New here, 71 years old, radical in 2008, proton in 2012, open heart new aortic valve and new ascending aorta in 2017. Started Casodex in feb 2019 50 mg. PSA down from 3 to 1.1. Stopped Casodex in April 2021. PSMSA scan at UCLA may 2021 small cancer in Prostate bed. PSA now 3.55. Going to talk with Oncologist 8/23.
Testosterone staying at mid 700s, in a quandary. What ADT would be best for PSA lowering and least damaging to my Heart? Shooting for Theranostics using Lu177 treatment at Loma LInda in 2022.
Thank you,
Tim
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forwardon
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The PET scan you had may have false positives in and around the prostate due to urinary excretion. Not a good idea to have LuPSMA with only that small amount of PSMA avidity.
Firmagon, Orgovyx, and orchiectomy are less damaging to the heart.
The final results from the PATCH study are not yet in, but I believe transdermal estrogen will probably lower PSA as much as Firmagon/Lupron but without some of the side effects such as worse lipid values.
Yes, I know that now, my urologist initially prescribed 50 mg, but my oncologist wants to try something else. Thank you though, I appreciate everyone's response.
Do you know if Loma Linda is going to do Lu 177 PSMA treatments to patients with castration sensitive cancer or it is a new clinical trial? I believe Lu 177 PSMA treatments are going to be approved based in the Vision trial which was made with patients with advanced mCRPC and who had failed multiple therapies.
Firmagon seems to have less negative problems in people with coronary artery disease or history of heart attacks and/or strokes.
Lima Linda is starting a Theragnostics program in 2022 but I do not know who will be approved but they are in the process of starting it now. Thank you for the info.
I doubt they will offer treatment with Lu 177 PSMA to people with mHSPC outside of a clinical trial. I hope they will do it.
In my experience Lu 177 PSMA in mHSPC could be very well tolerated and effective, but this is anecdotical information since to my knowledge there are not randomized control trials for Lu 177 PSMA in mHSPC..
If they will not treat patients with mHSPC, you could get this treatment in Europe or in India.
Hello tango, I believe that the FDA is going to approve this as SOC very soon then the next step is approval by Medicare and private insurance. Check out this video. urotoday.com/video-lectures...
FDA will approve LU 177 PSMA treatment based on the data of the Vision trial which recruited patients with mCRPC and who have failed chemo and anti androgens. I doubt they will approve it for mHSPC without having data showing that in mHSPC, Lu 177 Psma treatment offers a OS advantage.
Did you do proton at Loma Linda? They saved my friend there with a very successful kidney transplant .
I have been on Firmagon 2 months now & so far not many side effects, just the usual hot flushes, loss of libido & irritating at injection site. Reduced PSA from 19 to 3 so am staying with it.
Good morning or evening whatever it may be forwardon,I to have cardiac issues many not as many or the same as you maybe.
1. Had SCA cardiac arrest May 2011, spent 12 days in CICU plus rehab. Got my 1st ICD/pacemaker device then. On 2nd ICD/pacemaker since Jan 2019.
AFIB, several RF/Cryoablations for it. Many of the common heart issues.
Cardiomyopathy, hypertension, chronic left systolic heart failure(but my EF is still at 50-55%). Could add more.
I've been on ADT second round since Sept 2019 continuing on today.
1st round of ADT was 2008-2013 with only Casodex and Lupron only. 1st ADT treatment lasted till late 2013 then stopped completely till 2019.
What am I saying? I was on long term ADT casodex(bicalutimide) + Lupron for 5 years.
Now I am on Lupron 90 days injections, Abiraterone only 250mg(prescribed dose is supposed to be 1000mg/day) and of course Prednisone 5mg.
I too am overly conscious about my cardiac complications, really concerned. That's why I'm only taking Abiarterone 250mg daily. But my Lupron also has SE's affecting cardio health. Like HP, cardiomyopathy, arrhythmia issues.
Since I've bee non ADT round 2 for two years now my PSA has bottomed out at 0.2ng/mL the last 8 months. Is that good not according to some that say < 0.1 or lower is best.
But like me you gotta weigh in your cardiovascular issues in life.
Hey DepotDoug, Any time your PSA goes down that is a good thing. Life is a series of compromises and balancing acts, and attitude is everything and I think you have a great one.
Hi Forwardon, I wonder if PET PSMA only shows one met whether you could be looking at precision radiation on that spot? Not that it will cure you since that is only the visible part of the illness but it might slow down the spread and probably lower your PSA. I was planning on doing that based on advice from my oncologist but had to go on ADT because could not travel on time to Germany because of pandemic back in late 2020 but I am on intermitent ADT now finishing my 9 month tour at month end and as soon as my PSA is detectable around .4, I plan to do PSMA scan to see how much if biochemical recurrence shows visibility. I had open heart aortic valve replacement 0ctober 2020 and that plus pandemic delayed all my plans. Anyway you are on a long run, my RP was on 2017 and PSA resurfaced from null but very fast doubling time . Can only hope for the best for you and may God and science enlighten you
Thanks Rick, I had hopes of targeted radiation to that area and went to California Protons in San Diego Ca because they have Proton therapy using pencil beam technology. But since I have already had full prostate bed radiation at Loma Linda university in California. Dr. Rossi said their was to much of a chance of damaging my bladder so that is not an option. I have already had more radiation then the human body is supposed to be able too withstand. But I am still standing. God bless you Rick. Keep in mind that PSMA scans and LU177 treatments are going to be available at many places in the U.S. very soon. Loma Linda being one of them.
You might want to review the information on the the Orgovyx website.orgovyx.com/
I have been on it since April 2021. Drops your testosterone like a rock. It is a pill you take daily. If you find the side effects to disabling you can stop and testosterone is suppose to come back more quickly than on some of the other ADT treatments. It also offers some advantages it the cardiac area.
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