I was diagnosed with stage 4 prostate cancer in January of last year, three months after my prostate had been removed. It had spread to two lymph nodes and my bladder. Starting in February of 2020, I begun three treatments of chemotherapy which were not effective, and my PSA continued to rise. I had also started on hormone therapy.
Since the chemotherapy was not working, and with little precedent, I was put on immunotherapy (Opdivo) and Lupron, and my PSA went from 21 to 0.11 after one treatment. After the 0.11 reading, my PSA readings for the next thirteen months were “undetectable”.
I had a CAT scan after six months on immunotherapy and PA in oncology office said results were fantastic. For insurance reasons, I was switched from Opdivo to ketruda after about eight months of immunotherpay.
So, I am supposed to stay on Keytruda and Lupron for a total of two years. I have about another seven months to go. PSA is still undetectable and side effects have been minimal. Keeping fingers crossed for what happens when treatments end.
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tennis8285
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Yes, Foundation Science report on genomic testing indicated that I would be a good candidate for immunotherapy. Mutational burden was 44 Muts/Mb. Microsatellite status was "MSI-high".
Tall_Allen,I don't understand the genetic mutation numbers or their significance. Are you saying that my genetic mutation numbers were so unusual/rare or that my positive treatment response was "miraculous" based on my genetic mutation numbers?
You were lucky to have MSI-hi (although it is not a good thing to have except for this reason). It is a very rare genetic mutation to have with prostate cancer. Your response to Opdivo/Keytruda was expected, not miraculous.
If possible, please comment on my latest post about remission and the comment from JRPnSD which is copied below. Thanks.
JRPnSD in reply to tennis8285
"2 hours ago
I majored in Biology/Chemistry and an MS in Public Health and I am not aware that this is possible given today's technologies. Hmmmm Could there be some confusion in the nature of these tests? Check out Color.com genomic testing for Oncology for more info on the nature of testing at present."
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tennis8285 profile imagetennis8285 in reply to JRPnSD
9 minutes ago
"The original report in 2020 was based on a tumor slide at the bladder site. Results showed MSI-high and tumor mutational burden was 44 muts/Mb and was performed by Foundation Medicine.
The recent genomic was performed by Guardant and was based on a blood sample. Results stated: “No tumor-related somatic alterations.” “Bio-marker MSI-High was not detected.” Tumor response map was blank. Somatic alterations were not detected in the circulating cell-free DNA isolated from this patient’s blood specimen.
Please educate me as to why this does not seem right."
You mean that the Guardant 360 Cell-free DNA test (cfDNA) did not detect what your somatic Foundation One test did? That can often happen. cfDNA relies on the presence of tumor cell DNA in the diluted blood stream. A direct test of tumor tissue is a MUCH better test.
Color Genome Dx is a germline test only, it tests for specific inherited markers (NOT including MSI-hi) and is irrelevant for you.
It seems like the results of the Guardant test would have to be good news for my oncologist to say now that I was in "genomic and clinical remission". Right?
You would have to have baseline Guardant 360 and see if it's changed. Your cancer was vulnerable to Keytruda because of the MSI-hi. If it has rid you of cancer, why would you even question it?
So happy for your positive results my husband only had 2 treatments of keytruda then stopped bc of his liver but it was enough to put his psa into undetectable for over 2yrs.now. Tumors shrunk and still shrinking.
I am very encouraged by your post and the great results of Keytruda.
Been involved with PCA 7 years now. Gl-9 (5/4). Removal along with some LNs 9% positive.I've been on ADT close to 4 years now.
I tested very close to the same mutations as you did. MO said Keytruda would be the next treatment I would go to when I go castrate-resistant.
At first when I was reading about some of the trials; the results were less than impressive until it concluded the only patients it turned positive results for were those with our numbers. So, I'm glad to hear the positive results you are having.
Originally that was my Dx. Then decided to get to the biggest and best Cancer Center as soon as possible. Ended u.p at Fred Hutch in Seattle. They found a few # 4s so lowered me to (5/4). Some cores were 80%, all had PCa in them
They have been VERY good to me.
Again very glad you shared.
A very few have the necessary Mb to be treated with Keytruda.
There is really reason to have to wait you are castrate resistant. I started with keytruda and then added firmagon. Been in remission for 18 months and no treatment for 12
A friend did the Lupron for a couple years and his cancer seems to have gone away and he has not had treatment for the last also year and a 1/2 and it's still undetectable. Wish you the best.
Besides my Pca I am being treated for a Lung Melanoma. The treatment is (was) a monthly shot of Keytruda as shown below.
Number 1 treatment with KEYTRUDA on Tuesday 02/07/2017. FIRST
Number 16 treatment with KEYTRUDA on Wednesday 01/10/2018. LAST
It worked !!! If I could I would jump over the net to congratulate you. Good vibes to you. BTW
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My mutation burden with Foundation was only 0.46,,,really low. Not much of a candidate for this treatment... Did get Provenge done with a very low cancer burden and rising PSA. Stable to dropping slightly at last blood test.. Next one should show what is really going on now. Wishing us all good luck with our treatments... Life is Good. Enjoy every minute while it lasts.
I have been on Lupron for about 4 years now. It is working well for me, the only problems are the side effects. The side effects were fatigue, hot flashes, and peripheral neuropathy. Gabapentine 600mg 3 times daily has helped to relieve me of hot flashes and neuropathy. I still have the fatigue though.
Liquid biopsy should be performed when your PSA is above 5 or even better 10 otherwise you will not get meaningful results. That is the only thing what I would add to the above old post.
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Castration resistance
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