Next step. Some advise please

[anpun]

History: 53 years old now.

PCa, gleason 4+3. T2N1MO (1 lymphatic node of 28). Prostatectomy (Da Vinci) in february 2017. Recurrence in December 2019 (psa:0.21 ng/ml).

PET/PSMA GA68 show the prostate bed and one lymph node were illuminated.

28 session of radiation was given (august 2020) to the prostate area (61 Gy) and the dose increased (63 Gy) to the PSMA uptake area. To the pelvic area (50 Gy) and 62 Gy to the uptake area.

ADT 6 moths.(Casodex+Decapeptyl)

16/09/2020: psa: 0.02 ng/ml (T=21 ng/dl).

04/01/2021: psa:0.02 ng/ml.(T=456).

05/07/2021:Today psa: 0.16 ng/ml (T=508).

11/01/2022: psa: 0.51 ng/ml (T=385)

08/02/2022: PET F18-PSMA: Conclusion: showing no signs morpho-metabolic effects of locoregional or distant tumor recurrence.

I don't know what my MO will recommend if I wait or start treatment. What do you think? What treatment do you think I should start? SOC or more aggressive treatments?

[GP24]

I would just wait for the PSA value to rise above 2.0 or 3.0. If there are no visible mets on a PSMA PET/CT you need no ADT yet.

[Magnus1964]

Don't panic. You are still fine. You should probably move on to zytiga. It would be a good next step.

Question, why did you stop casodex after six months? It seemed to be working

[Hidden]

Hello a pun! I too was just 53 , six years ago . No surgery for me t-4 ,2 nodes lit up I did lupron and tak -700 ( now not available ) and 8 wks imrt . It worked for me six yrs so far . I wish you the same and better.. works outs a must . Good luck , Stay strong and live healthy.. live for today hombre! ✌️😎

[Tall_Allen]

Some trials have shown success with a brief (under a year) stint of ADT+ abiraterone or enzalutamide or apalutamide.

[anpun in reply to Tall_Allen]

does success mean cured, or "lasting" remission?

[Tall_Allen in reply to anpun]

The trials didn't have long enough follow-up for that. It means better progression-free survival.

[sharoncrayn in reply to anpun]

in response to ANPUN:

ABSOLUTELY NEITHER.

read the trial results and drill down through the specific results if enumerated (often they are not provided in any detail).

as pointed out here and elsewhere, the "lag analysis" for these CTs is almost always far too short and too simplistic to draw meaningful conclusions except for "marketing" or FDA "exemptions".

the d***** lies in the details...unfortunately.

QOL versus OS...as usual for most. your choice.

sharon

[CAMPSOUPS in reply to sharoncrayn]

I don't know. I think PFS is QOL for me.

[anpun in reply to sharoncrayn]

What does it mean QOL and OS?.Thanks to everyo e for the tips.

[Javelin18 in reply to anpun]

QOL = Quality Of Life

OS = Overall Survival

There were a couple threads in the past month, or so, with lists of acronyms.

[CAMPSOUPS in reply to anpun]

PFS=Progression Free Survival

[j-o-h-n]

Cure is for something you do to meat...... Remission is what you may expect (or aim for) if you have the big C....

Good Luck, Good Health and Good Humor.

john Thursday 02/17/2022 5:22 PM EST

[MateoBeach]

So you have BCR, biochemical recurrence indicated by rising PSA after curative intent salvage radiation and short term ADT. Sorry you are probably in for the long haul like the rest of us here. You don’t have to be in a hurry to start long term ADT with an advanced AR drug, though that certainly has proven increases survival. Not easy decision though, given the adverse side effects that accumulate with ADT and that eventually fail from treatment emergent resistance into castrate resistant PC. Still, almost all of us end up going down that road. Survival and QOL is the goal.Alternatively, you might get good control for some time, even years, from bicalutamide mono therapy or combined with dutasteride. Worked for me for 4+ years. Another option would be to go after the remaining cancer with a course of docetaxel chemo (better earlier and tolerated better when younger). New research is favoring combining chemo with ADT and abiraterone. Data comes from metastatic at diagnosis, so not really your situation but would discuss it with your MO as combined early therapies appear very effective. You are one of us now. Sorry and welcome. Paul

[PGDuan]

Hi there - I'm in a pretty similar situation with rising PSA after primary treatments (BCR). I'm still early for this stage (PSA about the same as yours, my last was up to 0.47). Not sure yet on my next steps, but tons of good info in this group. Good luck, lots of therapies are still available.

[anpun]

Hello,

See the beginning of the chat where I explain the steps I have followed.

Yesterday I did an 18F PSMA (PSA=1.20), where it concludes:

"PET/CT 18F-PSMA study in a patient with a history of prostate neoplasia, who

shows multiple subcentimeter and hypercaptant lymph node images

retroperitoneal lesions at the para-aortic level described suggestive of infiltration of prostatic origin. (M1)"

What do you advise? Is it treatable with radiation? Go directly to ADT? What type of ADT?

Thanks