RT, ADT and Apalutamide for N1, M0,castration sensitive status

[Nusch]

Looking for people with experience of RT, ADT and Apalutamide at the same time for N1, M0 castration sensitive status.

[London441]

I had similar stage and treatment to you but RP plus RT Taxotere and abiraterone for 3 months instead of apalutamide. What was your Gleason score?

[Hawk56 in reply to London441]

Not exactly the same but I did a triple regimen of ADT, taxotere and radiation. So far, it has provided 3+ years of PFS. The attached chart shows my clinical history..

My urologist was considering adding Zytiga to the regimen but based on my response to the ADT and taxotere, decided not to.

From my readings, more and more combining treatments and bringing them forward in the disease when it is in a state where "overwhelming it" can achieve durable remission though not many say "cure."

Still, I am 3 years and 8 months since my last Lupron shot cleared my system, so, happy with my decision. Then again, I have a friend who did only SRBT to a single lymph node, when his PCa came back.

I think the question may be what about "micro/metastatic" disease? Imaging can only see so much, so is radiating what "you can see" enough or do you need systemic therapy too?

Clinical History

[Hawk56 in reply to Hawk56]

Here's a chart which gives you an idea of why systemic treatment may be necessary vice mono therapy.

Volume of cells vs size

[Nusch in reply to Hawk56]

Many thx - got the message. I just read a lot about a) side effect of Apalutamide and some doctors say, Apalutamide isn’t necessary as long as I‘m N1 M0 and cancer is still regional - not outside the pelvic.

[Hidden in reply to Hawk56]

what do i need to download to do a chart like that? Thanks

[Hawk56 in reply to Hidden]

I created the chart myself. I have all my lab values so I used MS Excel to create the chart. I added the data on surgery, radiation, ADT, chemotherapy...using text boxes and symbols and shapes.

[Nusch in reply to London441]

My GS = 8

[London441 in reply to Nusch]

Clearly not even the best medical professionals are in agreement about best course of action for what we have, 'oligometastatic' disease. It does seem clear that surgically extracting lymph nodes is like stomping on individual cockroaches to clear a infestation, so that's become unpopular. Otherwise no consensus.

Especially with regards to combination treatments-how much, how many, how long, what kind etc. Spot radiation also controversial. We are lab rats.

Still a lot better than the old days, when we with oligometastatic pca were given ADT and sent on our way to near certain failure. There's too much we don't know, but systemic treatment probably makes as much sense as we hope it does. Great luck to you!

[Nusch in reply to London441]

Thx! You bring to the point what I feel as well. There are only a few studies available for these 2nd generation pills. So I hope we’ll see more as time goes on. I would give it a try with Apalutamide, but try to identify the best moment. And still try to find more people with less side effects.

All the best for you, too. If I find anything valuable I’ll post it here.

[London441 in reply to Nusch]

Thanks. Some will argue, but by far the best remedy for any and all of the side effects, whether from LHRH drugs, chemo or 2nd line anti-androgens, is exercise.

[Nusch in reply to London441]

Good to hear. I‘m jogging almost daily, do weight lifting and gym and are on vegan diet. I hope this will help.

[London441 in reply to Nusch]

Excellent. Fatigue will call to you like a toxic lover, ‘don’t work out baby, you need a nap!’

Work out first😀

[Nusch in reply to London441]

So true! Whenever I give in, only after RT now, and take a seat on my couch, I get terribly tired and fall asleep. As soon as I get up and grab my dumbbells and rub the stairs up and down in my house, fatigue disappears quickly.

[Hawk56]

Generally, all treatments have side affects. The two times I did radiation, first to the prostate bed and then to the PLNs, I had no SEs, still don't. That is likely testimony to the advances on software used for planning treatment, the technology used to deliver the radiation and the skill of my radiation team.

On the conservative side, I have seen where medical teams and their patients do radiation and short term ADT, six months.

Not being a medical guy, what I have read and "understand" is that the ADT sensitizes the PCa cells to the radiation, thus triggering a symbiotic affect.

With the new oral ADT, T recovery can be faster, you don't have the flare associated with Lupron and the CV SE profile is less.

Nobody wants to over treat but do you want to "under treat" and maybe miss an opportunity? That is a Gordian Knot decision we each face in our journey.

Kevin

[treedown]

I was N1M0 at initial dx so no RP. I had RT, ADT, Zytiga. After 2 years stopped all treatment. PSA showed slight increase March. Scans will start if/when it hits .5.

[Jpl506]

I wasn’t N1, N0M0, but I have received this treatment due to GS5 grade. 1 core of 9/12 positive for 5+5. I had SBRT and have been on Lupron + Apalutimide for 24 months. 1 more month and I’ll get a break to see what happens. Anyway, the side effects have been minimal in my case. Hot flashes and fatigue. Exercise has been key I think.

[Nusch in reply to Jpl506]

Great and congrats! This motivates me. All the best!

[j-o-h-n]

Greetings Nusch.

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, you may want to 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 Monday 03/21/2022 7:16 PM DST

[Nusch in reply to j-o-h-n]

Dear John, many thanks - I just updated my bio, you’ll find all infos there.

[j-o-h-n]

Dear Nusch,

Thank you sir. Most of the new members who I ask for that info think that info is for me. That info is for the new member's benefit when reviewed by other members. Get well, stay well. Keep Posting...Plenty of help here...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/22/2022 3:45 PM DST

[Nusch in reply to j-o-h-n]

Fully understand and appreciate. Let’s stay connected.

[j-o-h-n]

Of course............

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/22/2022 3:55 PM DST

[PGDuan]

Not exactly the same, but I'm in the CSPC boat at the moment with BCR. I had RALP with negative nodes and margins, but my PSA only dropped from ~12 to 4 after surgery so something must have been missed. EBRT and 18 months of ADT with Zytiga followed and I was undetectable then for about 18 months but now have BCR with a <60 mo doubling rate. I'm likely to commence on 12 months ADT, and possibly a trial that would add Zytiga or both Zytiga + Apalutamide. My first 18 months of Lupron + Zytiga (back in 2019-early 2020) while getting EBRT wasn't too bad. Hot flashes and fatigue at first, but I adjusted and found it tolerable. I kept surfing and doing yoga through most of it...but it was definitely harder and I lost muscle. Best of luck.