Next Treatment Plan Thoughts?

[cuphalffull1]

Recently given two Doctor's opinions for my next treatment plan, here is my history

Diagnosed Metastatic 9/2019 - PSA 662

Original Scans showed cancer in Ribs, Spine, Pelvis and Skull

6 Taxotere Infusions 10/2019 – 2/2020 (Scans in 2020 showed good response)

Also on Eligard & Casodex

28 Radiation appts to Prostate June/July 2020

Lowest PSA 0.06

PSA Has been rising slowly since 12/2020

PSA was .62 three weeks ago.

Recent PET scan shows 3 spots coming back

Doctor#1 would like to put put me on an Oral Pill (2nd Gen Anti Androgen)

Doctor# 2 would like to start 8 total infusions of Cabazitaxel/Carboplatin with a scan after the 4th infusion.

I am 52 years old.

Your thoughts?

Thank you

[Hidden]

The general thought is if ADT (Eligard) response to castrate resistance is very short, go to chemo next vs. second-line ADT (Zytiga, Xtandi).

But your ADT response doesn't look that short IMO. It looks similar to mine. I have done really well on Zytiga.

If you are still on Casodex, I'd get off that right away as it can feed the cancer. I'd try a second-line ADT agent (Xtandi or Zytiga) before going back to chemotherapy. If it doesn't work or doesn't work for long you can always go to chemotherapy next.

This is all based on my knowledge so it's best to discuss everything with the doctors and then make a decision. Wishing you the best.

[Tall_Allen]

Good idea to alternate chemo and second gen. hormone therapies:

prostatecancer.news/2019/12...

[Bigm789 in reply to Tall_Allen]

Dear tall

51 , 3 lesions , right apical horn , DIL, G7 , minor extrapasular, extension , 2 lesion G 6, right TZ, 3 lesion left midline G6 small, considering Tulsa dont want radiation, but seems HDR targeted therapy, MSKCC, 2 sessions 1 week apart , best option. Want. To still have kids, is all ejaculatory fluids gone or i treat hemi gland is AS for left G6 better maintain more sexual function ED not as bad, take Alfuzosin for a while , what your take?

[Tall_Allen in reply to Bigm789]

Bank your sperm.

TULSA doesn't work:

prostatecancer.news/2021/03...

It is a mistake to think that what's been found on a biopsy is all there is.

[Bigm789 in reply to Tall_Allen]

Tulsa can be repeated with 13 month monitoring , if reoccurrance than do HDR brachy therapy targeted at UCLA is a strategy consideration. its seems latest data says Tulsa allows ED and ejaculatory ducts to be preserved

[Tall_Allen in reply to Bigm789]

I guess you didn't read the article. A third of men had a recurrence and that was when the whole gland was treated. Potency preservation was less than SBRT, which unlike TULSA, is curative. You would probably have retrograde ejaculation. If you want kids, bank your sperm.

[Bigm789 in reply to Tall_Allen]

Focal Laser Ablation of Prostate Cancer: An Office Procedure | Protocoljove.com/v/61984/focal-lase.... Does this have promise .

[Tall_Allen in reply to Bigm789]

No, it has proven to be non-curative. It did not get rid of the cancer in 41% of treated men.

auajournals.org/doi/pdf/10....

Ablation of any kind has never been proven to be effective against prostate cancer, which is why it has NOT been FDA-approved after all these years.

[Bigm789 in reply to Tall_Allen]

redjournal.org/article/S036.... Is not HDR mono therapy 2 treatments 90% cure rate

[Spyder54]

Your “Pet scan shows 3 spots coming back”. Where?First: I know nothing. Just know what I read and see. Much of that is mis-interpreted. Trying to give you another idea here.

Dr Kwon of Mayo Clinic says when the scan shows some spots, we Spot Weld those with SABR/SBRT, and see a return to undetectable soon thereafter. Of course if these 3 spots are in a previous Radiated zone, it would always be the call of an experienced Radiologist! Obviously . Kwons videos are up on Youtube.

Best,

Mike

[Hidden in reply to Spyder54]

Based on his post, I think his mets are fairly extensive and these 3 are just new spots.

[Hidden]

Just a query..... you have two medical oncologists specializing in PCa?

[Hidden]

You don't say if you are still working. If you are I'd go with Zytiga. I believe the SEs are tolerable for most