PSA tripled in a month

If you are talking about the Relugolix Vs Zoladex then the aim of both is to stop the testes from producing testosterone but they work in different ways.

Relugolix is a nonpeptide GnRH receptor antagonist. It competitively binds to and blocks GnRH receptors in the anterior pituitary gland, resulting in decreases in the release of gonadotropins such as LH, FSH, thereby decreasing the downstream production of testosterone by the testes in men.

The Zoladex is an agonist so works in a different way to achieve the same job.

The second generation antiandrogens work in a different way again by selectively binding to the testosterone which stops the cancer cells from being able to get at their food.

Abiraterone works in a different way again.

By denying the cancer cells their testosterone food this should reduce the PSA. The problem is that the cancer can find ways round the blocking mechanism after being on hormone therapy for a long time. This is why changing the mode of action might help but also there is research going on to try and achieve resensitisation.

Hi !

Ok, so you’ve on continous hormone therapy since 2014 and your’e also on Abi now correct?

Maybe you could have a triplet; perhaps change Abiraterone to Apalutamide or enzalutamide and if I understand it correctly you’ve only done chemo with Docetaxel but not with Cabazitaxel/taxotere. not read in that much on chemo but I suppose your MO/medical team knows very well if they might fit you.

I suppose that when you had Lutetium-177 you also PSMA Pet scans and found out if and where you have your mets.

I know that Alwayshope (her husband) have had SBRT to mets and perhaps you could be a candidate. I also know that there is a specific targeted radio isotope for mets in bones. Could also be a possibility.

Next gen of targeted radio isotope is Actinium, a more powerful isotope then LU-177. Don’t know if there are any trials in the UK but I know there are trials in Europe.

Best wishes - Ulf

Hi Ulf.

My abiraterone and enzalutamide stopped when my PSA first started rising. It was then I had three sessions of chemo which also had to be stopped before I went onto lu177 which has now also stopped.

I've not tried Apalutamide or Cabazitaxel, so I'll add that to the list of things to ask about.

I don't know what SBRT is. Could you please let me know 

Many thanks 

Tim

Hi !

So besides Zoladex you where on Abiraterone as well as Enzalutamide but Abiraterone and Enzalutamide where stopped when PSA started rising correct?

SBRT is Stereotactic Body Radiation Therapy is external high radiation level radiation. In one fraction (or one session if you prefer) you deliver a very high radiation level (in Grey(GY)), so fewer fractions to the tumor/lession but with the same efficacy and perhaps even better than conventional / hypofractionated radiation. SBRT is, I think, often used in salvage radiation to prostate cancer and if you have few distant metastisis / lessions in for example bones and etc.

Like I Said Alwayshope’s husband had SBRT to a few mets I think.

Because you’ve had Lu-177 I think you must have had PSMA Pet scan(s) and perhaps even SPECT Scans after each cycle so they might even know where you perhaps have any mets and if I understand you correct you have a PSA value of > 0.5 so perhaps they could do a new PET to try to identify where the cancer is active. I mean, if your primary tumor in the prostate is still active you might be able to have salvage HDR Brachytherapy or even SBRT. just thinking.

Best wishes - Ulf

You are correct Ulf. SBRT is a very targeted form of radiotherapy. My husband had 5 sessions x 6 Gy per session to distant lymph nodes, a visceral met and 2 mets on the adrenal glands last April and all have disappeared except for the visceral met which has significantly reduced, plus 2 lymph nodes which have shrunk. It should continue to work to kill the cancer for another year. The technique was originally used for brain problems where accuracy is needed. The guidelines are that up to 3 to 5 mets can be treated but my husband had a lot more and is still doing well and has few side effects. It can be used on bone mets provided the area being targeted has not already had the maximum recommended dose. Greater care for planning and positioning has to be taken and often you are immobilised during the SBRT sessions to prevent collateral damage.

The radioligand therapy for bone mets that you mentioned is Radium 223.

Hi !

You never let down when it comes facts and truely a joy.

Anyway, because TimR123 had Lu-177 treatments there must have been PSMA Pet Scan so, there should be analysis of any mets.

Also, if there is PSA over > 0.5 there should be a possibility to do a new PET Scan and confirm diagnosis.

Best wishes - Ulf

Hi TomP

If I understand TimR123 and reading his profile he was diagnosed Stage 4 when they found out that he had prostate cancer.

Best wishes - Ulf

Hi again 

Yes, that's correct. As soon as my PSA had climbed to 0.5 they stopped the stampede drugs trial (abiraterone and enzalutamide). I then moved my treatment to France in anticipation of getting lu-177 which was available there, but I had to have chemo first.

I'm seeing the consultant on Tuesday so I will ask about SBRT.

Thanks again 

Tim

It's been 10 months since I last posted so I thought I'd do an update.

I think I mentioned that my lu-177 was stopped as a result of an acute kidney problem which they, incorrectly, assumed to be as a result of the treatment. Despite me trying to argue that it couldn't be that they went ahead and stopped the treatment. In the end the kidney problem turned out to be as a result of a ganglioma strangling the tube from my kidney. Stent inserted and problem solved but lu-177 not restarted.

They decided to put me on cabazitaxel and a 3-weekly cycle. Until recently this appears to be doing the job as the met in my liver shrank a little and my PSA dropped. But now the PSA is increasing again, now at 3.9. I have a couple of scans coming up which will hopefully tell me what's going on.

I'm on the 11th chemo cycle with another programmed for the beginning of September but that will depend on the scan results. I'm guessing it won't be long before I will have to stop this chemo but have no idea of what would be proposed for the next treatment routine. My UK oncologist suggested that it might be possible to restart the lu-177 but I have no idea if this would be the best way forward.

At least from the last scans taken, it seems the the main problem lies in the liver, with one largish met and a number of smaller lesions. I'm still relatively in good shape although I think that either or both the cancer and the chemo is having a cumulative effect. It/they have affected my digestive system as well so I often have multiple visits to the loo.

Any insights or advice gratefully received.

All I can add is that I don’t know my own body at the moment after 3 years of calm and routine my bowels are alien to me now.

I’ve given up guessing whether I’m needing a nappy or three laxido a day.

Sorry it don’t help much but you’re not alone. 

Patterns only appear after time, be patient.