Well, I have some new stuff to report today but I’d have to say that we are still pretty much running in place. My second report from Caris Lifesciences came back on Monday and although it was helpful, it certainly didn’t provide any crystal-clear answers on what to do next. There was an unequivocal result that I am negative for a BRCA-1 or BRCA-2 genetic mutation, which rules out the use of a newer drug showing good efficacy with prostate cancer called Olaparib (aka Lynparza). In the plus column though is that I *think* the negative BRCA results bode well for my two sisters as far as not developing breast cancer in the future.
The Caris report did show that I am positive for an AR V7 variant, which indicates that the prostate cancer is now becoming resistant to anti-androgen therapy, which we kind of already knew based on my quickly rising PSA and where the cancer was recently found. Outside of that, the report did not show an “actionable target,” which in layman’s terms, pretty much means I just must make a decision and roll with it.
As I type this, I am waiting for an updated PSA result. I did start a new androgen blockade drug called Casodex a few weeks ago. This is strictly a bridge medication to try to control things a bit until we know what the next steps are. It is one of the very oldest of the anti-androgen drugs so I am not expecting to see much cancer control out of it, but we shall see.
It looks like I have a choice of two clinical trials – one at the National Institutes of Health in Bethesda, Maryland and the other at the University of Michigan in Ann Arbor. My medical oncologist was of the same mind as me, which is a preference for the trial in Ann Arbor. The Ann Arbor trial relies more on a combination of FDA-approved drugs rather than the other trial, of which none of the drugs are FDA approved. He also feels that I need to start on one of the two clinical trials or start chemotherapy within the next month.
Since it is likely but by no means guaranteed that I will get into one of the two clinical trials, he did go ahead and schedule me to begin chemotherapy about a month from today. If I go the chemo route – in what can only be described as an incredible irony proving that the universe has a sense of humor – I will lose my hair. This would be a problem on two fronts: (1) my vanity when it comes to my hair and (2) Diana is not a fan of guys wearing ball caps in the house. I have a lot of great ball caps thanks to our extensive travels, and I will not want to walk around bald, so we may have to have a “come to Jesus” meeting over that one.
Until next time,
Steve