Advanced prostate cancer

Hi 

Hi westobutch 

chemo and zytiga together ? I understand about castrate sensitive & castrate resistant as I am in the medical field and ur point that at some point that you would become castrate resistant . But would like to know the reason for the only 2 options for castrate resistant ie docitaxel chemo & zytiga started at same time and exhausting the options rather than one at a time ? Would be interested to know how your oncologist reasons this ? 

Bcos I am almost in similar position psa went up after chemo so now on zytiga . 
also is any radiotherapy planned ? Thanks 

Thanks for the question.  Some quick personal family background then reasoning.  BRCA2 in our family including me.  Been in a pancreatic cancer screening program for 6-7 years now and holding steady.  Mom and only sibling turns out both BRCA2 .  Mom died at 66 of pancreatic cancer, my uncle age 69 of advance prostate.  Before genetic testing.  I'm turning 69 this month.  My oldest son died 2.5 years ago of pancreatic cancer.  Also BRCA2.  Wicked genetics.  My PSA never got above 6.5 in last 3-4 years (and then only twice before back in the 4's right away) but due to some urological symptoms in late fall 2021 (assuming it was classic BPH) I pushed my PCP and then my urology provider to really check for cancer.  Both assumed I was fine and probably BPH. Prostate MRI showed advanced cancer with subsequent mets to about 4-5 bone areas but not not at pathologic fracture stage concern or painful.  In consultation (I've been a dental health care provider for over 40 years and well acquainted up to this point about pancreatic cancer issues) with my oncologist (I love him!) we decided that the findings of the PEACE-1 investigation (especially presented at the ESMO Congress 2021) would be used in my case.  Triplet regimen of ADT, abiraterone acetate, and Docetaxel.  Throw everything but the kitchen sink at it.  I am completely on board with this approach especially in light of my family's history.  At any point in time I am in agreement with my oncologist that should a treatment either show no response or if the side effects become too debilitating we will always re-examine our path.  I am truly at peace with my life, will attempt all reasonable and rational treatment approaches, but will pray I have the courage and strength to know when it's time to "move on to other things" awaiting me.  Sorry if this answer is too long winded but a shorter response is not fair to this most reasonable ask by you. 

Hello westo, very nice of you to get in touch. My story is on my profile if you would like to read it, I am similar to yourself. Can I ask what is Lynparza? Take care 

Hi

Well put reply, seems you have a plan B ready and waiting, that’s my thing, make sure there’s a back up. You never mention about radiotherapy although your only on second chemo. Your family has been hit hard with this disease, be it in one way or another, very sad. Still good to see your doing battle and have a good rapport with your oncologist long may it last along with yourself.

Stay safe

Joe

Lynparza (generic olaparib..Astra Zeneca) is a PARP inhibitor which tries to mess up cancer cells repairing themselves. BRCA 2 mutations don't allow your immune system to fight cancers the same way a lot of people might be able to.  Gives it a green light instead of a red light light.  From my limited understanding PARP inhibitors are used especially for germline genetic mutations such as BRCA 2 and BRCA 1 along with maybe some others that I haven't researched.   I've been looking over this since I found out I was BRCA 2 back less than 10 years ago.  Unfortunately really didn't do anything for my son and I am in consultation with his previous oncologist (as a welcome sounding board but not to interfere at all with my treating oncologist) and unfortunately for his patients (BRCA2) he has not seen much clinical success using PARP inhibitors.  That being said...we throw everything but the kitchen sink at this disease process and see what' sticks.

Thank you for the detailed information, I am awaiting my results from a genetic test I had done last July to find out what mutations I have and could my son and daughter potentially have the same. I presume that information, when I get it will tell me if I would be suitable for that treatment in the future. Thank you again 

There has been mention of a clinical trial (maybe in June?) that separates participants with a choice of either some radiation treatment(s) or surgery.  I will definitely not be taking a surgical approach and my oncologist agrees.  If and when the bones start getting nasty there are obviously some pin point radiation options available but we're not anywhere near that yet.  The horses have left the barn already.  Radiation if in clinical trial...we will see.  I am of the mindset that a "chemical" approach will have to do the trick to prolong things as long as it can and I'm thankful and lucky that my overall health (other than Stage 4 cancer  :)  ) is good.  No heart, lung, kidney, liver disease, no circulatory nor diabetes issues, etc.  Good starting point as the poisons start entering and trying to do their job. 

Paul...on my Caringbridge.org site I encourage ANYONE who has cancer in the family to get genetic testing done yesterday.  Targeted therapies (while still in their infancy) are definitely being looked at more and more and in some cases are life changing.  One of my 3 daughters is BRCA 2 (thankfully other two spared) and she will be getting her ovaries removed at some point although she just had her second child born 6 months ago and not sure about a 3rd.   Mid 30's.  She's seen enough in our family and won't be messing around as breast and ovarian cancer are much much higher risk for her. 

Yes that is my big worry regarding my children as I have got this diagnosis so young, I am scared for them. I will have a look at your website, thank you again for the information, you have been most helpful. Take care