Treatment options for metastases post Radical Prostatectomy

[sipanda]

Hi,

I am writing on behalf of my father (Age: 65). My father was diagnosed with prostate cancer in 2015, following which he underwent radical prostatectomy (2015), hormone therapy (2015), and radiation therapy (2016). This year his PSA level started rising and PET CT scan has revealed metastases in right iliac bone. Please find below a detailed case history with PSA levels at different points in time.

We’d be grateful if you could share what are the potential treatment options and implications on quality of life because of the disease. Thank you!

Case History:

+ 2015 Jan: Diagnosed with carcinoma prostate cancer (PSA: 9.3) through fusion biopsy of prostrate (Gleason score-8 ) – age at the time of diagnosis: 62

+ 2015 Mar: Surgery done; histopathological report post operation: Tumor 2C reported (Surgery methodology - Robot Assisted Radical Prostatectomy with Extensive Pelvic Lymph Node Dissection)

+ PSA post operation: 0.11 in May 2015; 0.50 in August 2015; and 0.82 in Nov 2015

+ 2015 Nov: Hormone therapy (Firmagon) started - loading dose (240) followed by five maintenance doses (80) at monthly intervals

+ 2016 May: PSA .07

+ 2016 May: Bone scanning done – no traces found, MRI done - no issues found

+ 2016 May: Radiation given (IGIMRT – 30 times) between May 2016 May and Jun 2016

+ PSA post radiation: < 0.07 in Oct 2016; <0.07 in Jan 2017; <0.07 in May 2017; 0.11 in Aug 2017; 6.6 in Jan 2018

+ 2018 Jan: PET CT Scan done – metastases detected in right iliac bone à one dose of Hormone given, Doctor have suggested Orchiectomy to contain growth

[Dr_WHO]

Sorry that it came back but there are options. First, you may want to consider the Stampede/Latitude treatments. These are two trials that came out last summer which showed tremendous results by taking Zytiga (and prednisone) with another hormonal treatment, usually Lupron. Two abstracts covering this are listed below:

ascopost.com/News/55699

ascopost.com/News/55700

Listed below is a 2017 article outlining some of the current treatments for bone mets

ascopubs.org/doi/full/10.12...

A lot recent discussions surround the use of radium 223. Listed below is an article on it.

ncbi.nlm.nih.gov/pmc/articl...

I am so sorry that your family has to deal with this, but it is the burden everyone here is going through. Please know that you are part of our family. We are here for you! You will never be alone again. After all, people like us we have to stick together!

Walt (a retired chemist not a MD).

[AlanMeyer]

I agree with Dr_Who's comments about Stampede and Latitude treatments. They are combination therapies of two different drugs which have more power when used together than when used separately.

Orchiectomy is cheaper than the drug treatments that do the same thing without surgery, but it is not reversible - which may not be an issue. Orchiectomy would presumably be a substitute for one of the drugs used in the Stampede and Latitude treatments - with abiraterone acetate or docetaxel as the other drug.

I also think it's very important to find the best medical oncologist that you can find. How to do that will depend on what country that you live in.

Best of luck.

Alan