PCa advice

[SC19]

My dad has been diagnosed with Gleason 8 PCa, with small spread to bone. PSA 43, some minor urinary issues initially ( which have lessened since starting HT) but otherwise asymptomatic. I think he has an anterior prostate lesion as nothing untoward was felt during 2 DREs. He has started HT and due to start 6x chemo in January.

Every morning I wake up and remember and my heart breaks again but seeing some messages of hope on here helps.

I have 2 questions.

1) is chemo the best way to go? I have heard other members start off with HT and Abiraterone or something similar and wondered why you would pick one over the other.

2) oligometatasis talks about 5 hot spots or less. Is there any clarification on the size of these spots? If somebody presented with 3 large spots, would they be in a better position than say somebody with 6 separate tiny spots? Or is the jury still out?

Thanks for the help.

[GP24]

You can add chemo or Abiraterone to HT and both should work equally well against the cancer. You can use Abiraterone if you want to continue working while the chemo side effects may stop you from that. On the other hand you will have to take Abiraterone for years while the chemo ends after six months.

I would ask the doctor if you can have radiation before chemo or Abiraterone according to this study:

thelancet.com/journals/lanc...

In this study they come to the conclusion: "However, a subgroup analysis supported the hypothesis of HORRAD, that prostate radiotherapy improves survival in men with low metastatic burden." HORRAD is another study testing prostate radiation for patients with bone metastases.

This should improve his prognosis even more. Your doctor may have heard of this study already and agree to this treatment.

The size of the mets does matter a bit but it does not change the prognosis very much.

[SC19 in reply to GP24]

Thank you for the clarification. My dad is retired now so maybe the chemotherapy is the best way to go. He is 70 but otherwise fit and healthy.

They did mention possibly doing some radiation to my dad but after the chemotherapy - will this still work or do you think it needs to be sequenced before the chemo? Thanks again, much appreciated.

[GP24 in reply to SC19]

I personally would do the radiation before the chemo, but I have no study to show one is better than the other. I think that systemic therapy like a chemo works better when there are fewer tumor cells to fight against. So removing the cells in the prostate with radiation before the chemo is beneficial.

[Tall_Allen]

(1) Here are your options for metastatic hormone-sensitive PC:

pcnrv.blogspot.com/2017/06/...

Based on the latest STAMPEDE study, advanced hormonal therapy is equivalent to chemo. They also found that chemo is equally beneficial for high volume and low volume metastases (which contradicts and supercedes an earlier finding on the CHAARTED trial). There is a logistical advantage to chemo first - in just 15 weeks he can start Zytiga; whereas, if he does Zytiga (or Xtandi or Erleada) first, it may be 3 years before he gets to try chemo. Side effects of chemo are lower earlier in progression.

(2) The studies that counted did not differentiate on size. They only counted the lesions visible on bone scan/CT. There was a study that found that there may be a benefit (at least on short-term PSA results) to oligometastatic treatment only when there were 3 or fewer metastases on both a bone scan/CT and on a PSMA PET scan. PSMA PET scans are not yet widely available, but you may be able to get insurance to cover an Axumin scan (get pre-authorization)

[ctflatlander]

My case is similar. Age 76 now, Oligo, mets to the bone, PSA 34 and started Zytiga, Lupron, then IMRT to prostate and SBRT to the bone 1 year later after the study was complete. Now undetectable. Bob

[j-o-h-n]

Tell us where he's located? Treatment location(s)? Doctor's names(s)? All info is voluntary, but it helps us help him and helps us too. Thank you...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 12/29/2019 10:40 PM EST

[SC19]

Thank you all for the helpful advice and information, and for sharing your similar starting point ctflatlander. Seems like we are going down the right path at least for now.

Does anyone have any tips for how to deal with this mentally? I want to be hopeful that the treatments will keep it at bay but I am paralysed with fear and anxiety.

He is based in the North West of the UK so will come under Clatterbridge hospital.

Many thanks again.

[Hidden in reply to SC19]

How old are you please?

[SC19]

I also wondered if somebody could fill me in on the latest PCa treatment advanced and what is coming down the line in the next few years? I understand the first and second generation hormone therapies but would like to be across other options too. I have heard of LU-177 and MKC8866 but I’m not sure how far away they are from being SOC.

Thanks again.

[SC19]

Thank you so much for this - really useful info that I’m starting to get my head around.

You mention PSA doubling time - I have a question regarding this. I think I worked out that my dad’s is around 15 months, but he is a Gleason 8. Is this possible? Does Gleason score correspond with doubling time or can you have a high Gleason and slow doubling time? Many thanks again all.