Looking for input on Chemo & Oligometastatic

[ndirish]

Looking for input: Diagnosed in June 2020 with Oligometastatic prostate cancer via CT & Bone scans. (spot on right pelvic bone) / removed prostate via surgery in July 2020, have been on Lupron & Erleada since Aug 2020 & did IMRT radiation to pelvic bone in Feb 2021. My PSA is currently undetectable. The plan is go off of the hormone drugs (Lupron & Erleada) at the end of this month (March). My question is this: Does doing Chemo make sense right now? My Dr. says no, but I wonder if the Chemo would help by addressing the microscopic cancer that probably is in my body. I am 59 years old. Any input would be appreciated - Thanks Jeff

[GP24]

The chemo will not cure you. If you have been on Lupron and Erleada I do not think the chemo will have that much benefit to justify the side effects. Make a break now and restart Lupron and Erleada when the PSA value rises significantly.

[ndirish in reply to GP24]

Thank you for your input - much appreciated!

[Tall_Allen]

Chemo makes no sense unless the cancer is rapidly growing.

prostatecancer.news/2019/02...

I think it is a mistake to stop hormonal therapy. That is what is keeping your micrometastases from multiplying. However, if you need a temporary vacation, it is reasonable. You cannot use PSA to tell you when it is time to end your vacation because you have "treated PSA."

[Chadsdad in reply to Tall_Allen]

TA, I’m 2 years undetectable on Eligard and Erleada. Had the opportunity for a PSMA scan and the manager of the facility convinced me that with a 0 PSA, the test would be a waste of time ( kinda odd for a for profit medical facility). What scan or test could I justify to prove that I don’t have metastasis growing that doesn’t make PSMA? My only metastasis were 3 lymph nodes that were not visible after a year on this cocktail.

[Tall_Allen in reply to Chadsdad]

The manager is right. You can't test for metastases now.

[ndirish in reply to Tall_Allen]

Thank you for your input Tall - much appreciated

[garyjp9 in reply to Tall_Allen]

TA, if you can't use PSA to tell you when to end the vacation, what can you use?

[Tall_Allen in reply to garyjp9]

Time with normal T

[RonnyBaby]

Chemo is not the answer AND a vacation MIGHT reveal the success or lack of success, in terms of a cure or any other 'marker' that would help measure your actual state at that time in the future. 'Microscopic' cancer cells don't automatically become a major health concern. There are several factors at work here that make predictions difficult and the path moving forward may be ongoing ADT. The best way to know the 'outcome' of treatment(s) to date would be to 'vacation' but close monitoring is a MUST to see if the vacation 'fails' to show any positive gains versus negative feedback.

You should follow the MOs advice and guidance - it's still relatively early 'in the game' to have all the significant answer settled with a clear path moving forward. It is a judgement call at this point in time and there are no guarantees.

Wishing you the best on your journey ......

[ndirish in reply to RonnyBaby]

Thank you for your input - much appreciated - much reason for taking a vacation right now is to try and see where I am at.

[Hawk56]

After surgery and SRT both failed, I did a combined regimen of ADT, chemotherapy and radiation to the PLNs.

A C11 Choline scan at Mayo showed only lymph nodes but no organ or bone involved.

Am I "cured," doubtful...have I been off treatment for 3-1/2 years, yes, how much longer, who knows...

My PCa was aggressive, GS 8 initially, BCR after only 18 months, rapid PSA doubling and velocity times.

I do actively monitor my PCa, labs and consult with my urologist every 2-4 months. We have discussed the way ahead should PSA begin to continuously rise, what are the trigger points for imaging, where, with what...

I stay abreast of the evolving landscape for advanced PCa should decision time come. In the meanwhile, enjoying my "vacation!"

Kevin

Clinical History

[ndirish in reply to Hawk56]

Thanks Kevin - best wishes to you on our journey.

[j-o-h-n]

Greetings ndirish,

Would you please be kind enough to tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 3/13/2022 9:41 PM DST

[Battle_on]

Husband was diagnosed oligmetastatic based on CT and bone scans. Firmagon and Xtandi kept psa at undetectable, but suffering extreme fatigue, nausea, weight loss. So had PSMA scan to determine viability of radiation to mets instead of ADT. Got results yesterday and major spread to skeleton, lymph nodes, mass in abdomen. Get a PSMA scan, find a reason. Don't rely on low psa as sole indicator of remission as our doctor did.

[Chadsdad in reply to Battle_on]

Do I understand correctly that the PSMA scan picked up metastasis with an undetectable PSA? My reason for asking is that I was approved by my insurance company for the scan and the manager of the facility convinced me that with a 0.014 PSA, nothing would show up.

[Battle_on in reply to Chadsdad]

Yes, apparently it's rare, but it happens. Here is a quote from the doctor's notes "PET CT scan showed extensive bone metastases, probable metastasis in pelvis, and probable metastasis to mediastinal lymph nodes despite undetectable PSA. I discussed this with patient and told him that he should consider docetaxol based chemotherapy for treating castration resistant metastatic prostate cancer that has failed to respond Xtandi. Questions answered and he concurs with medical oncology referral."

His PSA 7 weeks prior was <.13 NG/ML, or "undetectable". I know that "what if's" don't solve anything, and they often can't do tests if the result wouldn't change the treatment plan. But we certainly would have made different choices for our personal life if we knew this sooner. We actually went into the PSMA PET scan with high hopes of confirming oligometastatic disease that could be treated with focal radiation.

[Chadsdad in reply to Battle_on]

I was looking for some verification that my treatment was working. I have fatigue and hot flushes but nothing I can’t handle. However, I have heard of just treating the PSA in some patients was a real thing and while your in the I’m fine mode, the cancer is growing. Thank you for your quick reply. I wish you guys much success with the next treatments.