Metastatic Castration Resistent Prostate Cancer: Clinical Trials?

First, I'm sorry. A diagnosis of metastatic prostate cancer is a major life shock, so give yourself time and grace to adjust.

Standard of care for high-load mCRPC these days seems to be what's called "triplet therapy":

1. ADT
2. an ARSI (like abiraterone or one of the newer -lutamides)
3. chemotherapy and/or radioligand thererapy (Pluvicto).

Up until a few years ago, they believed in "sequencing" -- give you one treatment until it stops working, then escalate to the next one. But study after study has shown that it's more effective for metastatic prostate cancer (dramatically so) to do everything all at once up front to shock and awe the cancer.

For oligometastatic cancer, which means few metastases, research also supports radiating the metastases (metastasis-directed therapy, or MDT) and the prostate (prostate-directed radiotherapy, or PDRT), but there's been no benefit found for polymetastatic cancer like yours, so you probably won't be offered those treatments. Chemotherapy and/or radioligand therapy is far more effective in your case, because they can attack all the metastases at once rather than one-by-one.

Best of luck! It's never a good time to get advanced cancer, but there are so many new treatments and practices now that you're far better off than you would have been in, say, 2020. All the old survival data is going out the window, because no one knows yet how long we'll live with these new advances: there are promising signs that metastatic prostate cancer is becoming a chronic disease that we'll live with rather than dying of.

Best of luck, and remember that it's OK not to be OK after experiencing a big life change like this.

Thank you for taking your time to provide some feedback. Yes, the pet scans look awful but all in all I manage quite well. I am 61 and are managing my daily activities as I have always done. I will get feedback on how well the Pluvicto is working around mid August. And I hope you are right about the new methods of treatment and lack of updated survival statistics 🙂
Jakob

@jsemmerhoff We're the same age now. I was 56 when I got my diagnosis of de-novo metastatic prostate cancer in 2021. It's become a normal part of my life, but there was nothing "normal" about it at the time, especially when the doctors told me I had only a few years left to live* (based on the SEER data, which is always out of date).

DM me if you'd like to chat.

* They don't say that any more.

please check for vir-5500 trials

@pragati Thank you. Highly apreciated.

@northoftheborder Yes, a chat would be fine. I am Norwegian ang gues I am minimum 5 hours ahead of you

When I read through advanced situations like yours, as I read the details I make a list of diagnoses and therapies, as well as questions, in order to see where things are going and what’s next:

> what were your PSA & Gleason scores pre-primary treatment?

> what primary treatment did you have?

> what are the SUVmax scores (in the PSMA PET scan report) of the lesions in your lungs and lymph nodes?

> what is your testosterone level now?

Hormone therapies you’ve had: Zytiga (abiraterone), Xtandi (enzalutimide), & Zoladex (goserelin).

> since you have castration resistant prostate cancer (CRPC), is the Zoladex doing anything?

Isotope therapies you’ve had: Pluvicto (Lutetium-177)

> Other possible treatments: chemotherapy; immunotherapy; PARP (poly-ADP-ribose polymerase) inhibitor therapies.

There were combinations of drugs approved (by the FDA here in the U.S.) in 2023 for certain mCRPC patients:

> Olaparib plus abiraterone and prednisone or prednisolone for the treatment of patients with BRCA-positive mCRPC.

> The PARP inhibitor talazoparib in combination with enzalutamide (Xtandi) for patients with homologous recombination repair (HRR) gene–mutated mCRPC.

> The combination of niraparib and abiraterone acetate (Akeega) plus prednisone for patients with mCRPC with deleterious or suspected deleterious BRCA mutations.

And there are ongoing clinical trials with an isotope therapy that is more powerful than Pluvicto - it’s called Actinium-225.

As for other possible therapies in the pipeline, attached is a chart from a webinar I attended a couple of years ago showing both diagnostics and therapies that were in the pipeline at the time.

@brianjarvis
Thank you for all the information you provide.
Pre treatment: Gleason 9, PSA 8.5, 3Tb
1.treatment: Removal of prostate (Nov 2022). 5 weeks after treatment PSA<0.1, no evidence of cancer outside the prostate.

2. treatment: August 2023, bone pain left hip. PET scan showing 10 tumors in each lung, but only one confirmed with biopsi, one tumor left hip and multiple lymph tumors in pelvic area. September 2023 started first round out of six chemo theraphy rounds with three weeks interval. In addition zoladex injection every 3 months and Abiraterone.
3. treatment: June 2024, Radiation (13 repititions) of left hip just to be on the «safe» side.
4. treatment: August 2025, ct scan shows two tumors in my chest (25 mm and 19 mm). one with 2 mm clearance to my main arterie and one with 4 mm clearence to my heart. Changing from Abiraterone to Xtandi and continued with Zoladex. Cyber knife treatment of these two tumors.
5. treatment: March 2026, pet scan showing 20 tumors in each lung, the biggest around 12 mm. May 2026 first Pluvicto treatment out of possible 6. SUV values ranging between 6 and 13. Some tumors in the lungs are not lightening up.

I am not sure what my testosteron levels are.

I don’t know if the Zoladex have any effect or not. I am just following my onchologist’s advice.

In June 2025 I also did a couple of months with Ivermecton and Fenbendazole. No effect appart from extreem liver values.

Jakob

@jsemmerhoff Man, sorry for all your grief…so the docs really don’t know if those lung tumors are all of prostate origin, right?
Did they attempt to biopsy any of them?
Phil

@heavyphil yes, did a biopsy back in 2023 which confirmed prostate cancer. But due to the fearly small size only one tumor was biopsied. After my latest pet scan in March this year no additional biopsies were taken.