Into the 4th year, updates and next step

[Juliane314]

• Aug 2019 Initial diagnosed 4 mets in pelvis area, lymph node involvement. Gleason score 5+5, somatic BRCA 2. Microsatellite stable, TMB 10. Started abiraterone and Zoladex.

• Feb 2020 PSA Nadir 0.01 minimum side effects from abi+ADT

• April 2020: RT 25 sessions 79 Gy, covering prostate, lymph nodes and mets.

***********PSA remained undetectable and still is today **************

• Dec 2022: hip pain, CT and bone scan revealed new mets on hip bone, one single RT resolved pain. Continuing on abi + Zoladex

• March 2023, new hip pain, new mets on pubic bone confirmed by CT/Bone scan,RT for pain management , switched to Olaprid (full doze) + Zoladex Acceptable side effects, blood works fine.

• May 2023 Bone Scan stable, continuing on Olaprid + Zoladex

• End of July 2023: new hip pain, CT/Bone Scan revealed mixed reaction to treatment: existing mets improved but new mets on ilium bone,

Up to now, no soft issue mets detected through these traditional imagining methods.

As you can see, my father has had very good reaction to abi + ADT, and it was effective for 3.5 years, given his high gleason score and his somatic BRCA 2 mutation. But his cancer progressed while PSA remains undetectable. I asked the doctor if it might have evolved to a neuroendocrine carcinoma, but the doctor dismissed it. They believe that neuroendocrine carcinoma type would have more aggressive progression, while my father's progression has been relatively mild. They say it's a subtype that doesn't express PSA, but they didn't include NSE in his blood work.

I also asked about biopsy on the new mets, but was told that it is hard to do biopsy on the pelvis area and it has risk to cause fracture, it would be better to wait till he has soft tissue mets then do the biopsy.

I’ve also asked about a FDG PET + PSMA scan, doctor said that the Canadian guideline requires the patients PSA to reach 2 to offer the scan.

We are meeting with the doctor this Thursday to discuss the next step. Any comments are welcomed!!

[FormulaRob]

I don't have a lot to offer at the moment although I too am from Canada. I looked into the PET scans and found them pretty accessible if you are close to one of the American locations and pay out of pocket. I am in Toronto and found a clinic in Buffalo that was available. Although my father decided against going

Hoping you get some answers tomorrow , good luck !

[Juliane314 in reply to FormulaRob]

Thank you! I contacted VMMED (a Montreal private clinic) today, they declined our Dr's referral earlier this year, but agreed to review my father's case again. If they accept us, we will be able to do the PSMA scan here in Montreal! Fingers crossed.