Follow up after MO Visit and PSMA Pet

[Keeper70]

I have taken a lot of information from this group and so very much appreciate it... Here is where my husband is at.. Saw MO and discussed the PSMA... he is castrate resistant, psa is at .20 as of Friday.. The most interesting idea she has was to try to immediately get rid of the cancer still looming in the prostate by 2 cycles of Docetaxel........ She also is taking him off Casodex and prescribed Zytiga. We also were advised to contact a radiation oncologist ... They want to UR to biopsy his prostate again and the 1st one in 2018 and send these samples to Caris. Life Sciences ( profiling tumors) ........ Once that info is obtained and analyzed,.. the MO will follow up with us and give us best treatment options....... My question and I hope you all get this explanation.......do you think we can he wait to do Chemo for a few months and just start the Zytiga/Pred? .. . we are going to spend the winter in AZ.... Have health care set up there till we're home in April.. thanks to all, J

[tango65]

Zytiga offers a survival advantage in mCRPC,

pubmed.ncbi.nlm.nih.gov/289...

Please, let us know about the RO opinion.

[Keeper70 in reply to tango65]

thank you Tango65, will do

[tango65 in reply to Keeper70]

Best of luck.!!

I agreed with TA .

I do not understand why they want to do docetaxel, which is usually used in cancers with more than 4 or 5 metastases and particularly in his case since he had docetaxel before..

The best way to stop the cells coming from the prostate is to treat the prostate with radiation.

Perhaps they could do a biopsy of the metastases in the lymph nodes, since the genome of mets could be different than the genome of the primary tumor.

[Keeper70 in reply to tango65]

that makes a lot of sense! Thank you

[Tall_Allen]

Docetaxel has no significant value unless there are rapidly growing metastases. I don't know what the value of 2 cycles is. Genomics are more relevant for metastases than the prostate.

[Keeper70 in reply to Tall_Allen]

So he should wait until they get the biopsy sample sent over to Caris correct? He’ll still be doing Ellegaard plus Zytiga and Pred

I’m not sure why she suggested Chemo other than There are cells that are trying to escape prostate and that would “nip it in the bud”

[Tall_Allen in reply to Keeper70]

No, I said biopsy a metastasis.

Chemo only kills actively growing cells; it doesn't "nip them" when they aren't actively growing.

[Keeper70 in reply to Tall_Allen]

I do believe that he has active cancer, is what PSMA pet showed and why they want a biopsy and would see an RO as well

Thanks so much ! Replies very much appreciated as I am learning so much here and trying to get a handle on all this.

[Tall_Allen in reply to Keeper70]

When it is actively growing, PSA is increasing rapidly. The cancer is sometimes active, sometimes dormant. PSMA PET just shows sites where there is cancer, not how active it is.

[Keeper70 in reply to Tall_Allen]

Hmmm, so what determines active cancer? His psadt has been every 3 months May <0.05 august .1, sept .17, Oct .19 , November .2

Doubled from May to August and doubled again august to November

I know you think that’s low, but his psa was 4.1 at dx

More to this story I think but appreciate your responses

[Tall_Allen in reply to Keeper70]

PSADT requires 2 tests, all over 0.1. It is not defined for values below 0.1. Use this calculator:

mskcc.org/nomograms/prostat...

Active cancer requires evidence of quickly dividing cells. For those with low PSA, such evidence is provided by imaging showing enlargement or spread of metastases.

[Keeper70 in reply to Tall_Allen]

thank you TA, That tool was very helpful as was the link to their website. I now have another new resource! Love technology!!

[TJGuy in reply to Keeper70]

Eligard side effects can be more severe than Lupron for many people. They do the same job.

[Keeper70 in reply to TJGuy]

thank you TJGuy! The switch was made due to difficulty getting Lupron back in 2019, he does well in Eligard so far , we will see how Zytiga and Pred performs with it. Casodex failed after 8 months

[slpdvmmd]

Have you also had a radiation oncology consult? Do not exclude Lu177 or other radioligand. Experience with radioligand therapy in the USA is in the infantile stages. Radioligand therapy may have a role. You can often get an opinion out of country of your PSMA/PET where they have more experience. I did this by uploading to people in Australia and Germany.

[Keeper70 in reply to slpdvmmd]

slpdvmmd, thank you, we are in process of setting up RO now, good idea to consult MO in other countries, we are a little behind their research and advances and have thought about successes with LU177 as possible treatment down the road

[yeatz]

sorry for the late reply. /this is mrs yeatz now. mr yeatz lost his multi-year battle frrom complications that prevented continuing his cancer treatments. i wish you the best.