WHAT'S NEXT AFTER HT STOPS WORKING

My husband has just completed a 6 month HT on Degarelix. His PSA was no longer effective before his last shot last month as his PSA was 0.1 when it had been <0.1 while on degarelix.
The trend is upwards now it is now 0.2.

He had been on Lupron for the last 2 years intermintently and that had worked but our Oncologists decieded to change to Degarelix.

What is trending out there at this point for my husband to try.

Thanks,

BOOGEE

Thanks Allen,

I hope he isn't there yet for provenge. Isn't that kinda like the end of most options?
I'am hoping for our Oncologist to mix different therapy's or perhaps go back on Lupron.
I feel he never had the severe SE from Degarelix as he did from Lupron and I questioned how effective Degarilex was.
We will ask to possibly be inc. in a study.
As far as his Met. it doesn't show up where it once had with scans.

Thank you,

BOOGEE

BOOGEE,

I don't think it's useful to think of therapies as "the end." We are learning that many therapies work better when used sooner rather than later. We just learned, for example, that Taxotere adds a median of 14 months to life expectancy in men with multiple mets who are still hormone sensitive, but only 4 months when used at "the end." I expect the same is true for Provenge.

Response to HT is very individual.

The reason the met didn't show up is because the hormone therapy shrinks it. In fact, that's how you know it was a met. Because it's undetectable on an FDG scan after HT doesn't mean that the cancer cells are no longer there. HT doesn't cure bone mets - it only makes them less active. Only radiation can actually destroy the cancer there. Sometimes, the cancer is only in a few mets (called oligometastatic cancer) and it can be completely eradicated by radiating the mets with SBRT (5 doses usually); more often, the cancer is micrometastatic and floating around systemically, so it can't be eradicated that way. In your husband's case, there may also be residual disease too in the prostate fossa, which was never treated.

- Allen

You can't see where the cancer is while the PSA is that low -- it won't show up on even the most sensitive PET scans. It's an option to come off HT for a while and let the PSA rise to over 2 so you can detect where the mets are.

We will see if his Mets show up on his next scan, and cross the bridge
whether to get radiation to the Met.(s)

His Psa seems to climb quickly or it did whenever off Degarilex and not so quickly when off Lupron.
I just wonder if many have had better response on Lupron VS. Degarilex

Will keep you posted.

BOOGEE

Tall Allen is my mentor and I am in the Oligometastatic camp he refers to.

I could have as he said come off Lupron for several months (due to its half life) to make the PCa visible to the F18 bone scans, as I am sure being on Lupron since 3-28-13 continuously is doing some masking.

I chose instead to do the combination of Provenge and 5 fractions of very high dose SBRT (8 Gy each) versus the 7 weeks IMRT totalling 79 - 81 Gy.

My rationale was that even though there is probaby much more cancer that the Lupron is masking, the SBRT would zap it anyway and the combination therapy that my buddy Ray the Steel Guy and others convinced me is better than monotherapy one after another as each fails, leads to what Tall Allen refers to as the absscopal effect.

prostate-cancer.org/abscopal-effect/

I think you may have been thinking of Taxotere rather than Provenge as "end of the line". The old conventional wisdom used to be to avoid chemo as long as you could but the study Allen referenced makes that no longer the case, with the 14 month result so much better than all the other remedies that average about 4 months.

That figure though is a median and the results can very greatly. So don't dwell on the metric, other than comparatively. It's also measuring montherapy not combinations.

I see you are in San Jose CA.

I had been there most of Oct 2 - Oct 21 even though I live in FL. My treatments for Provenge were in Van Nuys CA on altrnating Fridays and Marina del Rey CA on alternating Mondays and my 5 SBRT treatments sread over two weeks were by Dr Chris King at UCLA.

I found it cheaper to stay with my son and his family in SJC if I scheduled my SW Air flights early enough @ $69 or $75 etc than to pay LA hotel rates.

I will be there again Halloween weekend but consumed with grand kids swim meats on that short trip.

We'll be there over Christmas too and perhaps during that more extended stay my spouse Karen and I can meet in person with you and your hubby.

Don't know if you frequent the Inspire.com PCa board too.

www.inspire.com/groups/us-too-prostate-cancer/discussion/remote-advanced-cancer-discussion-group/

On that baord, Rick Davis screen name Ardeee (his initials) is the Tall Allen resdient guru, a layman whose knowledge matches up well with most PCa doctors. Rick works for UCSF and lives in nearby San Francisco.

So you may want to friend him on the Inspire,com board. My spouse Karen and I got together with Rick, his buddy Jerry who is on chemo, and another Inspire.com poster Nick (Haliday) last June while we were in the area, and may do so again over Christmas holidays. I can facilitate a meeting if you want to join us then.

It's either an hour drive to San Fran or an hour flight to LAX so you have lots of options if it comes to that.

LupronJim

Boogee,
Like Lupron Jim, I am ogliometestatic. I had a single met show up at L2 with rapidly rising PSA, rad onc hit it hard and I have been <0.02 for the last 20 months. But, this met qualified me for Provenge - had the treatment in march/april this year. I'm looking at Provenge as just another detail in my treatment, but with lower PSA it should have the maximum effect possible re extension of life. It's definitely NOT a last option, in fact it works better if given earlier in the disease progression.
You also mentioned better luck with Lupron rather than Delgarex - might be worth a try at switching back.
Bob

Boogee, I replied to your email. No need to wait until Dec when Karen and I are in San Jose though. I am sure the contacts I listed at the end of the long email would be happy to meet with you before then, particularly Haliday (edit - Margot) who like you does most of the on line research for her husband (edit - Nick), and is closer to SJC than going an hour or more to San Francisco where the others reside.

She posts on both this site and Inspire.com but I don't recall any recent posts, as her husband is doing quite well.

You may also want to friend Wampuscat and Mrs Worry Wart who are also spouses who carry most of the family research load. There are many others that do as well. So check out the caregivers thread.

www.healingwell.com/community/default.aspx?f=35&m=3009873

This oneI found via Forum search is titled "Part 4" so there may be three other prior threads that got too long for the site maximum.

LupronJim

Yes, screen name is Haliday, real names are Margot who does the research and Nick who met with Rick Davis, his buddy Jerry who is undergoing chemo, my spouse Karen and me. Margot could not make it that day, so we are looking forward to meeting with her and you in Dec.

Nick said Haliday is Margot's middle name. Both of their email's are on my note to you.

LupronJim