To Abi or Not to Abi

[meowlicious99]

We consulted 2 uro oncologists ( one of who performed TURP ) . Both of them seem to indicate that role of 2nd gen anti androgens is not clear based on the existing literature.

We also consulted 2 MO's ( including Dr. Joshi from tata memorial hospital) seem to suggest using Abi + pred .

Now we are confused as to what to do here. Currently he is only on lupron 3 months since aug-2021. I am bit worried that we might miss the chance to get the early start benefit of abi/enza .

Any thoughts appreciated here.

relevant details : ( more in my profile)

Biopsy :

Gleason - 4 + 3 = 7

12 positive cores

greatest % of core involvement = 70%

% of prostate involved by tumor = 40 %

Periprostate fat invasion = not identified

Seminal Vesical invasion = not identified

Lympovascular invasion = not indentified

Perineural invasion = identified

Intraductal carcinoma = not identified

PSMA:

Irregular soft tissue dense mass lesion noted in entire prostate with Ga-68 PSMA avid tracer uptake

( SUV Max: 30.9 , measuring 5.7* 5.7*.5.2 cm) .

Mass is involving base of the bladder and anterior wall of the rectum.

Enlarged perirectal, prescaral, bilateral external, internal and

common iliac lymph nodes ( suv max 11.2 on left external iliac node, measuring 1.9 * 1.6 cm)

[Magnus1964]

Since he has only been on Lupron for three months I would wait to see he responds before adding any other medications.

[meowlicious99 in reply to Magnus1964]

would he lose out on benefits of early 2nd gen addition, if its added 1 yr down the line for, example?

This is causing crazy amount of anxiety for me. lol.

[Magnus1964 in reply to meowlicious99]

I would not wait that long. Just see what his PSA is in the next month or so.

[Tall_Allen]

To summarize: he is stage T4, N1, M0. It may be curable. At Tata Memorial, see Vedang Murthy. My understanding is that he is running a trial of (1) whole pelvic radiation + (2)Lupron+abiraterone for men in your exact situation.

Of course abiraterone is needed in addition to Lupron for men in this situation. There is now just no question about it. A recent STAMPEDE trial (2 weeks ago) just proved it.

[meowlicious99 in reply to Tall_Allen]

> At Tata Memorial, see Vedang Murthy.

I have a virtual consult with him in 2 weeks. TM wanted a referral from Dr. Joshi at TM to him first.

> A recent STAMPEDE trial (2 weeks ago) just proved it.

TA would you be kind enough to link to me this if possible. I will take a print out and talk to my MO.

I think this is it, just wanted to make sure

clinicaltrials.gov/ct2/show...

[Tall_Allen]

That link won't help you- there are half a dozen different STAMPEDE trials.

The results are so new they haven't yet been published. You can email him a press release (below) about it. Never take in print outs with you. That will only cause a negative reaction. Instead, email a link before the meeting.

urotoday.com/conference-hig...

[j-o-h-n]

Also, never take the litterbox with you....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/03/2021 6:57 PM DST