Patterns of Cancer Progression of Metastatic Hormone-sensitiveProstate Cancer in the ECOG3805 CHAARTED Trial

[tango65]

"ECOG3805 is a randomized trial of testosterone suppression with or

without docetaxel for metastatic hormone-sensitive prostate cancer (mHSPC).

One in eight patients had clinical progression below a PSA

level of 2 ng/mL, and approximately 25% developed clinical progression in the

absence of confirmed PSA progression. Overall survival from randomization was

shorter in patients with clinical progression without confirmed PSA progression

than in patients with PSA progression alone as the first progression. Patient

demographics at study entry were not predictive of the pattern of progression.

Study limitations include its retrospective and post hoc nature.

Conclusions: Clinical progression prior to PSA rise or at low PSA levels is a

relatively frequent phenomenon in mHSPC and is associated with poorer overall

survival. Further biological and clinical studies of these patients are warranted."

euoncology.europeanurology....

[Hidden]

Check out Dr Kwon's video from about 12:50 to 14:12: youtube.com/watch?v=Nkqizmv...(Not working as expected?) . PSA zero needs to be backed up with imaging.

[Dett]

Is the implication here that men with APC need more frequent imaging studies to get a better handle on cancer progression? Is cancer progression with a low PSA likely to be the result of neuroendocrine or other rarer, more aggressive cancers?

[tango65 in reply to Dett]

I agree with MateoBeach :

"The takeaway is that those who are hormone sensitive still (PSA has not progressed while on ADT) a significant number (25%+) will be having progression on scans and/or clinical symptoms, even though they may not be having a rising PSA.

Those who are mHSPC should monitor with periodic advanced scans and not PSA alone."

We do not know if the cancers progressing with a low PSA were neuroendocrine, or small cell cancers etc. The type of cancers in these patients was not studied. They found that these cancers progressing with low PSA had a worse outcome.

Since these cancers progressed with a los PSA one could assume that the cancers mutated to the type of cancers you suggests. If that were true is very interesting and alarming that just doing chemo with taxotere in castration sensitive cancer could select or induced much more malignant cancer. My impression was that these types of very malignant cancers appeared much later in the treatment of castration resistant cancer.

[MateoBeach]

The take away is that those who are hormone sensitive still (PSA has not progressed while on ADT) a significant number (25%+) will be having progression on scans and/or clinical symptoms, even though they may not be having a rising PSA.

Those who are mHSPC should monitor with periodic advanced scans and not PSA alone.

[tango65 in reply to MateoBeach]

I agree and that is the main reason I posted this study.

[5_plus_4]

I recurred as Stage 4 mHSPC with metastasis to unknown location and likely rectal invasion. I'm on my third 3-month Lupron shot and my PSA is <0.1. Blood work is also all normal.

I am starting to experience symptoms like pins and needles in my toes and weakness in my legs.

My Kaiser MO downplays my concerns. Thank you for posting this tango65.

[tango65 in reply to 5_plus_4]

Your symptoms could be related to a peripheral neuropathy. You could consider to consult with a neurologist.

Best of luck on this journey.!!

[V10fanatic]

Unfortunately, I learned through a discussion with the Doctor running the PSMA-PET clinical trial at UCLA that FDA approval is still months away. Once that's done we will still have to wait for another 6+ months before Medicare gets it coded. Private insurance coverage will follow after that.

[tango65 in reply to V10fanatic]

There are several clinical trials for PSMA PET/CTs

clinicaltrials.gov/ct2/resu...

clinicaltrials.gov/ct2/resu...

best of luck on this journey!!.

[V10fanatic in reply to tango65]

The trials can be quite expensive. It will be nice to have insurance cover the scans.

[tango65 in reply to V10fanatic]

I agree, but I believe some of the trials do not charge the patients. I was going to have one done at Stanford and they told me they did not charge anything. UCLA charges $ 2800. One has to call the centers doing the studies and find out if they charge the patients.