Abiraterone failing and PSA rising

Hi fyneside sorry you are in this position, I know what it is like after the PCa starts to get round HT.  Have you had a PET scan to detect where it has escaped to?  In my case it popped up in my sternum and I had 3 hits of RT SABR.  
Hopefully someone will be along soon with knowledge of Abiraterone not working fully.  Best wishes, David

Thanks David. Had a bone scan and CT scan. Bone tumours have not really changed but now have tumours on my adrenal glands. Best wishes to you too.

Hello fyneside . My husband has not had Abiraterone but he has had several progressions in the last 5 years since he was diagnosed with advanced metastatic prostate cancer. I think you still have options but the first thing to find out is what is the source of the cancer and whether it involves less than 5 sites (oligometastases) or many more sites (polymetastastases). With a small number of sites then radiotherapy can be effective. For many sites then you are looking at a more systemic treatment like chemotherapy with the first line being Docetaxel. If this fails then it can be followed by Cabazitaxel or even a platinum based chemotherapy like Carboplatin if you have certain gene mutations. A PSMA PET scan is the best method of finding this out. It is my understanding that you can have Enzalutamide following the cancer overcoming Abiraterone so maybe an option for you?. How long these therapies work for is variable. I will summarise my husband's treatment but the caveat is that he does have a rare aggressive form.

July 2020 diagnosed and put onto Prostap and Bicalutamide plus 33 sessions of EBRT to whole pelvic region.

1. Jan 2022 taken off Bicalutamide and put onto Enzalutamide due to progression.

July 2023 Enzalutamide failed so stopped and given 6 rounds of Docetaxel.

April 2024 further spread to abdominal lymph nodes and adrenal glands so given 6 rounds of SBRT to these areas.

Feb 2025 spread to right clavicle and left femur so 5 rounds of EBRT and low dose steroids added in.

He has recently changed from Prostap to Orgovyx which has really reduced the testosterone but the PSA is on the rise again.

My husband's cancer seems to be radiosensitive as all the areas targeted have killed the cancer.

The options being discussed are PARP inhibitors (Olaparib). Docetaxel, Cabazitaxel or Cisplatin. Pembrolizumab. Lutetium 177. Radium 223..

The decisions about 'what next' are revolving around quality of life vs side effects of treatment Vs how much longer will it give him bearing in mind that he is a young strong 81 year old who has recently had a pulmonary embolism thanks to the treatment he has had.

Alwayshope. Thank you for your reply. Unfortunately my cancer has more than 5 metasteses in various sites in my bones. I did ask my oncologist about the possibility of enzalutamide but she said that after abiraterone there was not really any evidence that it would be effective. Yes. Looking at Docetaxel as the only viable option now. 

Radium 223 is sometimes offered for men with bone mets but normally it is after Docetaxel.

 Radium 223 before Cabazitaxel for advanced Prostrate cancer. 

Hi fyneside 

My husband has had Abiratetone for 2.5 years . He’s taking a break from it , not because it’s failed but the side effects are getting a bit much, also to see if he can go on with just Zoladex . We were told when/if Abiratetone fails he will move over to Enzalutamide, because it could have some mileage in it  and also would target any areas with RT. If it’s spread further - Chemo ( saved for this very reason ) 

So in a way that’s a second opinion on the Enzalutamide. I can’t see anything is lost by trying it for a few weeks and checking your bloods. Then if it’s not working go for Chemo.  Bringing the big guns in on this, see how it goes for you, why not? It should hopefully kill off a nice lot of cancer cells. 
Best wishes

L

Thanks L. I'll have another chat with my doc.