Fewer drugs after surgical castration? Upside? Downside?

[ronton2]

Is Orchiectomy a durable cure? Does one continue on some form of ADT or wait until a rise in Testosterone and PSA? I admit my ignorance, so please be kind (thinking of Nala...et.al).

[Hidden]

Hey:

ADT deprivation therapy with drugs or with orchiectomy is not a cure for metastatic prostate cancer. The advantage is that you do not get the negative cardiovas ular effects of lupron, and the cost since all these medicines are expensive.

With ADT eventually the cancer becomes castration resistant and other drugas such as Zytiga, enzalutamide and or chemo should be added and they will fail as well.

Besides these therapies, if the cancer is PSMA positive it can be treated with Lu 177 PSMA which is a nuclear medicine therapy developed in Europe mainly in Germany and very effective in some patients with metastatic disease.

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

I do not know your clinical situation, so I can not be more specific.

Anything, please let me know.

Best

Raul

[ronton2 in reply to Hidden]

Raul, Much appreciate the link to LU177 studies. I believe that a clinical trial is planned soon in the US. I have so much to learn!

[Hidden in reply to ronton2]

Hey:

There are at least 3 clinical trials going on for castration resistant metastatic prostate cancer.

clinicaltrials.gov/ct2/resu...

The first things is to determine if there are metastasis and if they are PSMA positive.

A Gallium 68 PSMA PET/CT will identify metastasis is they are PSMA positive with a PSA of 0.2 or more. There is an ongoing study a UCLA:

clinicaltrials.gov/ct2/show...

This is a link with all the scientific studies about LU 177 treatment I read before going to Munich for the Lutetium treatment in 2016.

drive.google.com/file/d/1HG...

If your cancer is hormone sensitive you will probably have to go to Australia or Germany or the Netherlands.

If you need anything else please let me know.

Best

Raul

[RLSharp in reply to Hidden]

Raul,

I can't get your link (drive.google.com/file/d/1HG...) above to work. Is there another way to access the scientific studies about LU 177 treatment?

Thanks, Richard

[Hidden in reply to RLSharp]

Hi:

Try this link:

drive.google.com/file/d/1HG...

To download click on the down arrow at the upper left corner.

These are articles I read during 2016 before going to Munich. There are many other published since that time.

Please, do a search in pubmed.gov for Lutetium 177 and prostate cancer and you will get a list of articles and some of them will have summaries.

Best wishes

Raul

[RLSharp in reply to Hidden]

Thanks, Raul.

I will be doing some searching in pubmed.gov

Richard

[ronton2]

Nalakrats, Many thanks for a more thorough explanation. I think I am in a state of flux--anxiety replaces acceptance in a cycle. I am just tired of the shots, the blood work and the visits to the MO. Call it a pity party on a small scale. I am learning so much about this disease. Appreciate your kindness.

[rococo in reply to ronton2]

As we all say here. Never tire, beat the beast. Iknow it sounds easy to say, but it can be done as othes here have shown. Wish all the besat. Rocco

[ronton2 in reply to rococo]

Rococo, That's so true. Consider the alternative. Not ready to give in now.

[eggraj8]

The testicles production of testosterone needs to be permanently shut down. Whether it is by Lupron or Surgery is the issue. For me the decision will be based on whether taking the shots for the rest of my life is better than the one time surgery. Since I am nearly 74 with lots of Mets I am not sure what is best answer for me. I think I would have selected surgery if I knew what was going to happen to me a couple of years ago.

[ronton2 in reply to eggraj8]

Eggraj8, Many thanks for the response. I really is difficult to decide which route to take. Will continue to work on this with help from you and others. So many decisions!

[Hidden]

I am not a physician, just a 71 year old man who has fought the battle of Stage 4 PCa since Confirmation of mets in early May 2004.

In my case my primary treatment in April 2003 with a Gleason 7 (4+3), Palladium Seeds followed up with 25 course of IMRT external radiation, did not matter. If I had any other primary treatment it would not have mattered. The reason is micro-metastates - minute cancer cells floating in the vascular and lymphatic systems looking for a place to attach and grow. Please discuss the possibility of micro-metastatic cells with your Specialist before you make a decision. Neutering may be all for naught.

The only way known today to cure the spread of metastatic PCa is to kill these little bastards with chemotherapy. Lupron or castration will keep spreading cancer at bay for an indeterminate period, but do nothing for those cells that have escaped the Prostate.

Men who do not have micro-metastatic cancer cells moving through their system, have various cures with the many silver bullets available to delay; some into complete remission or cure. Men who do have these little buggers carried through their systems, fight the battle of delay and hope to outlive this dreaded disease.

After, 84 PSA test (with about three pages of other blood tests) and 20 Nuclear Full Body Bone Scans and soft tissue CT Scans, I never get tired of the procedures; nor should you. Pain, yes, but they are necessary to fight PCa cancer equipping your Specialist with information necessary to help in the fight.

Your job as a wife is to support your husband with positive thoughts and refrain from talking about getting tired about visits to the Medical Oncologist, having blood draws and hormone injections. I encourage you to smile and not worry about your daily tasks in this support. Please don't think that I am being critical. I am only reminding that a positive family and their positive friends are needed to maintain and re-inforce positive thoughts to the guy fighting his disease. Personally, when ever those around me wanted to speak or yell negative thoughts, I simply walked away. That very last thing that you want to enter your husband's mind is the sense of "woe is me" or "why me". Mental health is critical to physical health.

I admit that I am in a very small group that had Metastatic Prostate Cancer and now enjoy undetectable PSA, stopped Lupron injections eight years ago, and have taken small (4 mgs, twice a week) supplemental doses of testosterone for seven years. I look forward to the blood draw and the results the next day with my Medical Oncologist three times a years.

I do want to wish your husband the best in his fight; and may he be successful giving you and him many years of companionship.

Gourd Dancer

[erjlg3 in reply to Hidden]

💖 So happy for you Gourd Dancer!

Jackie

[erjlg3]

That's was awesomely worded Ronton2!

Thank you.

Jackie