Treatment Plan- I Need Your Ideas...

[goodgoal]

Hello,

My father's PSA value was 24 in February 2022. According to the biopsy results, 8 of 13 foci had a Gleason score of 10. Ga-68 PSMA PET scan revealed metastatic prostate cancer. There was no spread in his bones. Her chemotherapy started in February 2022 and ends in June. He also gets a Zoladex injection every three months. His PSA dropped from 24 to 0.0876 in the process.

Coming to my question, his oncologist said he would do a PET shot at the end of June. According to him, he mentioned that either radiation therapy or surgery could be done. He said that he would decide this situation according to the shooting results. But with PSA at this level, I guess the shots won't show any metastases.

I'm curious about your thoughts on this subject. What should I ask the doctor?

[Tall_Allen]

Where were the metastases? How many?

[goodgoal in reply to Tall_Allen]

Hello Allen,I could not find out how many in the report, but there is reporting as follows:

- In the pathological appearance of the seminal vesicles, increased PSMA uptake was not selected.

- One subcentimetric lymph node located in the right presacral area of the pelvis with slightly increased PSMA uptake was observed.

- In the upper sections, another lymph node, approximately 1.5 cm in size, with increased PSMA uptake, located in the midline in the presacral distance, was observed.

- LAPs with intensely increased PSMA uptake were observed in bilateral obturator - internal iliac and external iliac lymphatic stations, the largest axial dimension of which was approximately 3.3 cm.

- There is a LAP located in the right upper paratracheal area in the mediastinum, with its widest axial dimension measuring approximately 2 cm, showing intensely increased PSMA uptake.

[Tall_Allen in reply to goodgoal]

It has been found that prostate radiation is still useful when there are 3 or fewer distant/bone sites of cancer. Most of his cancer is still in the prostate and pelvic lymph nodes.Your father has only one probably cancerous lymph node that is distant from the pelvic lymph nodes - the one in the paratracheal area. It is therefore a good idea for him to have radiation to his prostate (called "debulking").

prostatecancer.news/2018/09...

I don't know what he is looking for in August. He can have the prostate radiation now.

Consider adding Nubeqa (darolutamide) now. If you wait, it will be useless. This was recently discovered in the ARASENS trial and his oncologist may not be aware of it:

prostatecancer.news/2021/05...

[goodgoal in reply to Tall_Allen]

Thanks Allen for your valuable ideas. I can't convince his oncologist for abiraterone or Nubeqa as my father is not currently hormone resistant. The doctor keeps telling me this.PET scan doesn't make sense right now does it? What kind of screening would you recommend to find out about my father's current status?

[Tall_Allen in reply to goodgoal]

You obviously didn't read the article about ARASENS. I don't understand - he already had a PET scan, didn't he? You wrote: "Ga-68 PSMA PET scan revealed metastatic prostate cancer"

[goodgoal in reply to Tall_Allen]

I may not have been able to express myself fully due to my bad English. I'm so sorry Allen. I read the relevant article, but as I said, the doctor is not convinced. Yes, PET was done beforehand, but at the end of chemotherapy, the doctor wants to see what happened again.

[Tall_Allen in reply to goodgoal]

I recommend you email this to his doctor:

nejm.org/doi/full/10.1056/N...

They proved the benefit of chemo+darolutamide in newly diagnosed patients.

[Hidden]

How old is dad? 54? I’m pretty sure that no surgery will be done after chemo is used? The psa is responding . My high psa was 20 but it was aggressive just the same . Lots of love to dad is the best medicine . Just get him through the chemo . Good luck

[goodgoal in reply to Hidden]

Hello, my father is 54 years old and receiving chemohormonal therapy. He has one last chemo left. We are always with him.

[Hidden in reply to goodgoal]

I was 53 myself starting this in 2015 .. I’m no expert here . But You being by his side is in greatly in his favor .. some have lived for decades beyond even worse conditions . There is much hope to put this down for years . He will suffer losing t . If he can exercise often it helps everything . Good looking out for him . Keep him up ! Love rules ! My dad had this too . It sucked . Don’t feed into negative people! Take care .

[Garbonzeaux in reply to Hidden]

I had RP surgery a few months after taxotere chemo, but it was part of a clinical trial.

[goodgoal in reply to Garbonzeaux]

Hello, thank you for your answer. How is your treatment going? I am wondering.

[Garbonzeaux in reply to goodgoal]

So far, so good. I have had undetectable PSA and clean scans for over 4 years and am currently on Lupron vacation (since Nov.). I'm due for testing next month, so we'll see if all still OK.

Thanks for asking.

[goodgoal in reply to Garbonzeaux]

I am so glad you are well. I wish you healthy life.

[Hidden in reply to Garbonzeaux]

That’s great! 👏👏

[Hidden in reply to Garbonzeaux]

Wow! I did not know it could be done . Did it work?

[Balsam01]

With such a high Gleason score, I would think that genomic testing would be warranted to look for mutations some of which are treatable.

[Justfor_]

You wrote: "His PSA dropped from 24 to 0.0876"

I don't know of any lab reporting to 4 decimal places (4 digits after the decimal point).

I guess it is 0.876. Right?

[goodgoal in reply to Justfor_]

Hello, this is what it looks like on the hospital report.

rapor

[Justfor_ in reply to goodgoal]

Interesting, I wonder what analyzer they may be using, but this is no concern of yours.

Your father is quite young and in such cases radical prostatectomy is the preferred procedure, so that irradiation can be saved for later.

[goodgoal in reply to Justfor_]

Yes, I was wondering too. I will definitely ask when I go. Thank you very much for your reply.

[CharlestonSC in reply to Justfor_]

Hi Justfor. LabCorp has an Ultra Sensitive PSA test. My PSA has been consistent at 0.002 for 13 years after Brachytherapy

[Justfor_ in reply to CharlestonSC]

Three decimal places isn't hard to find. Four, is the first time that I come across. Ten years, or so, ago there was one down to five (5) decimal places, yet it didn't meet market success, so I gather is not in production today.

[j-o-h-n]

Where are you and your Dad located (country/city)?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/22/2022 5:44 PM DST

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

Hello, Istanbul, Turkey.

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

Hello Pasha...... I am a Hamal. As my father used to say when he banged his finger or was just angry: Sickteer...

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/22/2022 9:58 PM DST

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

Mine: kiopoglou kiopek (son of a bitch)

[Cooolone in reply to Justfor_]

It's hysterical that mostly, we learned the BAD words of a language first...

😂😂😂🙂🙃🙂🙃🙂🙃🙂🙃

[Justfor_ in reply to Cooolone]

True.

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

I'll use that one on my ex-wife.......... Thanks

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 05/23/2022 9:35 AM DST

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

that's great we mostly use this

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

Except for "afendi and fezz" that's all else that I know in Turkish. I am Greek and my Father and Mother spoke Turkish when they didn't want us to know what they were saying....

Welcome to the best Pca information and camaraderie site in the U.S. Keep posting.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/22/2022 10:05 PM DST

[MateoBeach]

Re-emphasizing: send the article link T_A gave you to on the ARASENS trial to your oncologist and ask him to read it before your next visit. If he still will not prescribe the darolutamide ask to be transferred to a different oncologist. Or go elsewhere if you need to.

[goodgoal in reply to MateoBeach]

Hello, thank you for your reply. Darolutamide is not available in Turkey. Only abiraterone drugs are available.

[goodgoal]

Thank you very much for your reply. So can mets appear in such a low PSA?