73, RP 2021, BCR peaked PSA 2.2 2023, scrambling

[jackwfrench]

Hello writing you as you are very active, knowledgeable and experienced. Just respond if you like-

PSMA 4/18 showed T10 lesion and right iliac lesion, low volume.

MRI 5/28 confirmed, plus showed some probable spots lower left sacrum.

Rad oncs I went to deferred to med oncs for systemic treatment, although I thought they should have spot welded the two confirmed lesions. They say if the HT does not manage the lesions they will radiate.

Just got Lupron 8/30 and phasing off Casodex to avoid T flare 9/17.

MO says plan is to stabilize then add Abiraterone/Prednisone, worried a bit about blood pressure.

Is BAT a viable way to push out the castration resistance window?

Is Orovyx useful as an alternative to Lupron, worried about my heart?

I'm having a hard time reading good stuff for me to do as a CS; everything seems written for CR.

Thanks for any observations.

[Tall_Allen]

No one knows if radiation to bone is beneficial. Safety is the biggest concern.

BAT is only used experimentally for CR, because the dangers of adding testosterone outweigh the potential benefit.

If you have known heart disease, you may want to discuss orchiectomy. Orgovyx, or Firmagon.

[Concerned-wife]

There are a lot of discussions on UroToday by the specialists about hormone sensitive disease. We have leaned much there as well as here.

[Fermented]

Not sure I have any useful advice as everyone has differing symptoms, differing responses to therapy, and differing health issues.

For me, with bone mets similar to yours, the stereotactic radiation we believe was very effective as my mets were regional and could be targeted with the month long version. It is the targeting that is critical, the design of the radiation treatments. After two years of intensive hormone treatment (initially firmagon every month, then lup Ron (will not let me type it as one word !) quarterly, daily abaraterone, prednisone my bone mets have disappeared on PSMA Pet scans and I will soon take a "vacation" as I am 75, otherwise healthy and have not had any blood pressure issues. I have no illusions that the mets will be gone forever, but will monitor PSA and see what transpires. Good luck with the therapies.

[jackwfrench in reply to Fermented]

There are nuggets in your story for me - Thanks-

[j-o-h-n]

Give us some bio to chew on, Man........... but not in French........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/12/2023 2:55 PM DST

[VHRguy]

Tall_Allen as usual has good advice. I'll only add that in my case testosterone wasn't ever going to be my friend again. I had no interest with a G9 case of risking growth by intermittent hormone therapy, so for permanent testosterone reduction I chose orchiectomy. It's not a common choice today, but the surgery and recovery was pretty minor, and I have been very pleased with the results.

I'm also on estradiol (active part of estrogen) to minimize the unpleasant side effects of lacking testosterone. Also very pleased with that.

Something to consider, though it's rarely ever discussed by urologists.