What would be next?

[rfgh20]

From my hx, Gleason 9 RP. PSA went to 0.2 8 months later. PSMA 4 hot spots. IMRT, Lupron and Zytiga. Doing great thus far. MO said if recurrence, Provenge next. Agree? No scan till PSA rise. Agree?thank you

[Justfor_]

Conditional agreement: No scan until ADT washes out, PSA rises (it most probably will), at a PSADT of 9 months or less.

[rfgh20 in reply to Justfor_]

Thanks!

[Ianrs]

My oncologist told me no new scan until PSA rises. PSA has been undetectable (<0.03) for almost 2 years (radiation 6*6, enza and zolodox as ongoing treatment). I feel good apart from fatigue.

[rfgh20 in reply to Ianrs]

Thanks for your input.

[Wolfee53]

I was on Eligard for 2 years, zytiga for 1 1/2 years PSA undetectable. I decided to take a vacation at the 2 year date(Feb 2023). I had an intracranial hemorage and OC said it could of been a side effect of these two drugs. So I am off ADT and I'm monitored every 3 months with a PSA blood test.

[rfgh20]

Oh my. Wasn't aware of ICH risk. Best wishes.

[TMcgee]

Your bio doesn’t mention chemo, so I imagine 6 to 10 cycles of Docetaxel would be your next step, followed by Proverge and targeted radiation for pain relief.

My 2 cents! It seems to me that androgen receptor inhibitors have been the focus of science to date. Clearly, science understands how to inhibit the initial progression of the cancer cells. But (there’s always a but), as the cancer evolves and becomes resistant to the drugs, the science seems to be at a much earlier stage, which leads to all kinds of questions.

I went through triplet therapy (Lupron, Abi, Docetaxel). Science found that taking chemo with ADT worked better than chemo after ADT. If that simple change increases overall survival, why not replace Lupron with Firmagon and Abi with Nubeca when PSA is lowest (nadir)? Since they interact differently with the body, could they restart the clock to drug resistance?

My MO told me that when my PSA turns up, he will wait 1 month to retest before taking action. I started triple therapy based on the Peace-1 clinical trails. The median OS from the trial is 42 months. If I do labs quarterly and wait 1 month to verify the PSA, I may be wasting more than 10% (42 month media, 4 months between decisions) of my lifespan waiting to act. What’s wrong with this picture?

I’m a statistician. I understand the flaws in my analysis. Regardless, I know the outcome. Also, I believe the science has focused on one half of the equation, getting the PSA down. Immunotherapy is really the only choice when the PSA turns. So, what can all of us do to maximize the time to drug resistance without sacrificing QOL?

Sorry for the rambling…

[rfgh20 in reply to TMcgee]

Thank you your input. I have not had any chemo. I read without certain genetic changes in the tumor or germline cells, Provenge isn't recommended. Two MO's said no triple therapy since I had localized disease. One thinks I have a good chance for cure. The other isn't as optimistic. I appreciate you.

[TMcgee in reply to rfgh20]

I would recommend that you update your profile. The members here will reference it before responding. The more info that you provide the better the responses. 😜

[rfgh20 in reply to TMcgee]

Hmmm.... I did but guess i did something wrong

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