

My father's journey, aged 76, started in July 2022, when he was diagnosed with de novo metastatic prostate cancer, with multiple bone mets and a PSA reading of 839 ng/mL, gleason score 8. At that time, his right hip and lower back were in excruciating pain, his mobility was impaired and his appetite was significantly reduced.

Soon after, he was put on androgen deprivation therapy, including the quarterly injections we all know and bicalutamide tablets (150 mg initially and later on 50 mg, daily). Xgeva has also been administered, for his bone mets, on a monthly basis.

He was doing well, as his PSA level followed a declining trajectory :188 in August, 40 in September, 20 in October, 10 in November and 8,5 in December 2022. But, in January 2023, it rose to 15. In February, he had CT scan, showing no changes and PET scan, showing two new small areas (in a rib and a vertebra) and amelioration of the already known mets. And, even though his testosterone was at castrate level, his PSA reading was 50 ng/mL, in February, so he switched from bicalutamide to enzalutamide. But after 20 days, that is today, his PSA has skyrocketed, reaching almost 150 ng/mL.

Good news that he eats well, has no pain and walks. 

But I'm very concerned and that is the least I can utter...

Edited by member 08 Apr 2023 at 16:15  | Reason: Not specified

User
Posted 16 Mar 2023 at 11:31

Hi Teta,

Sorry to read about your father, this is a worrying time for you.   That he's no longer in pain is good.  I can't offer any advice on the use of drugs unfortunately but it seems he's being offered different treatments and some work better than others.  Sometimes they offer combinations of drugs.    All the best Peter

User
Posted 18 Mar 2023 at 07:38

It might be worth asking about switching to Abiraterone. In theory, he can only be switched if he gets unacceptable side effects from the Enzalutamide in the first 3 months, and not because the main effect isn't working, but the oncologist might be able to wangle this providing the switch is during the first 3 months on Enzalutamide.

There's not a high chance Abiraterone will work any better, but it does work differently so there's a small chance it might work better. It has a disadvantage that it must be taken with a low dose steroid which can have side effects, which is probably why they tried Enzalutamide first.

Edited by member 18 Mar 2023 at 07:40  | Reason: Not specified

User
Posted 03 Jul 2023 at 18:48
A rise from 9 to 13 is insignificant at this stage in your husband's treatment. If it goes back up towards the 100 mark, they would probably stop the Xtandi
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 16 Mar 2023 at 11:31

Hi Teta,

Sorry to read about your father, this is a worrying time for you.   That he's no longer in pain is good.  I can't offer any advice on the use of drugs unfortunately but it seems he's being offered different treatments and some work better than others.  Sometimes they offer combinations of drugs.    All the best Peter

User
Posted 16 Mar 2023 at 13:00

Thank you for your contribution Peter. Oncologist insisted my father stay on enza for one more month, in case it starts working. No chemotherapy has been offered yet. This might be the next step. 

Teta

User
Posted 18 Mar 2023 at 07:38

It might be worth asking about switching to Abiraterone. In theory, he can only be switched if he gets unacceptable side effects from the Enzalutamide in the first 3 months, and not because the main effect isn't working, but the oncologist might be able to wangle this providing the switch is during the first 3 months on Enzalutamide.

There's not a high chance Abiraterone will work any better, but it does work differently so there's a small chance it might work better. It has a disadvantage that it must be taken with a low dose steroid which can have side effects, which is probably why they tried Enzalutamide first.

Edited by member 18 Mar 2023 at 07:40  | Reason: Not specified

User
Posted 18 Mar 2023 at 17:55

If his PSA keeps rising, which, unfortunately, I deem as the most possible scenario, he will be offered a CT scan to have his cancer restaged. And then he will be offered either a different drug or chemotherapy. Last two days he is in mild pain, that might be in part due to the sudden change of weather, which is unusually cold for March, in Greece. 

Edited by member 18 Mar 2023 at 17:57  | Reason: Not specified

User
Posted 12 Apr 2023 at 15:21

Just an update. His PSA dropped from 154 to 139. Xtandi seems to have started working, at least to some extent. Still good news. 

User
Posted 14 Jun 2023 at 18:47

Further and spectacular PSA drop in May (11.5) and even further in June (9.5). Seems that Xtandi has worked so far. Next PSA test planned for early July. However, today he experiences pain in his right hip (an area with bone mets) almost like before he was diagnosed. He usually aches when PSA is well on the rise, but how is this possible, that fast. I wonder if bone/joint pain is a common symptom while on Xtandi or is it just that cancer progresses and causes more trouble?

User
Posted 03 Jul 2023 at 15:40

July PSA reading 13.Guess it is not considered a slight rise. Nor a fluctuation. Any ideas? 

User
Posted 03 Jul 2023 at 18:48
A rise from 9 to 13 is insignificant at this stage in your husband's treatment. If it goes back up towards the 100 mark, they would probably stop the Xtandi
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 04 Jul 2023 at 10:10

Thank you for your response Lyn. 

It is actually about my father.

Tomorrow  he will meet his onco and will have a talk. Hopefully his PSA does not reach the hundreds that soon, again.

Kind Regards, 

Teta

 
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