Rare: Intraductal Prostate Cancer

[pelikin22]

Hi, I'm a newbie here looking for any first hand information and support given that this form of cancer is rare .

My husband, 70 years old, was just diagnosed with intraductal prostate cancer (IDC-p) gleason 9 (5-4); 4/12 cores 95% tissue involvement; psa 15; stage 4; Tx, N2, Mx. No previous history at all and he is asymptomatic.

PSA scores were in normal range until this year when number jumped from 3.97 to 15. No bone mets. CT scan: lymph node metastasis to pelvis including (bilateral); external iliac (bilateral) and abdomen (cavity behind the intestines). Prostate measures 98 grams and the largest tumor sizes found are 18 & 13 mm. There is also perineural invasion. Also found small lesions found in liver and a lingular nodule in the lower lobe of lung.

Treatment: Started a 2 week course of Casadex (50 mg) to be followed by a 3 month injection of Lupron (not sure if Casadex will continue with the Lupron). After 3 month period he will be restaged for further treatment. Not considered a candidate for surgery and will be having a consultation with a radiation oncologist to determine suitability for radiation treatment.

Wondering:

What are other treatment options given intraductal version is very aggressive and can be resistant to treatment?

Given the poor prognosis how long (no sugar coating): years, months?

Would this be classified as localized or distant spread?

PSA normal numbers have masked cancer existence in previous years given the sudden on-set in one year?

Still in shock and this feels like a death sentence right out of the blue. People on this board seem really knowledgeable and any feedback would be most appreciated.

Thanks

[Tall_Allen]

That is an awful shock. I hope you have a medical oncologist with some experience treating it. I would think that aggressive hormone therapy (e.g., both Lupron and Zytiga) together with chemotherapy (perhaps a cocktail with docetaxel and carboplatin) may be useful - but I really don't know.

This is distant spread, especially if the lungs and liver are affected (M1c) and because there are abdominal lymph nodes affected (M1a). Perhaps the radiotherapy can be used to debulk the cancer and slow it down.

[gusgold]

real bad news...especially cavity behind intestines....radiation can't work...need systemic treatment...hormonal and maybe chemo...survival time depend on how long ADT works until crMCPa...no sugar coating..my guess from reading the history of other PCa patients if you fail Lupron/Zytiga in under 6 months probably have 12-15 months but their are some new drugs in trials...Darolutamide and Proxilutamide that could give him years

[pelikin22 in reply to gusgold]

Thanks for the information on new drug trials. There's always hope!

[pelikin22]

Thanks for the information; you are a real fighter! I'm in Toronto, Canada where chemo is not usually combined with ADT (don't know why, maybe slower to accept alternative treatments). But, my oncologist has referred Dave to a well known cancer centre at another hospital with much more flexible protocols. Idea is to start Lupron with Docetexel immediately. He is now on Casodex and will get Lupron next week. Probably not a candidate for radiation because of lymph node locations in the abdomen.