Amphicrine PCa

[TeleGuy]

Greetings, fellow travelers!

I haven’t seen this term used around the forum but since I have it, and I think (from the treatment protocols I see) that others do too, I thought I’d tell this part of my story as that’s where I am right now. I’m 7.5 years in from G9 T3b PCa with RRP (see my profile)

“Amphicrine” seems to be a stop on the progression from adenocarcinoma to neuroendocrine. Here’s a paper that explains this state:

pubmed.ncbi.nlm.nih.gov/287...

I’ve had a good 16 months of undetectable PSA after five LU-177-I&T treatments in Germany, the last of which showed a collection of paraaortic lymph nodes still drinking the juice despite an undetectable PSA that made us decide to stop. I’m now just over two years from the end of those treatments and starting my next.

The same aortocaval node that was drinking the Lu177 was the first to wake up, so we did what I think was a fairly miraculous biopsy. The pathology revealed that the cells look like adenocarcinoma but they stain for the neuroendocrine markers NKX3.1, synaptophysin, and chromogranin. The pathologist reports that the findings are consistent with metastatic prostatic adenocarcinoma with neuroendocrine differentiation. And my MOs label the state as “amphicrine.”

My MSK IMPACT study of the sample shows that I’ve inherited a PTEN mutation in addition to the TP53 that we already knew about. I also have AR and LZTR1 mutations (and a bunch of copy number alterations I’m not going to list).It seems that there are some promising treatments coming up, including some DLL3-targeted therapies and a BiTE therapy, but these are all for the post-chemo state. So yesterday I started my first treatment with a combination of docetaxel to hit the plain old prostate cells and carboplatin to try to push back on the neuroendocrine component. So far so good.

I included a biopsy photo for fun. The lymph node is tucked right between my aorta and inferior vena cava (IVC), and the doc was able to push down hard enough to move my guts out of the way to get a straight shot in through my chest. The pressure also separated the vessels from the node to make it easier. You can see my aorta to the right, the LN in the middle right, and the IVC is kind of crunched and not highly visible. You can see the trace of the probe and the shock wave from the spring-actuated sampler getting its piece of the lymph node. That's coming in from the left. Everyone was happy that this approach worked!

[Hidden]

Eeeek. That's some biopsy.

[PresidentOfBelgium]

Hi there, I just joined and wanted to reach out to you since I have been diagnosed with amphicrine PCa last March. I started right away with ADT and ARPI treatment and got 6 times Docetaxel. I am still taking the ADT and ARPI drugs but the Docetaxel has been stopped for now. Today I got a bone scan and I’ll have a CT scan tomorrow to check how good (or bad) the metastasis nodes have reacted on the drugs so far. PSA has decreased systematically since treatment was started and is now down to 0.56. Same for NSE, down to 9. On Friday I’ll have my appointment with my urologist. Needless to say that my wife and I are crossing fingers until then.

I wish you a nice day and I am looking forward to reading your feedback on this forum .

Greetings from Belgium, a small kingdom west from Germany,

A.

[TeleGuy in reply to PresidentOfBelgium]

Hi, welcome to the group! I'm sure you will find lots of valuable information here!

It would help if you put more detail in your profile. Do you know you have amphicrine PCa from a biopsy? It sounds like you must have a high disease burden given that you jumped right onto triplet therapy? When mine mutated into amphicrine, my first treatment after that was chemo with docetaxel+carboplatin, which is supposed to help with the neuroendocrine component. You mention your urologist, if you don't already, you should find a medical oncologist at a center of excellence to be the main driver of your treatments. It sounds like you are having a good response so far!

[PresidentOfBelgium]

Many thanks for your advice about updating my profile...I'll surely follow up on that one.

Indeed, the "amphicrine" diagnosis was done from a biopsy.

I will have probably more things to share as from Friday.

Take care !!!

[CAMPSOUPS]

Hmmm. The good with the bad.

The good you had 16 months of benefit from Lu-177 after the 5th infusion?

Its a selfish question lol. So far 4 months post Pluvicto I'm having great results.

[TeleGuy]

Right, I don't think I can blame any one treatment, the longer you treat the more crazy the mutations become. People didn't used to live as long with this cancer as we do now.

I hope you continue the good run on Pluvicto! I just got three more months after two more treatments along with darolutamide. PSA is rising now, figuring out what to do next.