6 months in and ADT already failing

[mysticmini]

6 months of ADT and already failing. Firmagon and Zytiga. Was scheduled to have surgery, but that's off the table since its spread to lymph nodes in neck region. Starting chemo next week. Looking for stories of hope. How long do we have? To know its already MCRPC is devastating.

[Tall_Allen]

What did biopsy of metastasis show, if anything? Any histology or IHC results?

[mysticmini in reply to Tall_Allen]

Still awaiting full results of biopsy. Oncologist has sent for staining to see if possible neuroendocrine (praying its not) It is showing as cancer, but not established what kind yet. However, it also lit up on PSMA scan. The same one that was biopsied as well as another one higher up in chest cavity. ATM mutation was identified in genetic testing. Asked oncologist about lutetium-177 but was told its only offered to men who have already tried chemo.

[Tall_Allen in reply to mysticmini]

There are many possibilities other than NEPC - some have clinical trials. Let me know what it says.

It sounds like Pluvicto would not be a good choice for you anyway because of your discordant PSMA/FDG scans.

[mysticmini in reply to Tall_Allen]

Not sure what you mean by discordant PSMA/FDG scans? Same spots lit up on both scans,

[Tall_Allen in reply to mysticmini]

"new FDG avid lower cervical and retrocrural nodes" - those also lit up on PSMA?

[mysticmini in reply to Tall_Allen]

Yes, correct.

[Shorehousejam in reply to mysticmini]

How are you doing presently? Has MSK offered any treatment?

[EdBacon]

PARP inhibitors are one option for treatment with an ATM mutation. Something to discuss with the doctor.

I hope it's not NEPC too, but if so Carboplatin could be added to the chemotherapy regimen.

[Seasid]

What is your PSA now?

[mysticmini in reply to Seasid]

.53. But its always been low. 1.4 at time of diagnosis.

[Seasid]

What made you think that your therapy failed?

[mysticmini in reply to Seasid]

PSA rising and new mets to distant lymph nodes.