Advice on mets needed

[Cygnus52]

Uncle, 83, active, asymptomatic, no diseases other than PC, had RT early 2019, with post- surgical PSA detected at low level, followed by radiation therapy, after which low level psa still persisted but did not increase significantly until recently when it jumped to 3.5, more than doubling in 6 month period. Pylarify scan revealed apparent mets on spine, ribcage, pelvis in small numbers. His urologist suggests lutron+ docetaxel. This is a relatively rural area far from big cancer centers. Is this treatment optimal? Can he/ should also get radiation treatments for the detected lesions? Other options? And, at his age, how aggressive should he be with rigorous treatments, taking into account remaining quality of life? Is there a regimen, short of “going all out,” that might gain him a bit more time without taking too heavy a toll on day to day quality of life?

[Hidden]

if 5 or less metastases whack a mole seems a good idea to me. By that i mean radiate those little spots and kill them till they form somewhere else, which they will, but maybe on down the line a ways. Lupron will zap his testosterone and energy but is a more systemic treatment. Up to him really. If radiation he may have to say they hurt so that it is considered palliative. Maybe, I don’t know Medicare’s position on that.

[Cygnus52 in reply to Hidden]

Thanks!

[Hidden in reply to Hidden]

Actually, the radiologist will determine if it will be done. Lying about pain is not a good idea.

[tango65]

ADT plus zytiga has the same results or better than ADT plus docetaxel and it may be better tolerated. He needs systemic therapy with a metastatic hormone sensitive PC with bone metastases.

[Cygnus52 in reply to tango65]

Thanks. will look inti Zytiga.

[Cygnus52]

Thanks. will look into Zytiga.

[j-o-h-n]

I'm 86 and had been taken Lupron and Casodex for about 15 years. Just stopped the Casodex last month and replaced it with Nubeq/a (/ = no U). I managed for a total 20 years fighting the fucking scoundrels.....Tell him he'll be around till he's 95 at least.....

j-o-h-n <===<<< Senior management is about to spike my spikes....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/16/2023 11:23 PM DST

[Hidden in reply to j-o-h-n]

You are amazing. In many ways! ❤️

[Cygnus52 in reply to j-o-h-n]

Thanks. Nubeqa looks promising.

[Cygnus52 in reply to j-o-h-n]

j-o-h-n, in your long and highly successful battle have you used any so-called “alternative” therapies? Also, just found this newly published paper on treating PC mets in an animal model. Not suggesting anybody try this but it is intriguing. rdcu.be/dab6f

[j-o-h-n in reply to Cygnus52]

to: Cygnus (swan song),

Nope.... I'm a straight arrow with my M.O. If he says bend over..... I say Oh Not Again Doc...... Especially since I had the "mother ship" removed in 2002...Do you think he's having fun? As far as the treating animals goes.......I think they should begin with gang bangers in our major cities............

j-o-h-n <===<<< Senior management is about to spike my spikes....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/18/2023 12:15 PM DST

[Cygnus52 in reply to j-o-h-n]

Thanks.

[j-o-h-n in reply to Cygnus52]

You're welcome. Reminder: Don't forget to tell your uncle 12 more years to go....Time enough to meet a nice woman and have some fun....

j-o-h-n <===<<< Senior management is about to spike my spikes....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/18/2023 1:45 PM DST

[Cygnus52 in reply to j-o-h-n]

Thanks he's working on that; his older brother is 99 and has a very lively 52 year old girlfriend

[j-o-h-n in reply to Cygnus52]

Holy chit.............I'll have to up my prediction by 4 to 5 years......God Bless your two uncles.......

j-o-h-n <===<<< Senior management is about to spike my spikes....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/18/2023 3:48 PM DST

[Hidden]

Listen to his urologist. Unless the bone Mets are causing real pain radiation would just cause unnecessary side effects. It is not without risks. All cancer treatments come with risks and side effects. My husband had radiation for very painful rib and shoulder blade pain a couple months ago. The side effects of radiation and resulting distress to his esophagus really made me wish we had skipped it! Finally his bones felt better, but only for a couple weeks! Rigorous treatment at 83 often is not reccomended. BUT...everyone is different. His doctor knows him best. But your uncle should be the one to decide what he thinks he can tolerate and wants.

[Cygnus52 in reply to Hidden]

Thanks. Very helpful. And, given that he is not on any therapy at all post RP in 2019 and RT in 2020, I wondered whether he might still have options other than ADT. He has fewer than 10 bone mets if the PSMA scan is accurate and he has no pain or other symptoms.

[Cygnus52]

Thanks! I value your advice.

[meowlicious99]

Edit: not sure if you are under ADT monotherapy ( or no therapy at all) ? That opens up other options, since you are still HSPC.

I believe current go to for doublet is: ADT + 2nd gen ( abi/enza ect)

I think ADT + Taxane is little bit out of favor for initial doublet. But your doctor probably has taken your general health profile and toxicities into consideration before arriving at that next step. Its not a bad option if you trust your MO, also no harm in getting second opinion.

I've also seen ADT + PARP as initial doublet recently.

> Is this treatment optimal?

Yes. Its one of the treatment paths.

> Can he/ should also get radiation treatments for the detected lesions?

only with palliative intention if needed

Other options?

1. PARP inhibitors. Check mutations either with tissue sample or approved liquid biopsy.

2. Theranostic agents : LU, Radium ect . LU will be off-label. I belive there are shortages in USA atm.

There are lots of posts in this forum with patients in your situtation. Might be able to read through those for references to trials to find toxicities.

[Cygnus52 in reply to meowlicious99]

Belated thanks for those helpful commentd. My uncle is on no therapy at all at present but is meeting with his doctor soon to commence treatment.