PSMA Results...and decisions ahead

[shueswim]

Quick summary:

- G9 PCa Dx in 2016: RP and adjuvant radiation and ADT therapy.

- 2018 biochemical recurrence with 6 week PSA doubling time.

- Participated in Condor Trial. PSMA scan located recurrence in a handful of LNs. Treated with RT and 20 months of ADT/abiraterone/prednisone.

- Undetectable (<0.02) PSA for 33 months...until Oct. '21

- PSA reached 1.08 July '22 w/PSADT of 2 months

- PSMA scan 7/25/22: two mets detected: "right transverse of T3 (SUV max 15) and lateral aspect of the left eight rib (SUV max 8.2)"

No discussion about this with doctors yet, appointments set with RO and MO next week. I'm hoping to hear that RT is possible from the RO. I assume the MO will recommend some systemic therapy to accompany the RT.

Any thoughts or suggestions going into those appointments would be appreciated.

Gene

[Blueslover]

Hope you get some great advice Gene

[tango65]

If I understood correctly, you are not on ADT at the present time.

The PET/CT indicates you have oligometastatic mCSPC. The SOC will be ADT plus one of the new anti androgens. You could go outside the SOC and try direct treatment of the mets which could delay the start of systemic therapy.

urotoday.com/conference-hig...

jamanetwork.com/journals/ja...

[DMohr011]

I wish you the best with whatever they come up with!

[GeorgeGlass]

what is your current platelet count?

[shueswim in reply to GeorgeGlass]

178…in the “low normal” range. All my blood number are low normal. Probably related to the radiation treatments of the past. Why do you ask?

[GeorgeGlass in reply to shueswim]

You don’t want to have low blood levels if you do lu 177. Your numbers are good.

[Ramp7]

After 18 months, Lupron and Zytiga were loosing their effectiveness. PSA doubling time was 3 months. In December of 2021 accepted in the LuPSMA177 trial at Dana Farber. There were mets at L4 and lymph node in left groin area. Prior to interring the trial I had 5 sessions with the radiologist on the spine. PSA has gone from 8.1 to 0.23. My scans state cancer is stable. That's my story. I contacted Dr. Beltran directly at Dana Farber myself and it worked out. Something you may consider.

[Brysonal]

When I went ogliometastatic ( T1 and third rib) my RO in London said to try SBRT to both first to see if I had the ‘abscopal effect’ noted in 30% ( her number). I did this over 2 weeks and all was well for 6 months when my PSA took off and mets landed all over my skeleton. So o wasn’t one of the 30% despite those mets responding. 10 months later I was fully metastic and needing urgent systemic treatment.

I went beyond standard of care:

Degarelix ( SOC)

Early Lu-177 x 3

Early Docetaxel chemo ( x 3) Soc would have been 6

Stampede trial type radiotherapy to prostate and pelvic area ( Soc for my sub type based on basic scans done as opposed to my advanced scans.

SBRT to T9 which seemed stubborn after Lu-177/ Docetaxel

2 x Brachterapy to prostate

Now on Degarelix and Apalutamide and PSA < 0.03

My onco has taken a early v aggressive approach using standard of care base but with a fair few add ins.

No idea what all this achieved or if it would be any different if I’d just gone straightforward SOC

Appreciate I haven’t left much on the table which could come back to bite too!

59 now and still assymptomatic bar the tiredness from HT which has also robbed me of my libido of course.