I couldn't find anything about radiation therapy or surgery related to the nmCRPC. I understand that at this stage of the disease the cancer is already metastatic only not visible on conventional STAMPED scans (bone scan and CT).
Even if you don't have any visible Mets on the PSMA pet scan you are probably already metastatic.
I am just wondering if there is even a theoretical possibility that radiation or surgery could cure this form of cancer?
I believe it is possible but it would take away a lot of resources therefore nobody is doing it for this unlikely scenario (that the cancer is still not metastatic.,)
So, what do you think?
If you have any statistic about the likelihood that the cancer is still not metastatic I would appreciate to know it.
I understand that people with nmCRPC should stay life long on ADT. There could be two types of cancer. One is the CRPC in the prostate and the other coud be the HSPC outside of the prostate.
It would have a great benefit to kill the nmCRPC, the cancer in the prostate.
I have a similar situation now, maybe it is not a nmCRPC per definition but I don't have any visible Mets on the PSMA pet scan but the CRPC in my prostate. I am receiving ADT with early chemotherapy.
I was diagnosed polymetastic but now after 5.5 years I am still on Firmagon injections only and my prostate developed a CRPC.
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I had some radiation to the prostate and just now, 18 days ago started Bicalutamide 50mg per day. My PSA is still rising and it was 1.98 last week. I hope to see the RO and I am also thinking to ask for consultation with a urologists about a possible operation, at least that is my idea. Interestingly the prostate irradiation didn't solve the issue and my PSA from a minimum of 0.23 started to rise quickly with a PSADT of 2 month and now a year after radiation my PSA is around 2. They just simply don't have experience dealing with the nmCRPC.
In Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC), cancer is found growing after hormone treatment. Scans may show it has not spread to other parts of the body. In the advanced form of prostate cancer, it becomes metastatic. It spreads beyond the prostate to other parts of the body.
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I have a similar diagnosis because the entire surface of the prostate is tumor, and there is no sign of bone, lymph or seminal vesical metastis. but since it covers the entire organ, they have to assume some adjacent tissue mestastsis. I did 5-1/2 weeks of external beam radiation and I also had an HDR surgery of 17 catheters into the prostate with controlled high intensity radiation. They are also doing 2-3 years of hormone suppression therapy. I have Gershon 4+3=7 and this was the only option they could recommend which may get me to 10 years.
You had previous scans showing metastases. The cancer is incurable. If after treatment the scans don't show mets it doesn't mean the mets are gone, it just mean they are not detectable.
The scanners using the most sensitive tests will miss mets smaller than 4 mms.
nmCRPC is a wrong name. The reality is CRPC with no detectable mets at this time.
I was just hoping that my bone Metst are still HSPC and that they are not growing.
My old GP said that I have a rational approach towards my health. What should I do to find out what is happening? Would Jevtana plus carboplatin chemotherapy help? Why not just try 3 cycles of the chemotherapy first?
My sister was just diagnosed with two cancers first stage ovarian and third stage of the cancer of the uterus. She already had a big operation and she is still alive and now she started taxol 150mg per m2 (or something similar but not Docetaxel.) plus carboplatin. After three cycles she will do 20 internal radiation for 20 days. After that she will do 3 more cycles of chemotherapy.
I really hate Enzalutamide and I would like to do chemotherapy. I had early chemotherapy and it was effective until now. I had radiation and it was not effective for long time. The cancer is back in my prostate.
I know that I have Mets but I am keeping them stable with degarelix injections alone therefore my Mets are HSPC, while the cancer in my prostate is CRPC.
Even if you ever had detectable Mets on the PSMA pet scan only, and the cancer in your prostate is growing despite ADT you are officially nmCRPC and at this stage I don't have any detectable Mets even on the PSMA pet scan. My Mets are not growing therefore they are HSPC. The cancer in my prostate is growing and it is CRPC. My fear is that the CRPC from my prostate will soon metastasize out of my prostate. I really hope to understand better my situation in order to decide what to do next.
I don't have detectable Mets for years, only the cancer in my prostate is now CRPC. It was Radiated, the PSA dropped from 1.4 in 6 months to 0.23 and it is back now with PSA 2.
I can keep my bone Metst stable with Firmagon injections alone. Therefore my Mets are still HSPC and they're not detectable on nuclear medicine bone scan (not even on the PSMA pet scan).
I found a study from Argentina about nmCRPC. They removed people prostate surgically and some have now no evidence of disease. (Not all.)
There's always a possibility. It's also possible that your immune system - the only thing on the planet that can actually discriminantly target and remove cancer from your body work as well. I wouldn't rely on either wrt a cure.
I personally don't like the wording of cure. If cancer could be cured, we'd not be here. I think its more prudent to look for ways to better manage it with the aim of dying from something else with as little SE as possible.
By joining clinical trials you are poisoning yourself for nothing, for an suboptimal result.
"Eleni Efstathiou, the lead investigator of the MAGNITUDE trial, believes that the trial design explains why men without DNA repair defects benefited from the PARP inhibitor in the PROpel and TALAPRO-2 trials, but not in the MAGNITUDE trial. She believes that the subgroup that was stopped early might have shown some benefit if they had continued. I can also conjecture that:
Olaparib is a stronger PARP inhibitor (based on worse side effects)
The olaparib group was less progressed
The previous docetaxel use by ¼ in the olaparib trial sensitized the cancer, whereas the previous abiraterone use in the niraparib trial had no sensitization effect. "
Again: they will not allow you get previous chemotherapy therefore you are getting suboptimal results. The purpose of the clinical trial is not to help you, the purpose is to experiment on you.
Unfortunately this is very wide spread. I wanted to take olaparib only during radiation but they would not prescribe it even as off label use when I would pay from my own pocket.
It wasn't a clinical trial still was not allowed or taken into consideration. Very disappointed.
Your research medical oncologist will prescribe you a treatment not what is a best to you (Nubeqa) but enzalutamide so you could be meaningful as a control group. Enza plus ADT plus nothing. I am just warning you about this possibility so you understand what is going on.
I want to say that they are experimenting on you even if you are not a part of the official clinical trial in order to gain knowledge on you. Very disappointed.
You should understand and my doctor explained this to me early on that cancer that escaped the prostate has to land and grow. Cancer cells are delicate and most cannot survive the turbulence of going through the heart in your bloodstream.
So how many landed and are growing? And the ones that did need to grow to a large size tumor before they can then seed other areas.
I opted initially to have my prostate removed to prevent any additional seeding of PC cell from the prostate, so I am working against only those that were able to initially land anchor and grow.
I had whole pelvic which killed all detected spots in any too small to be detected in the radiation field.
My PSA since RP has been low so I'm dealing with initial the seeding, not reseeding.
We are only now getting effectiveness information because of the new PSMA scans. So what doctors thought for years is being rewritten by new technology.
For patients with few metastasis, we may be able to eliminate them, possibly all of them. We can certainly slow the spread and allow more time off ADT.
Also There is a on going clinical trial reporting very good early results of blocking additional androgen receptors to control Castrate Resistant PC stopping its growth, it's been given fast tract FDA designation. You might want to see it you can get into that trial.
The technology to beat PC has gone through a recent revolution with the COVID vaccines and the new abilities that have been recognized. Treatments to control cancer or cure cancer are coming with this new technology.
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