ISO a third MO opinion for my dad

[Dsmejkal88]

Hi all!

My dad was diagnosed with pca in 2021, prostate removal that summer. After radical - was told no treatment necessary and lo and behold January the following year psa went from .04 to 1.2 in 3 months. Put on adt and zytiga (not sure of spelling), scans show pelvic bed spots and 1 on s1, radiation summer of 22 and have been undetectable since. Now both advent health RO &MO and moffitt MO want him to stop the meds. He wants to but is very uneasy about it, as we all are. I didn’t think moffitt MO would agree with it but here we are. He wants a third opinion, I just don’t know where as moffitt is the go to here in FL. Any recommendations would be greatly appreciated. Thank you in advance.

[Tall_Allen]

" scans show pelvic bed spots and 1 on s1" What does this mean? There was a bone met too?

[Dsmejkal88 in reply to Tall_Allen]

Yes. Which is why I’m surprised at the idea of stopping treatment and testing once a month.

[103532 in reply to Dsmejkal88]

Lupron combined with Zytiga/Prednisone work very well to lengthen the time before treatment resistance while the cancer is still hormone sensitive. My husband is similar in his timeline as your dad for reoccurence, and we have no plans to stop or play around with intermittant therapy at this early stage in the journey. The minimum time we are even considering before cutting back would be 24 months and, even then, we may be wary. I would definitely explain your concerns to the oncologist and look for the studies that prove the long term benefit of extension of progression free survival from the doublet ADT therapy with Lupron/Zytiga/Prednisone. For a third opinion, you could check with Dattoli Cancer Center in Sarasota. Please keep us posted on how he is doing. Good luck!!!

[Dsmejkal88 in reply to 103532]

Thank you for the recommendation! I will def look into an appointment. I’m not comfortable but he will actually be 24 months in April. Sorry I didn’t make that clear in my post. Started April 2022 after seeing jump.

[Tall_Allen in reply to Dsmejkal88]

It sounds like they are recommending intermittent ADT. There are risks to a vacation, and there are risks to staying on those drugs, but both options are reasonable if that is what your father wants. Assuming the S1 met was only seen on a PET scan? A couple of trials (EMBARK and PRESTO, below) found that recurrent men with no metastases on a bone scan could have lengthy vacations if they used a second gen. hormonal with ADT for a while. Your Dad had Zytiga. It is up to your father - he has to understand the risks of both options, and he should do whichever makes him most comfortable. IDK if more opinions will help him - it's a decision he has to make.

prostatecancer.news/2022/09...

prostatecancer.news/2023/05...

[103532 in reply to Tall_Allen]

Thank you Tall_Allen. That is very informative for those on the "fence".

[Dachshundlove]

In the past few years, I read/ heard about research happening at Moffitt, modeling a treatment approach for cancer based on evolutionary biology. Surmising that outcomes may be better overtime if the environment (treatment) is constantly changing and no one cancer cell line is allowed to gain an adaptive advantage and dominate.

This is an article related to that work. I’m wondering if they are using this research to justify an intermittent treatment approach at Moffitt?

labpages.moffitt.org/anders....

[Justfor_]

There is not only black and white. There are shades of grey in between. But, silly docs are ignoring this. They only acknowledge full ON and full OFF. Check my Bicalutamide Maneuvers thread to learn the way I implement an adaptive minimum effective dosage in my case. You may get a eureka moment.