Just did FDG and PSAM scan after 6 infusions of docetaxel. When compared with the scan in April:
- the residual PSMA avid lesion within the prostate shows a further reduction of PSMA uptake.No FDG-avid component is visualised.
- Previously seen FDG avid predominantly sclerotic osseous metastases are less hypermetabolic with faint to mild residual FDG uptake. No new suspicious FDG-avid bone lesion is seen.
- PSMA : Some of the previously seen lymph nodes has resolved while others are smaller and less PSMA-avid. A lot of improvement seen in most of the PSMA-avid bone lesion - interval decrease PSMA update except for C7, T1, T8, 6th R rib and7th rib show interval resolution in PSMA uptake. No new suspicious PSMA avid bone lesion is seen. No new suspicious or discordant PSMA/FDG-avid lesion is seen for all the major organs.
- Blood Test : PSA continues to drop to 0.149 ( initial PSA 162 Nov 2018) Alk Phospohatecontinue to improve to 72.
-Path Forward: Every 6 weeks, Zometa. Every 3 months Lucrin. Daily intake of Metformin, Amlodipine as well as Prednisone 5mg (alternate day) beside Calcium and Vit D tablets.
MO is happy with the outcome of the docetaxel. Would like to seek any inputs from the team here with regards to the results above as well as the treatment forward being suggested. Have a blessed Christmas and a joyous New Year.
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bellyhappy58
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It sounds like your therapies are working as hoped. I think you are taking Zytiga too? I'm not sure why you had those PET scans since your present therapy is obviously working well, but I'm sure it gives you more confidence.
BTW, your experience is exactly why I think (subject to evidence, of course) that chemo probably should precede any PSMA-targeted therapy- it diminishes the degree of discordant heterogeneity.
Just a question re docetaxel before PSMA targeted therapy. If one has had docetaxel early in the treatment protocol as recommended because of results from clinical trials, should one have it again before any PSMA targeted therapy? I’m assuming so because changes to the cancer would have occurred in the interim. Would you repeat docetaxel or change the chemo?
Good questions, and good points. I wish I knew the answers. It's really a judgment call. And if your PSMA PET scan shows no heterogeneity, or concordant heterogeneity - as it will for most patients - no pre-treatment is needed.
Thanks for your inputs. MO suggest that I stay away from Zytiga for the time being and follow the Stampede protocol. The scans were done to have a new baseline especially with all the multi mets I have at lymph nodes as well as bones. It also gave me a lot of confidence that the treatment is working. Continuing my regular exercises like walking as well as gym where I am doing weight-bearing exercises too. My experience with docetaxel is not as bad as what people made it up to be. Guess I am lucky and GOD was with me.
Just a thought. For men who respond well to 6 rounds of doxetacel, why not do 8 rounds or even 10 rounds, etc? I know that 6 is standard, but I’ve always been curious when clearly it’s working but PSA is not yet <1.
Related, although I’m not naive enough to think my experience means anything as a sample of one, my MO started me out of the gate with a plan for “as many rounds as I could tolerate”. That ended up being 10 rounds before we called it quits. I ended with PSA undetectable and no visible cancer in a simple scan. Of course “visible” is misleading, but it was incredible considering I started with too many spine Mets to count.
I know my results are specific to ME and 10 rounds is not a magic number. But I also know that at only six rounds my PSA wasn’t yet undetectable and I 100% had improved results between round six and round 10.
I finished chemo in spring 2018, so I’m at 21 months still undetectable. Statistically my reoccurrence is coming soon. But I also like to trick myself into thinking those extra chemo rounds will give me some extra time on the backend here.
Just wondering why you think you're due for a recurrence? When I look at survival curves, there's usually no cluster around the median. The longer you go without a recurrence, the less likely it becomes in any given year.
I will hold on to that thought! My MO told me when I finished my last chemo round that average till reoccurring was 21 or 22 months. I didn’t independently research that.
Belly curve may be somewhat relieved as Drs are talking of taking full depth skin form belly for next graft and then just pulling edges together for simple straight line of sutures.
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