Stage 4 Prostate Cancer and Hormone Therapy quit working

Posted by cal77 @cal77, Oct 28 12:48pm

My husband is at Stage 4 for one and a half years now...The hormone therapy (Apalutamide and Erleada) seems to have quit working. For the past 8 months, his PSA keeps climbing. It's up to 12 now..
We're scared. Anyone else got to this point? How are you doing when the hormone therapy isn't working anymore.

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proftom2 | @proftom2 | Oct 29 9:05am

I was in the Responsive Zone for 2+ years. I am now in the Resistant Zone, started up Oct 23, so I've been in the Resistant Zone for slightly over a year. Both my oncologist aren't worried. We did a PSMA Pet Scan last month, I went from a zillion glowing spots to 9 spots so that's good. I feel great. My local oncologist referred me to radiation to radiate a couple of spine spots. Follow your bliss and may the force be with you.

jeffmarc | @jeffmarc | Oct 28 2:03pm

Zytiga is an option at this point. Usually it is used before Apalutamide but it could be used after. Ask your oncologist. You are working with an oncologist not a urologist, right. Best doctor to get is a Genito urinary oncologist, they specialize in prostate cancer and can give you the best chance for a continuing life.

northoftheborder | @northoftheborder | Oct 28 1:20pm

I'm sorry to hear that. My cancer team told me that if/when my ADT+Erleada stops working, there are "lots more" things to do these days — those are just the start of the treatment journey, not the end.

If you're doing your own searching, the keywords you want are "metastatic castrate-resistant prostate cancer" (or "mCRPC") — those will give you the most-relevant results.

I assume he's already had radiation to his prostate, but if not, that's one option. If he has only a few metastases ("oligometastatic"), then they can zap them as well; otherwise, there are treatments like Pluvicto for mCRPC that he can take in liquid form to deliver radiation to lots of small metastases internally. Then, of course, there's chemotherapy, PARP-targetting drugs, and probably lots of other treatments I can't think of right now.

I'm looking forward to reading what others post, because this may be in my future as well if/when my stage 4 prostate cancer becomes castrate-resistant.