Aggressive treatment

[Wahoo_]

I was diagnosed with metastatic prostate cancer to my hip and 3 ribs, December 2020. MO put me on monthly injections of Firmagon and 160 mg of Xtandi, daily. Would this be considered an aggressive treatment regimen? Thanks!

[Tall_Allen]

It is certainly the standard of care. This explains the options for mHSPC:

prostatecancer.news/2017/06...

[Hidden]

No.

[GP24]

You could get your prostate radiated based on this study:

esmo.org/newsroom/press-off...

They put four mets and more into the high risk group but I would just decide that I still belong to the low burden group and get it done.

[TheTopBanana in reply to GP24]

GP24, what is your thoughts on early chemo? (excuse me if you have already answered this, my memory is a bit in a haze).

[GP24 in reply to TheTopBanana]

If you are diagnosed with many bone metastases, you can get a chemo added to ADT and then continue with Abiraterone or a similar drug. I would call this an aggressive treatment. However, if you only have a limited time to live, what is the value of quality of life for you? You may live just as long with Abiraterone only and then you can avoid the side effects of the chemo. Some patients say, I will accept any side effects if I may live a few weeks longer.

An alternative would be this Australian trial:

Overview ProPSMA trial in Australia contact: [e-mail]

[Wahoo_]

Please see my profile. I love this site...so much info!!

[GP24]

"I just started Firmagon injections and Xtandi. What is confusing is my PSA is .8."

I understand that you did not get ADT for 16 years now. What was the PSA value before you started with Firmagon and Xtandi? Why did you get the bone scan which detected the bone mets, did you have any pain? What means "just started" - when did you get your first two Firmagon injections?

[Wahoo_ in reply to GP24]

I got my first injections in January. At the time of injections my PSA was .8. Now it is .03. My uro suggested the scan because of the doubling time . I had very little pain, something I did not even associate with my disease. MO says I should be around a while....when we talked life expectancy.

[GP24 in reply to Wahoo_]

Several points are unusual in your case. As Noahware pointed out, in theory bone mets should not occur with a Gleason 6. But I know two patients who got them, although after 25 years.

A value of 0.8 is rather low for calculating a doubling time. I am surprised that your doctor ordered a bone scan based on that PSA value.

A bone scan should be ordered when the PSA value is above 10 ng/ml. Below that you would expect to get no results.

If you have four bone mets detected with a bone scan, your PSA value should be much higher than 0.8 ng/ml.

I would try to get a PSMA PET/CT to verify the reason for the rise in the PSA value. You could also include the CGA and NSE values in your next blood draw. These are initial indicators for neuroendocrine cancer. This type of prostate cancer grows while expressing low PSA values. It is rare though.

[noahware]

It would seem some treatments might be considered MORE aggressive, like adding chemo. As an aside, I am curious: was your biopsy pathology ever revised upward after RP, or did post-RP pathology confirm that you truly had Gleason 3 +3?

[Wahoo_ in reply to noahware]

Yes, post op confirmed.

[noahware in reply to Wahoo_]

Thanks... it is interesting to me, because my understanding is that it is pretty rare for a confirmed 3+3 to become metastatic disease. But not impossible, obviously. Best of luck with treatments!

[Wahoo_ in reply to noahware]

Well, I’m a rare type of fellow...😬

[j-o-h-n]

Wahoooooooooooooooooooooo to you.......

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/04/2021 5:37 PM DST

[docbulldog]

I am also on Xgeva which is good for bone support where Mets may be found. I used Xtandi for just short of 3 yrs. My PSA has never gone undetectable but did drop to the 0.2 area. I am now on Zytiga, with not the best results but after PSA jump to 20, it has gone down into the 4/5 area. I was told it would hold steady there that is a good sign.

[Wahoo_ in reply to docbulldog]

Glad to hear that, thanks for your reply! I am supposed to go on something for my bones after I have some dental work at the end of the month.