I’ve got mixed ductal PC. I’m post RALP, post-rad, 6 months into ADT. Setting research about the increased likelihood of metastasis with ductal, and the unreliability of PSA in indicating ductal, I’m anxious to touch all bases before it goes to lungs bones brain or liver. I’m already scheduled for every-6-month PSMA PET scans (although I’ll be asking whether FDG PET is available instead).
I should have the initial genetic consult soon, but I’d like to have a good sense of what’s involved in the process beforehand.
I had an Ancestry test years ago and submitted it to Promethease, which identifies SNPs that may be associated with different traits/diseases. I just checked, and I have quite a few associated with PC. So I’m anticipating confirmation with the MD genetic process.
My main question: we identify specific genetic mutations. What then? Are there medicines or chemo specific to the variations? Are those initiated before evidence of metastasis? Questions I should ask them?
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Caldonia
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Very little is known about genomic tailoring of treatments, and there are few therapies available for genomic issues (with the exceptions of BRCA+ and MSI-hi/dMMR). But it may direct you to clinical trials.
Ductal prostate cancers are associated with a higher incidence of DNA repair genes (HRR defects), such as BRCA, ATM etc which could make them susceptible to treatment with PARP inhibitors such as Olaparib, Rucaparib, Talazoparib etc.
There are recent clinical trials showing an advantage when cancers with those mutations are treated with a combination of abiraterone and olaparib, or enzalutamide and Talazoparib.
Ductal cancer may be also associated with PTEN loss which is a mutation favoring replication of the cancer cells and there is not specific treatments a this time. One drug Ipatasertib showed some advantage in PTEN loss cancers but it was associated with significant adverse events.
My APC is also ductal type and my genetic testing shows messed up MSH2. Made me eligible for Keytruda, which I believe did the bulk of my cancer killing.
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