Change of Plan?

[Brysonal]

When my PSA took off in 2021 following an APC diagnosis in the January, SBRT to 3rd rib and T1 failing to prevent new mets (6 to spine on PSMA PET scan) I was referred to an MO for systemic treatment. He recommended SOC as:

Degarelix

Chemo

Abiraterone

RO said she would consider radiation therapy to my prostate once settled on HT as 'stampede style scans' showed only1 met.

I decided to replace Chemo with Lu-177. As I am hormone sensitive I had to travel to access and I chose Finland. They have done a course of 3 x Lu-177 and now recommend I switch to 3 cycles of chemo to kill any micromets or non PSMA avid cells that have survived. They say 3 cycles of chemo should not cause long term side effects though its tougher than Lu-177.

Pre 3rd Lu-177 yesterday PSA came in at 0.55 so I am happy with that

PSA since November 2021:

Pre-treatment 17.6

25th Nov 2021: 17.6 - Starter Degarelix

10th December 2021: 4.87 - given 1st Lu-177

23rd December 2021: 1.66- Given 2nd Degarelix

14th January 2022: 0.79 - given 2nd Lu-177 and third Degarelix

10th February 2022 0.55 - given third and final Lu-177 and fourth Degarelix

For the chemo they would use a cold cap/ cold gloves/ cold socks to prevent hair loss and neuropathy

Finally sorting a gene sequence on original biopsy tissue. Email came today. My germline test was negative but genetic professor recommended a somatic test so I know in case a treatment comes on line!

So not sure what's done what re mix of Degarelix and Lu-177 or what my nadir should be given I didn't have an RP or RT . Hopefully yesterdays Lu-177 will pull PSA down further.

I think 3 doses of chemo probably makes sense and we may regret not hitting it with a different treatment whilst in this stage!

As ever any views would be gratefully received ( I still haven't started Abiraterone). Anything else I should be asking about chemo as zero experience here?

Thanks all

[Shooter1]

Looks like you have a good handle on your aPca. I had RP followed by chemo with rising PSA and added Xtandi in the middle, again with rising PSA. Drove PSA down to undetectable. Now fighting 3rd mutation 5 years into this war... LU-177 still a rare bird here in US>

[Brysonal in reply to Shooter1]

Thank you but I am out of my depth here.. reading

. If these micrometastatic cells are not dividing actively, they will generally be resistant to chemotherapy because most chemotherapeutic agents target dividing cells.

How do you know if the micro mets are dormant or actively dividing?

[Shooter1 in reply to Brysonal]

Usually PSA will be rising faster...and above normal levels for a man with a prostate.

[tango65]

You could still consider having radiation to the primary tumor since the cancer is oligo metastatic by conventional imaging. Radiation of the primary may help with the control of the cancer and also with the control of local complications down the road. Consult About adding abiraterone since the cancer is de novo metastatic, like in the PEACE 1 trial.

[Brysonal in reply to tango65]

Thank you. I have first face to face appointment with London RO on Wednesday. I am written up to start Abi, just need to sign consent forms with London MO

Finland onco not keen on Abi/pred and isn’t worried about adding it. If I do want to add a new gen HT he would prefer Enza or Apa ( which is what a second opinion MO in UK said but my main MO said Apa not SOC for metastatic Disease. So many views!

[tango65 in reply to Brysonal]

I wish you the best of luck with these treatments.