Zytiga

[Fight11]

My husbands psa came down to 12.2 from 13.7 yet he has new spread. Could someone shed some light?

[tango65]

Some types of PC may not express PSA such as small or large cell neuro endocrine PC .

PC treated with chemo and the new anti androgens could progressively evolve into this type of cancer.

You could talk with the MO about doing a biopsy of the mets to do immunohistochemistry analysis to determine if there is neuroendocrine cancer and to study the genome of the cancer.

If the mets can not be biopsied, they could study the cancer genome by doing a liquid biopsy (blood drawing) to collect cell free DNA/RNA and or circulating tumor cells, These studies could identify mutations which indicate the cancer is susceptible to treatment with drugs such as olaparib and/or keytruda.

[Fight11 in reply to tango65]

He has the CDK 12 mutation

[tango65 in reply to Fight11]

His cancer could respond to keytruda.

precisiononcologynews.com/c...

[dhccpa in reply to tango65]

Just to clarify, the usage of chemo or ADT causes the PCa to evolve into the Neuro or Endocrine form? Without them it wouldn't happen?

[Fight11 in reply to dhccpa]

What exactly does that mean?

[dhccpa in reply to Fight11]

I was asking from the lengthy post above that seemed to say that. The one by tango65.

[Hidden in reply to dhccpa]

To be more accurate, may cause to become NEC phenotype. Percentages have been thrown around on this site but even those are 20-30 percent may evolve into NEC phenotype.

[dhccpa in reply to Hidden]

Sorry, not sure what you are saying about the 20-30 percent and whether ADT caused it in any way.

[Hidden in reply to dhccpa]

Some have stated on this site that 20-30% of men on ADT may develop NEC phenotype pca. I was clarifying it is not a given.

[dhccpa in reply to dhccpa]

G ot it thanks.

[docbulldog in reply to Hidden]

I’m sorry, what is NEC phenotype psa?

[Hidden in reply to docbulldog]

Neuroendocrine:A condition in which the neuroendocrine cells develop into tumors.

Phenotype:

the set of observable characteristics of an individual resulting from the interaction of its genotype with the environment.

[Fight11 in reply to Hidden]

Well that’s awful scary

[Tall_Allen]

PSA will fluctuate. Sometimes it is more or less active. The spread is what his doctor should be looking at.

[Fight11 in reply to Tall_Allen]

I called Dr Beltran she will be doing a tele visit Feb 3rd. Could you please tell me once again sorry. What med you mentioned for the cdk12 mutation . I wrote it down can’t seem to find it

[Tall_Allen in reply to Fight11]

Abemaciclib or Ribociclib or Palbociclib are drugs in clinical trials for CDK12 loss.

[Fight11 in reply to Tall_Allen]

Thank you so much. I so appreciate your support

[Fight11 in reply to Tall_Allen]

I asked my husbands Oncologist about these meds. He said he is not sure where he would find them. Do you have any idea? I feel so lost

[Tall_Allen in reply to Fight11]

Your husband would have to participate in the clinical trials for them.

[Hidden]

Agree with Tall_Allen on this, his response is spot on. To add, it isn't his PSA that should be treated but his tumor growth and spread.

[Fight11 in reply to Hidden]

Thank you