I'm new here. Introducing myself.

[Pleroma]

Hello All. 59 years old. DX PCa in July 2018 with Gleason 9 (4+5). PSA 87.

Mets to bladder, around right kidney, basically the whole pelvic area including pelvic bone, left hip socket, left shoulder socket. Quite a mess.

Put on ADT immediately. (Firmagon -then switched to Lupron a few months later.)

Treated at Mayo, Rochester under Dr. Kwon's supervision (urologist).

Did 6 cycles of Docetaxel. Finished Jan., 2019. No visible tumors showing on the MRI.

The choline PET scan showed still-active-but-shrunken tumor in the prostate and one lymph node.

PSA 0.9 at March 1, 2019.

IMRT (25 sessions) completed April 25, 2019.

Discovered I was BRCA-2 positive - June, 2019.

PSA <0.1 (undetectable) at Sept, 2019.

Zoledronic acid for osteopenia - Dec., 2019.

PSA started to creep up to 0.7 by March, 2020.

Added Zytiga April, 2020.

On a more plant-based/Mediterranean diet with plenty of vigorous exercise.

Looking forward to sharing this journey with you all.

[Tall_Allen]

That was an excellent response to docetaxel! You may wish to reconsider the radiation in light of two major randomized clinical trials that came out recently:

pcnrv.blogspot.com/2018/09/...

You may wish to follow-up instead with a second-line hormonal agent (Zytiga or Xtandi), or possibly Xofigo (for the bone mets, even the ones you can't see) perhaps combined with Provenge.

[MarkBC in reply to Tall_Allen]

Pleroma: You and I have a similar case history. I finished chemo in December and was supposed to have started radiation now. After discussing the two studies referred to by Tall_Allen, my oncologists and I decided not to proceed with radiation. The risk of collateral damage outweighed any possible benefit.

It's good to hear your treatment is working. So is mine. Last week's PSA is down again to 0.22. Best of luck to you.

[Pleroma in reply to MarkBC]

Thanks, Mark, for your input.

[Hidden in reply to MarkBC]

Congrats!

[Crabcrushe in reply to Tall_Allen]

Sir Tall_Allen;

I do Provenge infusion #2 next week as a response to PSA 4.2 (doubled over two quarters) after a year or so of bicalutamide on top of leuprolide commenced immediately upon Dx 10/16. Gleason of 9, bone Mets only, which are slowly encroaching. Got a great rad doc, just haven't used him. Would you consider it prudent, my being oligometastatic, to ask for 36Gy x 6 immediately upon completion of the Provenge treatment? I've been on enzalutamide for 6 weeks on top of the continuing Lupron.

Thanks,

Charlie

[Tall_Allen in reply to Crabcrushe]

30 Gy in 3 fractions to the bone mets, only if they are in a safe place to irradiate. During or after Provenge might be useful.

[Crabcrushe in reply to Tall_Allen]

I'm talking about Dr-bulking the gland, itself.

[Crabcrushe in reply to Crabcrushe]

"'de-bulking"

[Tall_Allen in reply to Crabcrushe]

SBRT of the prostate is usually done in 4-5 treatments, but I've heard of a 6 treatment protocol being used to get insurance coverage. But you would probably want around 43.5 Gy total with 6 fractions.

[Crabcrushe in reply to Tall_Allen]

Thanks again!

[Pleroma in reply to Tall_Allen]

Allen,

Thanks, that is a very useful link, and will be given serious consideration.

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

Greetings Pleroma (πληρόω): Although Dr. Kwon is not my urologist, I've seen his name mentioned (in a good way) many times here on this forum. So apparently you're in good hands.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/03/2019 12:05 AM EST

[Hidden]

Welcome Pleroma.. you’re getting answers .. sounds like you’re in good hands . Looking forward to positive progress..for you. I’ll stayed tuned..

[StePeteMN]

My first day here on this forum. Did you do IMRT in Northfield? If so, we were there at the same time (March).

[Pleroma in reply to StePeteMN]

No, I am being treated in Rochester, MN.