Is the a standard/preferred course of treatment for mixed ductal PC (post- RALP, post recurrence in prostate bed, post radiation)?

[Caldonia]

Gleason 8, 3 mos post-prostatectomy PSMA showed spot in prostate bed, just finished radiation of pelvic bed, in month 4 of Lupron (2 years planned). No evidence of spread outside prostate bed; recent psa was 0.4

Oncologist is a swell guy, but I don’t sense he has a great depth of experience with ductal. I’m also a tiny bit concerned about the psa reading.. was expecting <0.2… I know 0.4 is not huge, but after 3 months of ADT and a full course of radiation, I would have thought undetectable was likely.

Thanks for any info!

[Tall_Allen]

I think it responds with early heavy hormonals and chemo. It is usually a lower PSA subtype, so I don't know how useful PSA is in monitoring it. Maybe monitor with an FDG PET/CT.

Because ductal is rare, I don't think anyone has a lot of experience with it. If you want an oncologist with more experience in treating ductal, you can get a second opinion from Oliver Sartor at Tulane or Brian Chapin at MD Anderson.

[Caldonia in reply to Tall_Allen]

Perfect info. I’ll contact those folks and see if there’s something else I should be doing.

Thanks so much!

[Gl448]

Was your PSA ever high?

I also have ductal type PCa, and my PSA never went above 1.1 until a TURP and other physical trauma to the Prostate. Despite the low PSA it managed to spread to spine and pelvis bones.

Biopsy of a bone met showed PSA-negative tumor (PSMA-positive).

That’s a long way of saying I agree with Tall_Allen that PSA isn’t a good way to monitor ductal cancer.

I’m not sure how my MO plans to monitor after chemo triplet theory is finished.

[Caldonia]

My prostate biopsy showed a large mass on the right, all samples with ductal features, and a small mass on the left, samples showing normal adenocarcinoma. I assume that’s what they call “mixed”.

My assumption is that mixed type may not have the low psa of ductal, making it easier to detect, but still spread more readily like pure ductal. It’s hard for me to find a clear signal about how to proceed, since it appears much of the data on ductal is post- spread.

One thing I’m really unclear on is whether mixed type proceeds as a hybrid cancer, with characteristics of both types ( meaning psa would still be meaningful as a signal), or if the ductal can spread separately (meaning psa is not meaningful).

[DesertDaisy]

My husband also has ductal and acinar. His PSA is currently undetectable and his MO says no treatment is needed until he becomes detectable. He also says no scans are needed until he becomes detectable.

We have met with the RO who also agrees that no treatment is needed until he becomes detectable again.

Prior to surgery in April of 2021, where one positive lymph node was found, his PSA was 12. After surgery he was given a 6 month Lupron shot and his testosterone has since recovered.

I am not at all comfortable with this, but my husband is happy not to be taking anything and he feels great. He is being seen at Mayo Clinic.

[j-o-h-n]

youtube.com/watch?v=K8J3vdV...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 10/30/2023 5:56 PM DST