Hello all, first time posting. I’m 62. Diagnosed in January 2020. At Dx I had a Psa of 4.1. Bone mets in the spine and hips. Both prostate and bone biopsy showed small cell prostate cancer. Gleason score 9. I was given IM Lupron in February (3 month shot)plus Casodex. At May checkup Psa was 0.3, Casodex was discontinued and I was given a 6 month shot of Lupron. Just got results back today of my 6/18 PSA test and it has risen to 0.4. Does that make me castration resistant? Also what questions should I ask my MO? By the way, thanks to all who post here, this is such a great site full of information and compassion.Thanks and good luck to all of us.
Steve
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Hi Steve. I'm sorry to hear about your diagnosis. Unfortunately with small cell PC, a lot of the tests and therapies usually used for regular prostate cancer are useless. "Castration resistance" doesn't apply to you because small cell doesn't have an androgen receptor (and it puts out no PSA) and there is no benefit to androgen deprivation. However, your cancer is a mixed type, so continuing with hormone therapy is advisable for the cells that are normal prostate cancer. Chemo usually involves carboplatin.
Because of the type of cancer you have, you should consult with experts in the field.. If you are in the west coast you could consider to consult with Dr. Rahul Aggarwal at UCSF. You should also look into clinical trials. This is a link with clinical trials about neuroendocrine PC in the USA which are recruiting:
I welcome you Steve. You’ve come to the right place for pc answers. You will feel better once you know more ..our experts will chime in. All of us with this can relate to everything that you might go thru . Take care
Greeting thesteve, Would you update us on your location, treatment location(s) and Doctor's name(s). Thank you. This info helps us help you and helps us too. All Info is voluntary....
Thank u to all the generous people that answered my post but in the fog of war I misrepresented my cancer. I can’t remember why I thought it was small cell. I do not have small cell. I have adenocarcinoma. As per 2 biopsies. I apologize to the folks that have responded but at least others with that type of cancer can read your well researched responses. If anyone has any insights about my type of cancer I would love to read it.
Welcome thesteve. All cancer sucks and metastatic PC I s not considered generally “curable”. But many more options for keeping it controlled or effectively suppressed for a long time and living a happy life in the meantime with adenocarcinoma as compared with more aggressive small cell. Need more data from next PSA before concluding about castrate resistance.
Would consider discussing with your MO a bone strengthening regimen such as denosumab (Xgeva or Prolia) or Zolendronic acid (Zometa).
Also see if you can get approved to receive a course of treatment of Prolia.
How are your side effects on the Lupron? Estradiol patches can stop the hot flashes while also protecting your bones and lean body mass from the effects of ADT.
Must keep a disciplined approach to exercise including endurance (walk at LEAST 10,000 steps/ day or more, plus strength (resistance with weights or body weight exercises).
Keep your loved ones close and get out into nature every day.
In addition, regarding specific next step treatment if a repeat PSA confirms a rising trend (and perhaps even if not) should probably be chemo with docetaxel (Taxotere) 6 rounds is typical at 3 week intervals would be completed in 15 weeks.
If you have any questions you can ask here on this forum and get links to all the best relevant clinical studies, etc. We know it can be overwhelming to digest all of this as you become a knowledgeable and thus empowered advocate for yourself.
Thanks again for all the info. As far as side effects on lupron I have only noticed slight hot flashes and a small amount of joint pain but I’ve only been on lupron 4 months.
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