Is my cancer castrate resistant?

[dac500]

Since detection of abdominal and pelvic mesastasis by PSMA scan in October 2018, intermittant Lupron was very effective in keeping my cancer under control until July 2022.

From July 2022 until now I have been on continuous Lupron because PSA refused to become undetectable. From July 2022 until August 2023 my PSA hovered around 0.3. Then, from August 1 to November 1 (today) PSA jumped from 0.30 to 0.80 with a PSA doubling time less than 3 months. Since I am on continuous Lupron my T remained less than 20. I think I can assume that this increase in PSA is entirely due to Lupron resistant cancer cells.

Today I also had a PSMA scan. Highlights of the result of the scan are:

*Multiple PSMA-avid pelvic and retroperitoneal lymph nodes, some which have increased in size from prior CT Abdomen and Pelvis. Compared to prior PSMA PET/CT from 2018, however, some of these nodes demonstrate new radiotracer avidity, whereas, other nodes are no longer visualized on current examination.

* Left common iliac node (CT image 29), measuring 0.7 x 0.5 cm with SUV max of 11.6, previously PSMA-avid, and previoulsy measuring 0.5 x 0.3 cm on prior CT Abdomen and Pelvis.

* Retrocaval node (CT image 202), measuring 1.8 x 1.1 cm with SUV max of 38.4, previously PSMA-avid, and previously measuring 1.0 x 0.6 on prior CT Abdomen and Pelvis.

*Left para-aortic node (CT image 201), measuring 0.7 x 0.5 cm with SUV max of 11.1, previously not PSMA-avid, and previously measuring 0.9 x 0.4 cm on prior CT Abdomen and Pelvis.

The first and last paragraphs indicate that my cancer has spread to new lymph nodes not previously cancerous.

Now, the question is what are my treatment options. My MO would probably recommend adding Apalutamide to Lupron. Would adding Zytiga be a good option? Should we rule out chemo?

[Tall_Allen]

Yes, your cancer is castration resistant - it progressed in spite of Lupron. You may want to discuss combining docetaxel and enzalutamide as a next step.

[StayingOptimistic in reply to Tall_Allen]

TA, do you have any statistics about time to death from this point going forward? I know it’s different from one patient to another but this is the point which always scares me when I think about.

[Tall_Allen in reply to StayingOptimistic]

It depends on what you do about it, what your status is, and what competing causes of death there are. Lots of clinical trials measure overall survival, but it's hard to know what exactly the cause of death was.

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

My uneducated guess would be "From here to there".............Statistically most men who think about it....are miserable.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/02/2023 2:15 PM DST

[dac500 in reply to Tall_Allen]

You are right. My oncologist confirmed that my cancer is now castrate resistant. However, because of moderate increase in PSA he suggested Zytiga + Lupron now. Perhaps docetaxel in future.

[PCaWarrior]

How many mets? Just the three?

[dac500 in reply to PCaWarrior]

There are others as indicated in the scan report: "Multiple radiotracer avid pelvic and retroperitoneal lymph nodes are seen, including:"

[PCaWarrior in reply to dac500]

I saw multiple. I didn't see including. Three were listed. Are there many more?

I have two and am zapping them per ASTRO.

[Cooolone]

I would definitely inquire about genomic testing (biopsy) any tissue if at all possible for possible future use (drugs)...

I would also suggest discussing 2nd generation lutamide, Darolutamide over the older drugs as it seems to have a slight edge.

Good Luck!