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Advanced Prostate Cancer
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High Gleason Score - implications

I have a question about Gleason scores. I was diagnosed in July. Gleason 9. PSA 103. The ADT and chemo have worked so far. PSA is down to 0.36. Does my high Gleason score mean that my cancer is likely to become castrate resistant sooner than someone with a lower Gleason score? Once it does become resistant, there will be other treatments that the doctors will prescribe. Does a high Gleason score mean that it is more likely that other drugs will fail or not work as long as for someone with a lower Gleason score?

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Beginning treatment with ADT plus Chemo is a relatively new concept, so there is no data when patients will become resistant depending on the Gleason score.

On the average doctors expect patients to become resistant within two to three years on ADT alone. Since you added chemo I would expect that it will be about three years in your case in spite of the Gleason 9.

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GP, just a quick comment. I am glad that the concept of chemotherapy and hormone therapy has in the last two years been accepted by the “great powers”. I am an early guinea pig..... in 2004 when I developed mets, I immediately enrolled in a six month chemotherapy-hormone therapy trial. While I had four chemo drugs (two infusion and two orals paired) alternated everyweek for six weeks; then two weeks rest and two more repeated cycles, there is no doubt the commencement of 3 month Lupron/Eligard injections at the same time saved my life. Progress is being made ...... slowly...

Gourd Dancer

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Dr. Bob Leibowitz started the treatment of high-risk patients with ADT+Docetaxel already before 2005. Now we have the CHAARTED and STAMPEDE trials, it is used worldwide and called a "paradigm change".

ascopubs.org/doi/abs/10.120...

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If you are concerned about ADT resistance you should consider asking your MO for a prescription to Metformin. My husband has not yet been put on ADT but if/when he is we will request (insist on!) Metformin as part of his treatment. There is evidence it slows progression and resistance:

nature.com/articles/cddis20...

ascopubs.org/doi/abs/10.120...

clincancerres.aacrjournals....

askdrmyers.wordpress.com/20...

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Your excellent response to chemo is prognostic for a prolonged response. After PSA rises on Lupron, they will add second line hormonal therapies like Zytiga or Xtandi. If your mets are bone mets, Xofigo may help. Provenge would be good to take while you are on chemo or taking Xofigo.

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Tall Allen, I appreciate your input and knowledge. I had 6 month drug trial Zytiga and Apaludimide and RP August 30th. My PSA post op 1month was zero, second month .2, 3 month .6, 4 month 1.7. I have a Axium Pet CT Jan 3rd. Possible Radiation depending on the results

Their plan is to put me on Zytiga and lupron rather than Chemo? My treatment has been at MD Anderson but now consulting w a RO who is MD Anderson trained here in Colorado at UCHealth. My doubling time is obviously concerning. Dr indicated that since my PSA is rising rapidly the cancer is responding aggressively to elevated Testosterone and therefore Zytiga would be better than Chemo. Why would t both be efficacious?

Any thoughts appreciated,

Merry Christmas to everyone

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The evidence so far is that chemo does not contribute to radiation's effectiveness. I hope the Axumin scan is negative.

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My husband's PSA was almost 700 Aug 2017 at diagnosis. He did ADT plus chemo and PSA got to 20...now Xytiga plus prednisone has it finally under 10. So he is not castrate resistant yet and still responding to treatment.

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Wow! Almost on the same path for numbers although started at 4300. Aug 2017 . Did adt plus chemo now zytiga. Under 10 now. I thought everyone went to 0! Thanks for the input. We are hoping for time on zytiga.

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My husband's PSA was never tested until he had been on Bicalutimide for two weeks do it was probably higher. I have read some studies that show a slower rode to 0 PSA can be a good thing!

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My husband's oncologist also said that when we look at his PSA we should think about where he started. Chemo did take him from almost 700 to 20 (or 25? I need to check!) in just 5 months is a large drop! Even if not at 0 yet.

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The short answer is yes. High Gleason means high risk of progression. I’m a gl 9 but have low volume which is helpful because I’ve been able to use targeted radiation to eliminate mets. So far my treatments have kept me going for over five years. I’m doing fine. No pain. Minimal impact on my active lifestyle. Everyone reacts differently. Bob

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Thanks Bob. Your case sounds similar to mine. I just finished chemo. I'll be having a body scan and meeting with the oncologists next month. In the summer they said I didn't have too many mets in the bones and lymph nodes. The plan was to hit the remaining ones with radiation at the end of January. Like you, I have not had any pain. It's good to hear that you are doing well after five years. I'm hoping for the same. Best of luck.

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Markbc

Good for you. Read my profile to see what I’ve had done. I’ve never had more than two visible mets even with the new PSMA scan so I’ve been fortunate.

Merry Christmas!

Bob

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And which therapy? Hormones?

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Myriammole

Not sure what your question is but along with radiation and surgery, I’ve used intermittent ADT3 which is triple blockade ( Lupron, casodex, avodart) since 2015 but also added metformin, a statin and celecoxib which have been found to slow progression.

Thankfully I haven’t needed second generation adt , chemo etc.

Bob

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On average I think those with high gleason scores (I am 8) will have more aggresive cancer. But everybody is a little bit different. Certainly some will fare better and others worse. And it isn't a straight line progression. I had radiation, ADT and cryotherapy. My PSA was 4.2 before the cryotherapy of a small amount of tissue in my prostate. After the procedure the PSA dropped to below 1, then to less than 1 and 3 months later the PSA was undetectable. I was excited! 3 months later my PSA was 6.7. Even my doctor was surprised. Now I am back on Lupron to see how long it will suppress the PSA.

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