Need advice before Monday doc appt!

[Sewinggam]

Quick summary - my asymptomatic husband was diagnosed in June with metastatic prostate cancer from his pelvis to his lungs to the soft tissue in his brain.  PSA 9 at the time.  Lung biopsy and gene tests confirmed ordinary adenocarcinoma. He was immediately given Firmagon (which then moved to Lupron), had SRT radiation to his two brain lesions, and was started on Docetaxal.  Zytiga was added halfway through chemo.  Last PSA was in the 3’s.  He is now going for his sixth chemo and had MRI, CT and bone scans on Friday.  One brain lesion is what they call punctate (a dot).  The other is half its old size.  Of three bone lesions, only one in his pelvis is still visible.  The tumors in his lungs have also decreased in size.  My question is - what should we be asking the doctor tomorrow?  I’m sure he will offer next steps and I want to be prepared.  Since my husband is still asymptomatic, I was wondering if he might be a good candidate for Provenge.  Is it better to keep going and do 10 rounds of Docetaxal or keep that in the arsenal for later?  My husband has tolerated it extremely well.  What else should we think about/ask?  Thank you so much!

[GP24]

Your husband does not need additional therapies for now. He can just continue with Lupron and Abiraterone for a year or two.

[Boywonder56 in reply to GP24]

Maybe erleada......

[GP24 in reply to Boywonder56]

It will not make a significant difference if you drop Abiraterone now and use Erleada instead.

[Sewinggam in reply to Boywonder56]

thank you!

[Sewinggam in reply to GP24]

thank you!

[Tall_Allen]

That's a great response! Maybe he can reduce the rest with some more docetaxel? I think Provenge with docetaxel is an excellent combination. Docetaxel increases the presentation of dead cancer antigens to Provenge, and provenge supports immune function that is depleted by docetaxel.

[Sewinggam in reply to Tall_Allen]

Thank you! Since he is tolerating everything so well, I feel like we should stay aggressive and try to wipe out everything we can while we have the chance.

[cesces in reply to Sewinggam]

Statistically it best to hit adaptive diseases like this hard and heavy early with punctuated treatment as opposed to slowly escalating treatment.

This increases the time it takes for the disease to adapt.

[Schwah in reply to Tall_Allen]

but won’t his insurance company refuse Provenge because he still spreads to be castrates sensitive?

Schwah

[Tall_Allen in reply to Schwah]

He's had new metastases and PSA over 2 while on ADT- that defines castration resistance.

[GP24 in reply to Tall_Allen]

I understand that he was diagnosed this year. "Biopsy in Jun confirmed Gleason of 4+3 and 4+4. " He got triple therapy but is hormone sensitive still.

[Tall_Allen in reply to GP24]

If he only reaches PSA of 3 on ADT, I think he is not very hormone sensitive.

[Tall_Allen in reply to Tall_Allen]

If his insurance agrees, I think Provenge would be useful now with docetaxel.

[Bspouse in reply to Tall_Allen]

Hi Tall-Alan -. So my husbands PSA is still dropping slowly on ADT and abiraterone. But now down to 3.95 after starting ADT Oct 2021 and Abi January 2022. Does that mean he is NOT very hormone sensitive? I thought that , as long as it keeps dropping, he is still hormone sensitive. Thank you - Always value your opinion

[Tall_Allen in reply to Bspouse]

Prostate cancer does not go from hormone-sensitive to castration-resistant all at once. It is a process that occurs over time as the genomics of the androgen receptor evolves. If his PSA hasn't gone below 3.95 after years on ADT and many months on abi, there are a lot of castration-resistant cells, but also some hormone sensitive cells. I think his oncologist can convince his insurance to cover the drugs that are only allowed for castration-resistant patients. Earlier use is usually better.

[Bspouse in reply to Tall_Allen]

Wow. A little disturbed by this - but what you are saying makes sense. But he has only been on ADT for a little over a year - not for years - does that make a difference? MO has mentioned the possibility of additional docetaxel down the road - ( he had 6 rounds of chemo last Jan - April) but I guess, since husband is feeling OK, we thought we had more time. I will suggest Provenge then too.

[Tall_Allen in reply to Bspouse]

Everyone's cancer is different. I think docetaxel+Provenge makes a good combo.

[Bspouse in reply to Tall_Allen]

thank you

[tango65]

He is in triple therapy now and he received spot radiation to the brain mets. He has been treated correctly.

Since his PSA is 3 you could discuss having a PSMA PET/CT which is more sensitive than the imaging studies previously done, just to be sure all the brain lesions are under control.

[Sewinggam in reply to tango65]

thank you!

[tango65 in reply to Sewinggam]

Best of luck!!

[cesces]

Sounds complicated.

Start setting up second opinions. Mayo is good for complicated situations.

[Brysonal]

a history of PSA on your profile would help. It took 7 months of treatment for me to teach my Nadir of less than 0.04.

Hope today went well