One of those rare and aggressive cancers?

[Seabird12]

Hi everyone, I’m trying to educate myself about my husband’s prostate cancer, today I came a cross a post about ductal cancer and poor survival here , I reviewed his pathology report again and got more confused, is this one of those rare aggressive ductal cancers ? How bad is this report and what treatment would you suggest ? He just started HT. Wondering what should be next step. Thank you in advance!

[Tall_Allen]

Ductal and intraductal are different. He is diagnosed with high-grade intraductal (IDC-P) and metastatic to bone. Either advanced hormonal therapy (ADT with Zytiga/Xtandi/Erleada) or ADT with Docetaxel are indicated.

BRCA and other DNA-repair mutations are known drivers, so it's a good idea for him to get tested for it. It may open the door to PARP inhibition.

Consider heavy-duty radiation to the prostate and pelvic lymph nodes with brachy boost therapy.

Good idea to get Epstein to give a second opinion on the biopsy - a lot rides on it.

[Seabird12 in reply to Tall_Allen]

Hi Tall_Allen

Thanks for responding, you mentioned Zytiga/Xtandi/Erleada which are very expensive, are they covered by Medicare? Should he be on these super expensive drugs for the rest of his life ?

[Tall_Allen in reply to Seabird12]

If he has a medicare advantage plan, one or more may be included. If he has a medicare drug plan, the co-pays will be high until he hits the maximum for the year - after that, there are no co-pays. The manufacturers supply free drugs for those who can't afford them. They are used until the cancer becomes resistant.

[jersy in reply to Tall_Allen]

Tall_Allen, where in the report do you see metastatic to bone? I'm trying to understand how to read these things... thanks.

[Tall_Allen in reply to jersy]

It's in a previous post.

[jersy in reply to Tall_Allen]

ah, thank you.

[tango65]

You could obtain a second opinion of the pathology findings by sending the slides to Dr Epstein at John Hopkins

pathology.jhu.edu/departmen...

I f the staging studies do not find distant metastases, consider to discuss treatment with radiotherapy with a brachytherapy boost, and androgen deprivation therapy (ADT). You will need to consult with a medical oncologist and a radiation oncologist to make a final decision about treatment.

ncbi.nlm.nih.gov/pubmed/309...

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

[LearnAll]

IMO ...This biopsy report is indicating that your husband's PCa is basically Adenocarcinoma .

The word intraductal spread can be confusing as some people may misinterpret it as Ductal cancinoma(which it is NOT)

Small cell/ductal PCa is less than 1% of all PCas. Because this report is telling us that it is the most common type, Adenocarcinoma which arises from glandular cells....you need to treat this with standard medical therapy,that is Lupron plus Zytiga (or Docetaxyl chemo)

Again, It is NOT ductal Ca...it is Intra Ductal SPREAD ..meaning regular cancer cells spreading via ducts.

[Boywonder56]

Ive got an almost identical biopsy pathology....was lucky to get in titan trial 3 years ago because of distant met....was on lupron and earleada from get go...and .o5 psa at present ....was his psa < 20 ar dx?

[Boywonder56]

Read prev post and see his was like mine 12 at dx.....did he have blood in semen?