Rounding the corner of 3 yrs on Keytruda

[Chugach]

Hey brothers, I hope your all hanging in there. It’s been awhile since I’ve posted. Hoping for some feedback on this update.

read my bio if you want the nitty gritty details. Very brief summary: Dx at 46 stage 4 Gleason 9; ADT; Chemo round 1 (etoposide/cisplatin) concurrent with pelvic radiation; Zytiga; High T clinical trial; enzalutamide; targeted radiation on bone Mets; chemo round 2 (docetaxel)…. Hail Mary = Keytruda (MSI-h)

For the first year on Keytruda my PSA was undetectable; from the second year to now (almost yr 3) it has slowly built from undetectable >0.01 to now 0.71. Bigger numbers grow faster. So it’ll keep gaining.

I’m still on Pembro (Keytruda) and ADT. Just finished Keytruda infusion #26.

I got a PSMA PET (18F) a few weeks ago. Nothing showed up at any of the prior distant bones mets (awesome!!). The only thing of note was: “PROSTATE: Intense radiotracer uptake at the level of the prostate apex and mid gland involving left posterior and medial peripheral zones with suspected extension along the left seminal vesicle.”

my assumption is the Pembro killed all the MSI-h PC and I’m left with some kinda more normal PC that is likely not MSI-h.

I’m now 52; my kids are still at home (high school) and I’m still working FT. Anyway I want to hammer this dragon before it’s builds momentum. One Rad Onc said probably shouldn’t get more radiation to the prostate area. (No offense guys- but it seems these rule books were built as palliative for guys in their 70’s focused on QOL not max time ); I want them to fry this spot or cut it out. I want to slay this damn dragon.

Alright brain-trust: Whatcha thinking?!

[tango65]

The original tumor in the prostate may have a different genome than the mets. This is some info about re-irradiation with SBRT or high dose brachytherapy.

ncbi.nlm.nih.gov/pmc/articl...

frontiersin.org/articles/10...

[Tall_Allen]

You may want to biopsy those suspicious areas of the prostate to see what is really going on there. MSI-hi is typically found in prostate tissue.

[Chugach in reply to Tall_Allen]

Hi Allen - I’m assuming the areas of tracer uptake are PC. Is this a likely correct assumption ? Assuming it is PC then I’m not sure what a biopsy would tell me. Can you clarify please? I’m thinking just cut it out rather, perhaps this specific site is more encapsulated and I wonder if a biopsy could contribute to further spread?

[Tall_Allen]

False positives are common in the prostate.