Planning Ahead. Input very welcome

[PhilipMac]

Planning Ahead. Input very welcome 

Looking at future options. Would welcome input from you very knowledgeable folks. 

History: Dx Feb 2012 (PSA 7.7 Gl3:4, Age 51). Met to a rib (resected in diagnosis). T1/No/M1 -  Zoladex 10.8mg/3 months.Early 2013 – elected radiation to prostate bed 57.5 Gy/25FR. PSA nadir <0.01 June 2014. Ceased Zoladex one year later. PSA  slowly rose, reaching 0.58 June 2020. PSMA scan revealed met in pelvic lymph node. June – radiation 57.5Gy/25Fr. Nadir 0.10 reached Oct 2022. PSA bouncing around – apex Jan 2023 (0.20). Now 0.16.

Best options ahead – noting I’m based in Australia under Peter Mac hospital (best cancer centre in country)

1. Keep current regime and wait till PSA reaches 0.5. PSMA scan with option for further radiation treatment if found in a couple of spots. Not sure if my ROnc would do this?

2. Re-start Zoladex but at what PSA level should I start?

3. Combination of 1 and 2

4. Am I missing some other treatment option?

Your input would be very welcome. Much appreciated. 

[tango65]

it seems the cancer is metastatic castration sensitive .

Consider to start ADT (lupron, firmagon or similar drugs) and add abiraterone or one of the other anti androgens (enza, apalutamide or even darolutamide).

I would not wait until mets are consolidated and PSA starts going up more rapidly. If you had bone metastases there was systemic (blood) dissemination of the cancer .

Other possibility outside of the SOC is to do intermittent ADT and zap the mets that appear if there are less than 5.

healthunlocked.com/advanced...

It is unknow this approach will be beneficial in terms of prolonging your life. It has some advantages in progression free survival and time expend in eugonadal testosterone

[Tall_Allen]

IMO, you should have been on Zoladex all along. Your doctors are misguided in their reliance on PSA after resecting your rib met. There is no evidence that this was a safe strategy.