abiraterone first line use in high risk in U.K. debate after stampede research results

[SimMartin]

Lots of current comments in U.K. press re the funding for using abiraterone for high risk first line HT.

I was Dx with Gleason 9 - T2cN0M0 (10% 5 70% 4 20% 3 in one area plus couple of areas G7 8 months past failed HIFU for G7 (3+4 <10% 4 one site only) PSMA = locally contained No SV evidence.

I has moderate hypofraction IMRT 20 x 3Gy (no pelvic radiation - logic = risk PSMA clear plus other pre existing conditions) - 2 months bicalutimide the Zoladex (goserelin) - 12 months into it PSA 0.01 3 months post RT remains stable - so far.

Question: should I have considered

abiraterone - my Testosterone was initially at 3 months 0.06nmol/l then 0.7 and last August 9 months from LHRH Zoladex initiated gone to 0.8nmol/L. (23ng/dL)

Whilst this is still under the level that is suggested it seems to be creeping up and I have read that ideally it should be <0.6nmol/L (17.3ng/dL)

Should I bring this up at the next oncology meeting ? I do have a muscle wasting condition (post polio syndrome) and my oncologist is already saying maybe consider stopping and that was at 9 months. I declined given my high risk G9.

The stampede trial puts me slightly outside their protocol as I do have locally contained G9 but no nodal spread (as far as we can tell by the PSMA) but they then only include patients with PSA >20 who have no evidence of nodal spread - my PSA was always around 5 on AS and had HIFU when rose to 8.2 - 8 months post HIFU failure, highest PSA was 7.

Any advice re pros and cons or am I fine Just ploughing on with current recommendation SOC ?

[Tall_Allen]

You are entirely outside of the STAMPEDE protocol. I hope the radiation + 2 years of ADT is curative.