Newly diagnosed metastatic PC treatment options

[ShorePine]

Hi, I'm 68 years old. Here are the key points in my story so far:

In July 2023 a blood test showed a PSA value of 45.

On September 26 2023, prostate MRI showed a dominant tumor in the prostate with extension into the right seminal vesicle.

Also the fat plane between the rectum and prostate is lost at the superior margin between the rectum and the involved right seminal vesicle.

On October 9 2023, biopsy showed prostate cancer with Gleason score 4+4=8.

On October 25 2023, PSMA PET-CT scan showed four metastatic spots: two in the ribs, one in a vertebral body, and one in the iliac bone.

I will start treatment next week with Eligard and abiraterone+prednisone.

Should I also start chemotherapy with docetaxel?

And/or should I also start RT for the prostate and the 4 spots in the bones? Would proton therapy be advisable?

I will be very grateful for any input.

[6357axbz]

Very similar to me. Dx 7/2/2018, G8, 2 rib and 1 iliac bone met. Given 18 months by my dick head urologist. Still doing well. My suggestions: go to MD Anderson. RT to prostate, Lupron and abiraterone. RT later to Mets

[ShorePine in reply to 6357axbz]

Thankyou axbz! Glad you are doing well!!

[JohnInTheMiddle]

1. Read up on triplet therapy. All things being equal there is no question that it's a big advantage.2. Read up on oligometastatic and see if you qualify.

[ShorePine in reply to JohnInTheMiddle]

Thank you John.

[Tall_Allen]

Triplet therapy (with docetaxel, abiraterone/darolutamide, and ADT) is now standard-of-care for newly diagnosed metastatic patients:

prostatecancer.news/2021/05...

After triplet therapy has shrunk your tumors, you have a small enough metastatic burden that it may be beneficial to debulk the cancer in your prostate with radiation. Perhaps after shrinking it will be clearer whether cancer has invaded the rectal wall.

prostatecancer.news/2018/09...

X-rays or protons don't seem to make any difference.

[ShorePine in reply to Tall_Allen]

Thank you TA, this is very useful.

[LowT]

youtu.be/-RVVq0uDAEE?featur...(Not working as expected?). Well worth watching.

[Benkaymel in reply to LowT]

Thanks for posting but very depressing how little of this approach is followed by the UK NHS.

[EdBar]

I was also dx with metastatic cancer almost 10 years ago. You can read my profile to see what I’ve done. It’s really important to have an MO who specializes in prostate cancer and not just an MO. Aggressive early treatment, really good doctors and lots of prayers are working for me.

Ed

[dharmabodhi]

I went to California Protons in San Diego for pencil beam proton therapy,Had a great experience there.They are excellent.Highly recomended.Whether tx there is appropriate for you would be determined by their examination of the details of your cancer.

[Jewelrylady]

my husband was diagnosed with metastatic cancer. He had 3 spots on spine and one rib and prostate. He started Lupron, abiraterone and prednisone. He did SBRT to 3 spots before we went on vacation, and he’s getting SBRT this week to sacrum and prostate. He was never offered chemotherapy. He’s had mild side effects from hormone Rx (hot flashes) and none with radiation so far. Hopefully radiation to prostate will go ok. He did get spaceoar to help protect rectum.

[j-o-h-n]

Good Medical institution + Good Medical team = Best chance to make it.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/21/2023 1:21 PM EST

[AlanLawrenson]

As a PCa patient who had Proton Beam Therapy in South Korea in 2013, I know that PBT is not suited to your present condition.

May I refer you to my book An ABC of Prostate Cancer Today - 3rdEdition available from Amazon. It has helped thousands of PCa sufferers.

[CANAMA]

I share EdBar's comments above. I was diagnosed in 2016 with Gleason 8 and oligometastic APC. I was 67 and in very good health so I decided to treat my APC in the most aggresive way possible - so long as the treatments would not kill me. I also searched for the best physicians that I could find. In 2017 I started 2 years 5 mos. of Lupron and 21 months of Zytiga. I also had an RP, 2 sessions of SBRT and about 40 sessions of IMRT to my prostate bed. My APC has been undetectable since 8/2017. I hope my history helps you.