Hi everyone, first a big thanks to this group for all the input. I’m incredibly grateful for tons of input, the latest PSMA scans, and excellent medical advice.
Passing this along for anyone else on this path.
The very recent ARASENS trial results helped me finalize treatment plans for low volume mCSPC after BCR. The plans is —> ADT + Darolutamide + SBRT + Docetaxel.
This aggressive plan would not have been the recommendation just a months ago without the latest scans or recent trial results (and continued fast PSA doubling time). As for me, I’m in the controversial zone below where it isn’t fully established that adding chemo results in longer OS. However, I’ve had a 3-6 month doubling rate and am otherwise fit and healthy without any symptoms.
See below for a recent article and guidance. I should acknowledge lots of help from the terrific teams at Stanford, City of Hope, UCSF, and Prostate Oncology Specialists, all of whom helped look at the situation.
Now I just need to get ready for all the treatments…but I’m feeling strong and hopeful, and just caught some solid waves this morning.
The results of the triple therapy with darolutamide, chemo and ADT apply to newly diagnosed patients and consequently they do not apply to patients with BCR. It is controversial if chemo should be used in patients with oligo recurrent cancer. In the article you posted they mention that chemo may not improve overall survival.
""Dr. Fizazi highlighted that based on additional analyses of CHAARTED and GETUG-AFU15, we are able to identify men more likely to benefit from early docetaxel by assessing the burden of metastatic castrate naïve prostate cancer.2 Specifically, patients with low-volume disease showed much longer overall survival, without evidence that docetaxel improved overall survival.""
The data of treatments with triple therapy are from studies done with newly diagnosed metastatic castration sensitive patients. There are not data with BCR patients. Nobody knows if in these BCR patients the triple therapy will help or jusf cause more toxicity.
Some of fhe RCT did not show a survival advantave in patients with less than 4 metastases treated with docetaxel
He coudl be treated with adt plus zytiga, enzalutamide or. apalutamide.
Outside the SOC he could try direct therapy of the mets with SBRT which could delay the start of ADT or with Lu 177 PSMA abroad or try to enter in the trial of Lu 177 PSMA and SBRT offered by the MSKCC in NY.
PGDuan - saw your post earlier this week and great to see that everything is trending in the positive direction. My husband was recently diagnosed with metastatic Pca with spread to the bones. We are looking into Stanford, UCSF and city of hope consults to discusss treatments likely triplet. Who was the MO, RO that you consulted with at Stanford, UCSF and city of Hope. Thanks
Eventually, the recommendation came from Dr. Scholtz at prostate cancer specialists in Marina del Rey. I then worked with a local oncologist here in Monterey who had worked at Stanford. Dr. Srinivas at Stanford was helpful but it wasn’t her initial recommendation. Doctors at UCSF and City of Hope were also very supportive but did not recommend triplet at the time given limited conclusive studies for low volume, high risk cases. They were offering only advanced ADT (Xtandi) and maybe SBRT to the hotspots.
One thing I learned is that you’ll get one set of guidance from academic major research hospitals, tied to proven SOC or trials, and this may be slightly different from the perspective you get from others like Dr. Scholtz at Marina del Rey or practicing oncologist.
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Update on my father. Triplet therapy?
Triplet Therapy Failed. Now what?
Current PCa treatment options in the UK do NOT include Triplet Therapy!
