6 monthly update and potential treatment questions

[Rodeoz15]

Hi everyone

Thank you for continuing to help answer my queries for my father (75, Stage 4 PCA, Gleason 8, diagnosed April 21).

At the time of his diagnosis his PSA was 500. CT scan showed extensive bone mets. He was put on ADT (Leuprolide and Abiraterone). Looking at his age and health chemo is not an option.

After 6.5 months his PSA is down to 1.2 and fresh CT comparison states the following:

"Prostatic lesion shows decrease in size and PSMA uptake (approx. 20% decrease in size). Lymph nodes are not significantly appreciable now. Bony lesions show decrease in PSMA avidity with increase in sclerosis. No other significant interval changes or new lesions."

Alkaline phosphate jumped around during these 6 months and has fallen to 79 (from regularly being above 140). LFT/KFT are normal.

Blood sugar and cholesterol were normal generally but in the last 3 months both have increased. Blood sugar is 5.8% or estimated 120mg/DL (should be 5.6% or below). All cholesterol parameters have increased but are within range except LDL which is 110mg/DL (should be less than 100). We got a 2D Echo done few months back and it was normal then.

His total Testosterone has increased from 19ng/DL to 33ng/DL in 3 months (same period PSA fell from 2.6 to 1.2). He was on ADT all this while.

I was wondering why his total T has risen. Does it indicate anything?

Should we start monitoring Lipid profile and blood sugar on a monthly/two monthly basis now and seek separate treatment from a GP if they continue to rise?

Is this the right time to try any other treatment like radiation?

I speak to his MO in two weeks.

Many thanks as always!

Rodeoz

[Tall_Allen]

His age is not a contraindication to chemo- what are the health concerns that affect its use?

The small increase in T may indicate abiraterone suppression of adrenal T is not as complete as it once was, but it is still good. As long as his PSA is not rising, and nothing new on scans, there's no reason to change anything.

[Rodeoz15 in reply to Tall_Allen]

Thank you for your response, Tall_Allen .

He is physically weak and most MOs I have spoken to have said they would prefer Chemo to be added later if ADT fails and if there is no other option. Looking at him they seem to be in agreement that Chemo may affect his QOL. Although almost all his blood parameters are good and he has no co-morbidities, he is physically very weak.

The only other treatment plan they have suggested is to consult a radiation oncologist and take an opinion from them. Otherwise to continue ADT as is.

[Tall_Allen in reply to Rodeoz15]

The problem with that "save chemo for later" advice is that the cancer is debilitating and he will never be as able to handle chemo as he will be after abiraterone fails. Also, it is much more effective if used earlier. I am perplexed that with such good response to his meds, that his performance status should be so poor. Does he have heart disease or diabetes? Is he depressed? Do you know what his "ECOG Performance Status" is?

Why is he being referred to an RO? You didn't mention painful metastases. Has he had fractures or spinal compression?

[Rodeoz15 in reply to Tall_Allen]

Thanks. That sounds right. I will push the MO again to see if chemo can be considered.

He does not have diabetes or heart disease or any other co-morbidities. But he led a very sedentary life post retirement from a very active government job and over the years (15 now since retirement) has started looking very weak. His ECOG Performance Status would be 2.

He doesn't have painful mets, nor any fractures or spinal compression. His T score was low on Dexa indicating Osteoporosis. He has been put on Zoledronic acid since then. The MO at TMH, Mumbai suggested I consult with an RO so I was curious to know if radiation is needed when everything else is going fine.

[Tall_Allen in reply to Rodeoz15]

Not sure what would get the radiation, and to what purpose.

Perhaps he might benefit from an antidepressant?

[Rodeoz15 in reply to Tall_Allen]

Thank you. I will explore the depression bit as well as I never considered it.