Oncologist appt today didn't end up with the best news, PSA raising after only 9 months on Eligard and 6 months with Abiraterone added.
Dx in Nov 20 with biopsy results of 8 cores 5+4=9 & 2 cores 5+5=10 with PSA of 8.4. Urologist started me on Bicalutamide. Oncologist switch me to Eligard in Jan 21. PSA 2.42 in Jan. Staged as NO M1a IVB.
Feb 8 & 11 CyberKnife, Prostate only. 22 Feb thru 26 Mar TrueBeam to both Prostate and four lymph nodes in upper abdomen. 22 Mar PSA .145. Oncologist added Abiraterone/Prednisone in Apr. PSA in Aug was .067. Lab from 15 Oct was .777 and 11x increase in 2 months!
Oncologist ordered a retest on the PSA and a bone and a CT scan. Was sure hoping for more than a few months out of ADT. Waiting on the test results for the next move.
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Did also get a referral to a DNA counsellor. My oncologist and me had a minor disagreement about additional DNA testing, and he recommended the counsellor, so will see how that goes. Just had a biopsy of my pancreas, pre-cancerous, so on the watch list for now. I'm guessing everything will be on hold until the scan results are in.
My visit with the DNA counselor was a waste of time. They ordered a subset of the full screen that the lymph node biopsy gave me. Get the biopsy please.
Sorry that your news was not as good as hoped. Perhaps you should follow the advice of Tall_Allen and whatever your oncologist might suggest after further test results.
I have had the FoundationOne testing, lots of mutations. Our disagreement was about additional Microsatellite Instability testing and a new DNA panel on the current cancer cells, my current test, in Aug, was on the original biopsy core samples. Not a big disagreement, he just didn't think they were needed yet and I was wanting to lean that way, so he referred me to a Genetic councilor, which seemed reasonable to me.
I may be in over my head technically here. But part of my story is as follows: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".
Originally, Docetaxel did not work. Keytruda worked immediately. PSA has gone from 21 to undetectable for 16 straight months. Gleason score was 5+5. Tall_Allen said good result was to be expected based on MSI-high".
Agree with mixed chemo treatment...only thing I would do before it is to check biomarkers for Neuroendocrine type viz. LDH, Chromogranin A, Neuron specific enolase..(blood tests) and also ask Radiologist to check if he has Lytic type bone lesions on his scans/x rays.If these tests are normal then Docetaxel alone can be sufficient.
Guru Nal, These days I am studying Adaptive Therapy...very fascinating research from Moffit Center in Tampa FL. In a way, I am already using the basic principle of Evolutionary Model of adaptive therapy.Here are 2 articles about it:
I am very much interested and intrigued by NAL adaptive theory which he explained in this comment he posted earlier. It makes a lot of sense to me. I hope my MO agrees with me when time comes and I need it.
I am doing a modified BAT cyclic program this year. Six weeks 400 mg T-cypionate every 2 weeks then 4 weeks no treatment, just naturally low testosterone (70-80). Per suggestion of Tomazs Beer hold off on ADT or enzalutamide on off cycles for now and see. So far staying very stable with PSA .08-.09 at end of off cycle. On 4th cycle now. Sarcopenia and QOL much improved. I am N1 M0/X HSPC and hoping to stay that way as long as possible.
Letting cancer cells which are androgen sensitive RE-POPULATE by withholding ADT seems a very good idea...it also keeps side effects to low level as body gets a chance to bounce back from Androgen suppressed artificial state.
Please have some mercy on our only 33Ford ?. It’s all hell until you can stay undetech for a while and then it’s still hell that we pay from the treatments . My first three years were torture …. Although in our society chemo is a common fear many men here had success with it . What others recommend could put that pc down . I’ve yet to have the pleasure of chemo . But a mean aggressive pc needs poison to put it down . I pray for you do it right away. Then get back what you love in life . I’m no expert or doctor ,but IMO the 11x you speak of is still in minute fractions so I’m thinking you can still knock it out . Any uptick or bad news hits our gut . Keep the faith do your best to save yourself . Many guys here did well the new chemo . How do feel physically.?
Hi. Retest sounds really good to me. Kinda like getting a smog test, but not as stressful. Tall Allen's advice is usually right on the money. Stop it before it spreads.
In addition to the above considerations, I would add a suggestion that, in the meantime, take “advantage” that you are technically metastatic castrate-resistant. That means you qualify to have Provenge treatment covered by Medicare or insurance. And also get a Pylarify PSMA PET scan done so you can get ready to be covered for Lu177-PSMA treatments at the appropriate timing when approved in coming months. (earlier is probably better).Adding docetaxel to ADT and abiraterone appears to be strongly beneficial for de novo metastatic in general. But your situation is very complex being already CR and so many actionable mutations. You probably need a very sharp MO consultation to sort out best combination approaches.
But, when PCa diagnosed, we're in a fight for our lives. This is what we know now, circulating tumor cells (CTC) from the primary, mostly gets slaughtered passage thought the heart, but just a few survive, hence metastasis cycle endures. Eventually, the CTC will stick to a favorable soil (tissue) and become a stationary tumor growth. So, we zap it, rinse and repeat and so on...
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