March 6th PSA 467, Vitamin D 16. January 22nd -2nd PSA 393 (taken at lab after DRE) January 16th -Initial PSA 384.1 Age: 53, Stage 4, cT2c, N1, Gleason 4+4=8, Volume: 51.0 grams, Bxs: 5L + 5R
New diagnosis of stage IV Gleason 8 prostate adenocarcinoma to lymph nodes (N1); metastatic pelvic lymphadenopathy. High risk.
Started with a double loading sho of firmagon March 6th.
Discussed the additional recommendation of adding Zytiga/prednisone (STAMPEDE) or docetaxel (also STAMPEDE) to hormonal therapy in node positive disease setting; overall survival benefit is noted. Would want to start either therapy within a 3-month period; docetaxel would be for 18 weeks, Zytiga for two years
Discussed the need for prostate/pelvic EBRT down the road after systemic therapy, would initiate after his Taxotere chemo or after at least 3-6 mos Zytiga. RT would be for definitive intent. His pelvic LNs would be able to fit in a radiation field.
Plan to return April 3rd to begin Lupron shots.
My question: If you had to choose between these 2 plans, which would you go with and why?
Also, is it normal for the PSA's to increase so much in such a short amount of time?
What else can be learned from the info above?
He has now had CT, bone scan and 3T MRI