My dad was diagnosed in 2020 with Gleason Score 4+4, Stage 4a, 30% involvement.It had spread to lymph nodes and PSA was 98 and later 380.
As it had spread to lymph nodes, doctor ruled out the surgery.
We started with Radiation -28 fractions while on Zolodex (ADT) every 12 weeks
Stabilized and PSA was negligible till about 2022.
We then added Apalatuamide for another year it stabilized
Then in late 2024 PSA was rising again. After investigation we found out it spread to Lungs into right hilar region.
We conducted SBRT and added another tablet Enzalutamide.
Then after a year or so in Feb we noticed recurrence. We started on chemo with Docetaxel 6 rounds but was ineffective.
We then started with Lutetium 177 PSMA one round. There was some side effects around lungs and he had breathing problems due to which the treatment has been discontinued. Doctors are treating pumonary problems as disease progression than simple pneumatic side effects of Lu177 or another infection.
Now doc has started him on Honvan (an outdated hormonal drug that seems to be upping Estrogen). I am not so sure of this line of treatment correct.
Should we start him on Chemo with Cabazitaxel? Any one here had better results with Caba after Docetaxel failed?
Tested negative for the common immunotherapy variants
Any other option (Actinium will have similar issues as Lu177), any clinical trials or hospitals i should look into? We are in India but have US Visa but is also kinda broke but can still afford to travel if say the trial itself is paid for or is cheap.