PARP inhibitors or radiation: Any thoughts?

Posted by johnernest @johnernest, 4 days ago

I have stage 4 PC, spread to lymph node and pelvis. Being treated with ADT and Nubeqa, started last September, having an MRI tomorrow to see how much the cancer has shrunk and then meeting with radiation oncologist about radiation treatment. However, my urologist tested me for genetic mutations and found I am brca 2 positive. So I am wondering about being treated with Parp inhibitors instead of radiation, maybe less side effects. Just thinking about and wondering if this is ever done, or do they wait until the cancer become resistant to ADT before Parp inhibitors?

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jeffmarc | @jeffmarc | 4 days ago

You can do it more than one way. I Have BRCA2 And after 15 years, I have not yet taken a parp inhibitor. I had surgery and 3.5 Years later, radiation. 2 1/2 years later, I went on Lupron and 4 years later Zytiga, which kept my PSA down for 2 1/2 years. After some AFIB Issues I switched over to Nubeqa, The last 14 months I’ve been undetectable. I became stage four about six years ago. I did not find out I was BRCA2 Until four years ago.

My oncologist has always discouraged my switching to a PARP Because it is very hard on the blood counts.

I figured that When Nubeqa Stops working I will start taking the PARP, I am concerned about the wbc, RBC and platelets, Which are just some of the things I can have problems with when on a PARP inhibitor.

Depending on your cancer case some doctors want to use a PARP Inhibitor early. Read up on it and you will find some articles that discuss it.

Everyone is different with prostate cancer so I can’t tell you what your best choice is, ask your doctor, hopefully, you are working with the center of excellence that can better guide you on what to do.

johnernest | @johnernest | 3 days ago

Thank you for the information!

hikergal61 | @hikergal61 | 10 hours ago

My husband has been stage IV for 5 1/2 years. He's done almost all possible treatments. He did 4 Cabacitaxel chemo treatments recently, but his test showed he's becoming resistant to it. The test showed he's BRCA 2, so doc ended chemo and put him on PARP-Inhibitor, Lynparza. The side effects were awful for him, at full dose and half dose, so he ended that and went on Abiraterone, as his test showed it might help him. The side effects were pretty bad, and his PSA keeps going up, so she has him back on Cabacitaxel chemo. So far, it's not too hard on him. He'll have a PET scan in 3 weeks to see the results. So, the PARP-Inhibitor was a fail for him.

jeffmarc | @jeffmarc | 9 hours ago

Pluvicto works better than average with BRCA2 patients.

Rucaparib is supposed to work better for some BRCA people. It is a newer PARP inhibitor. PARP can extend life so it is a best bet for longer term survival, if you can handle it.

I was on olaparib for a week And got a lot of nightmares, So I convince my oncologist to let me go on Darolutamide And it has been working great for 18 months.

I know PARP inhibitors are tough on the blood test results. WBR, RBC PLATELETS and HGB can go down a lot causing anemia. Good luck.

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