6 MONTHLY UPDATE.

[doklam2017]

HI , I have summarised my case history as follows:-

Chief Complaints and History of Present Illness:

• LUTS Since Jan/Feb 2020. Past History Nil

Physical Examination

• PS 1

Clinical Notes/Old Reports

• TURP conducted on 22 June 2020

• PSA (post TURP): 258.47

• Biopsy: Adenocarcinoma Prostate

• Gleason Score (4+5=9) PNI present

• PSMA-PET: Prostatic Lesion with Peri prostatic Stranding. Presacral Soft Tissue with invasion of posterior and left lateral rectal wall. Multiple pelvis and RP lymph nodes. Multiple osseous sclerotic lesions

• Started on Degarelix and Denosumab (1 July 2020)

• MRI LS spine: Multiple metastatic focal lesions in LS vertebrae and bilateral iliac bones.

•Dexa Scan done on 20 October 2020: Normal T score-2.9.

• Genetic testing: BRCA1, BRCA2 Negative.

Tumor Markers

•27 June 2020 (Post TURP): 258.47 ng/ml

•28 July 2020: (After 1st cycle): 7.87

•23 Sept 2020: (After 3rd cycle): 0.88

•18 Dec 2020:(After 6th cycle) 0.10

Treatment

• Degarelix (80mg), Denosumab(120mg) (monthly injection) + daily Abiraterone (1000 mg) and Prednisone (5 mg)

Current Status

•PSMA PET SCAN conducted on 16 Dec 2020

•Findings

oNear complete resolution of large, ill marginated PSMA, avid hypodense lesion in left lobe of the prostrate and complete resolution of the peri prostatic stranding.

oComplete Resolution of:

PSMA avid presacral soft tissue thickening.

A few sub centimetre size, F 18 PSMA avid bilateral retro- crural lymph nodes.

All but one of the multiple PSMA avid para ortic, aortocaval, bilateral common iliac , internal and external iliac, and para rectal lymph nodes.

PSMA avid predominantly, sclerotic lesions, in multiple osseous structures and reactionary sclerosis in the underlying bones.

Multiple, up to centimetre size, most of these partly calcified and some non-calcified , para trachial , pre carinal , sub carinal and AP window nodes.

PSMA avid , right hilar and a left para bronchial nodes.

Non PSMA avid , likely inflammatory mucosal thickening in right maxillary sinus.

Scan findings are suggestive of very good response to therapy .

Prognosed Treatment

•Degarelix 80 mg (monthly)

•Denosumab 120 mg (monthly)

•Abiraterone 1000 mg (Daily)

•Prednisone 05 mg ( Daily )

If any one has any suggestions/ comments , to make they are welcome.

😀😀

[Tall_Allen]

Congratulations on the good response!

[doklam2017 in reply to Tall_Allen]

Sir,Thank you,

Would you like to add something to the current/ prognosed treatment pls.

Also , is there a case in point to experiment with rsdiatin to enhance the results?

I'll be grateful if you could give your views on this issue.

Regards

[doklam2017 in reply to doklam2017]

Radiation Sorry

[Tall_Allen in reply to doklam2017]

I think that it is fine the way it is for now.

[Doseydoe]

How are you feeling after all that?

[LearnAll]

Superb response to primary ADT...Radiation un necessary at this point IMO.

[MateoBeach]

I would take this time of very good response to build strength and fortify immunity. Request and go for Provenge treatment. Consider adding celecoxib to reduce inflammation, it pairs well with your bone protecting medicine denosumab. Uplevel cardio-endurance exercise and add weight or resistance training as compatible with your comfort and capacity. And dial in your diet-of-choice so you prevent or minimize fat gain and muscle loss from the ADT. You are doing very well. Enjoy life and do all that you can to fulfill what you came here for.

[CSHobie]

I am reading your post with interest.

I have similar issues in my spine, and bones, with tremendous pain, but no Denosumab.

How are you feeling? Is the Denosumab giving you side effects?

[doklam2017]

HiThanks for your response.

My doctor was very particular about Denosumab, in fact the moment so many Mets showed up he straightaway got my MRI done. In order to prevent any SRE issues he has put me on Denusumab 120, mg from the first day alongwith Abiraterone.

It has really helped : this combined with CCM and B12 has held me in good shape.

Frankly, I have fatigue and hot flashes. Apart from this I don't think there are any side effects.

I will send yo the crux of my CT SCAN ,the pictures on right and left are the comparison.

Do let me know if I can be of any help please.