Low PSA producing PCa. MO discontinued Abi +Pred. Is this right?

[Sparkler1]

My partner is Gleason 9, grade 5, BRCA 1. Highest PSA at diagnosis and prostatectomy was 2.67. Started on Lupron right away. Abi and pred started when PSA went to .26 a year after surgery.

We’re in Florida for a few months and went to Moffit for a second opinion. Doctor took him off abi and pred right away (he’d been on for 2 months). He said with low producing PSA cancer the risk of it flipping to neuroendocrine cancer is high so you don’t want to throw a lot of drugs at it right away.

Does this sound correct?

[Tall_Allen]

Treatment-emergent NEPC has not been reported in mHSPC, and is not a reason to avoid hormone therapy. Low PSA subtypes respond well to intensive hormone therapy. Here's what Rahul Aggarwal said:

"“Although long term androgen deprivation therapy may be associated with the development of treatment-emergent small cell neuroendocrine prostate cancer (t-SCNC) in a minority of patients, multiple studies have confirmed the long-term benefit of abiraterone and enzalutamide for prostate cancer patients in various disease settings. Use of these agents should not be limited by concern for the subsequent development of t-SCNC.”

You may want to get a second opinion from Rahul Aggarwal at UCSF.

[Sparkler1 in reply to Tall_Allen]

Thanks for the response. We’ll connect with Rahul Aggarwal. I appreciate you, and this group, so very much.