Oncologist says Chemo - Stage 4 Hormone Therapy Resistant

I'm so sorry. That's rough news to hear.

Have they considered and rejected Pluvicto, which could deliver radiation to widely-scattered cancer intravenously?

Did you know what his Gleason score is, That number can tell you how aggressive the cancer is. It could be the reason he only lasted one year on hormones. How high is his PSA right now?

Did they get a Decipher test For him? That also tells you the likelihood that it’s going to spread soon. See if you can get that test done

Did he get a PSMA PET scan? Is that how you know the location of his lesions?

You’re at a crossover where it comes to treatment. You really need to do the chemo soon because it may work better, sooner, when you have fewer and less aggressive tumors. If you hold off the chemo Tumors will grow. The higher the Gleeson score the more likely it will spread quicker. 9 or 10 Gleason scores means it is very aggressive. Does the diagnosis mention intraductal or cribriform, they are more aggressive things, if found.

Is more radiation the answer if last radiation treatments stopped working?

If you’ve had salvaged radiation, that is the maximum you can get in that area of the body. You can have SBRT to other areas.

The amount of time you get chemo is based on your situation. Need to know more about his cancer diagnosis, Things I mentioned in the first response.

After chemo, there is Pluvicto. Check with your doctor about that, if chemo is unsuccessful. It is very successful for about 1/3 of patients somewhat successful for about 1/3 and not successful for 1/3. You should have genetic and somatic testing before doing Pluvicto Because it is not successful with some genetic issues.

Gleason Score is 8.
PSA is up to 15
No PSMA PET scan, just a CT scan and Bone scan.

I'll ask about a Decipher test.
Thanks

The Oncologist didn't mention Radiation...only Chemo

A Gleason eight is aggressive, but I wonder if there’s something else. Did you check his medical record for Intraductal or cribriform, they are more aggressive things, if found. I know people that are 8’s that has successful treatments. While it is aggressive, it is treatable, normally.

You could ask that somebody else review the slides of his Biopsy to see if there’s more information. Sometimes they change the Gleason score.

Either one of those can be another reason that the cancer is so aggressive. Ask your doctor if that information was not supplied.

Have you gotten genetic testing for him? You should have both ancestry and somatic testing of blood. Is there a history of cancer in the family?

If the cancer is spreading into lymph glands and bones, then some kind of systemic treatment seems best. Chemo is one type of systemic treatment, as is Pluvicto, mentioned above, and there may be others by now. Also, based on my husband's experience with chemo, the patient does not feel terrible for the entire three weeks between treatments; it was more like a week of feeling unwell, then a week of feeling just OK, and then feeling pretty good during the third week, up until the next treatment. Ask your oncologist about options and side effects, but don't delay getting started.

The oncologist didn’t mention chemo only radiation.

Two chemo's killed most of my bone met yet second chemo caused reaction and fluid on lungs On Prednisone clear for 6 weeks now Also had PSA FLAR PSA 181 google that

Next is Xytiga and maybe half chemo of cab Later LU 177 when approved as standard

Xtandi and Radium 223 both failed in a year each