Looking for suggestions

[tfly59]

I joined couple of weeks ago, really impressed with the support and knowledge shown by everyone.

I'm 59, was diagnosed with PCa on November 21, 2018, Gleason 9, 4+5, with PI-RADS 5 lesion (MRI), and clean scans, PSA 6.1. I started a Study at MDA on December 13. Study involves Lupron, Abiraterone, Prednisone and Apalutamide for six months, then RP. I have always exercised, 3-4 times a week, with both light cardio and weights. Have now stepped up to 5-6 per week. Other than this damn PCa, I'm in excellent health. So far side effects have been minimal. Would love to hear suggestions on diet, supplements, etc. Thanks

[Tall_Allen]

Here's the trial:

clinicaltrials.gov/ct2/show...

As you can see, they only follow participants for 4 weeks post RP - not nearly long enough enough to see if it made a difference in biochemical recurrence rates. Mostly, they are doing this to see if pre-treatment effects surgical outcomes, like positive margins. No doubt they will find that it shrinks tumors - but what of it, if it doesn't improve oncological outcomes compared to other therapies (like brachy boost)?

Studies in the past have not yet shown that neoadjuvant androgen deprivation improves long-term oncological outcomes of RP.

"Better local control in cT2 tumors is only going to be of relevance if subsequently you can show that there is a better survival for these patients.""[This pretreatment] did not translate in a significantly better PSA progression rate."

karger.com/Article/Abstract...

In this study, both chemo and hormone therapy were used before RP with no statistically significant difference in biochemical recurrence:

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

I don't know if the trial you're in will be beneficial to you, but I do know that the standard of care, brachy boost therapy has been used since the 1980s and has an excellent track record of success. Consider this:

pcnrv.blogspot.com/2018/03/...

[tfly59 in reply to Tall_Allen]

Thanks TA, greatly appreciate your input. I am familiar with the findings you referenced, all good points to consider. I discussed my diagnosis with good friends who are Oncologists, both recommended RP. Additionally, I have two friends who were G8 and G9, had RP, and after 18/13 years are still living very productive lives, I decided to go with the RP. I’m hoping the triple play therapy Study at MDA will be beneficial for me long term. Memorial Sloan has the same Study. As you know better than I do, their is no single proven pathway for dealing with PCa. Time will tell on my decision. Thanks Again!

[George71 in reply to tfly59]

Hi tfly59,

The following is from an article about treatment options after biochemical recurrence post RT or RP (if it ever happens). It supports your thoughts.

"BCR after RP:

As mentioned, not all patients with BCR after RP will develop clinical failure; indeed, published reports suggest that an estimated 24–34% of men who develop BCR will experience clinically evident recurrence (i.e., metastatic disease) within 15 years of surgery [21, 23]. Furthermore, it has been estimated that 2–6% of men who experience BCR after RP may die from PCa [21, 23].

"Local therapy for PCa – RP or definitive RT – is curative in many patients, and remarkable technological advances over the last decade have led to efficacy improvements in both RP and RT. Despite this, biochemical recurrence (BCR) – that is, prostate-specific antigen (PSA) increase – still occurs in 27–53% of patients after definitive local therapy [1]. Within 10 years, 20–40% of post-RP [14, 15] and 30–50% of post-RT [16] patients will experience BCR. Once BCR occurs, the patient is understood to have recurrent PCa, even if there are no signs or symptoms of locally recurrent or metastatic disease. Despite signifying the return of disease, BCR alone may have no impact on either the patient’s QoL or their overall survival (OS)"

The Natural History of BCR

Although a rising PSA level universally precedes metastasis and PCa-specific mortality [1], BCR is not a surrogate for PCa-specific mortality or OS, and may pre-date local recurrence or metastasis by several years. On average, BCR precedes the appearance of clinical metastasis by 8 years after RP [21] and by 7 years after primary definitive RT [22].

The natural history of BCR and the risk of subsequent metastasis may be predicted by pre- and post-treatment clinical features (Table 1). These prognostic indicators are used as a means to assess the patient’s level of risk, and therefore, help physicians to determine whether to initiate early treatment or to adopt a strategy of active surveillance. Treatment decisions following BCR must balance the risk of metastatic disease or death with the impact of treatment, and necessitate involvement of a multi-disciplinary team, as well as informing the patient of the potential for a prolonged natural history of PSA-only recurrence [1]

George

[George71 in reply to George71]

tfly59

the link to the article is below

karger.com/Article/FullText...

George

[tfly59 in reply to George71]

Thanks G71, very informative!

[j-o-h-n]

"Would love to hear suggestions on diet, supplements, etc. Thanks"

Get ready to take notes and plenty of them.....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 02/09/2019 1:37 AM EST

[tfly59 in reply to j-o-h-n]

Thanks John!

[Schwah]

Your execise routine is the key. Great job. You should do quite well. Keep it up.

Schwah

[tfly59 in reply to Schwah]

Thanks Schwab, heading to WO now!

[tfly59 in reply to Schwah]

Sorry. I meant Schwah, damn spell Ck

[Hidden]

For me the sweet spot is increasing fitness activity 20 - 30%, if possible. Avoid falls and broken bones. Don’t be fat, but do keep your weight up, build muscle mass if possible. Eat protein. Don’t worry. Try to enjoy life more than before PCa, which means giving yourself permission to be very very happy, which goes against all our upbringing. It might kill me and it probably will but till then ..... cowabunga. Cancer was the best thing that ever happened to me.

[tfly59 in reply to Hidden]

Love your attitude PSA..02! Definitely going to go with your suggestions!

[Balsam01]

I assume they will do genomic testing.

[tfly59 in reply to Balsam01]

Pretty sure that is the plan, but will check with MDA MO. Thanks