ADT response and questions for MO

[Lovecherries]

Hi, I am newish to this forum, still on a steep learning curve but I want to thank you for your contributions and discussions. This is my first time posting. My partner is 60 yrs old, as I understand it he had low PSA 3 yrs ago, not tested until Nov 2023, PSA50, stage 4, 1 met in 'sit' bone. Started on firmagon in Nov, degalarix added in Dec, EBRT planned for this month, 40 sessions (over 8 weeks), but wont find out details until we see MO on Tuesday. So a few questions:1. On 29 Jan PSA was 0.21 ug/L, testosterone was 0.4nmol/L - that looks like a very good response to me ... is it?

2. Also white blood cell and lymphocytes low, ALP and bilirubin high. Is that anything to follow up with MO?

3. I gather RT takes 3 or more months to show effects. How do you detect whether it has been effective? Scans?

4. The MO said being metastatic treatment goal is not 'cure' but we are getting the 'gold standard' treatment. As he's got low volume, was healthy, lean (prior to ADT) and fit, and min symptoms we are wondering if he can go hard for total remission. Seems like ADT plus RT will knock it back for a while, until it comes back as CRPC. Why not try to go for elimination by 'mopping up' with chemo a while after RT? They dont seem to be considering this unless its more of a wait and see approach. What am I missing?

5. Also wondering if any have tried alternate therapies to increase effectiveness of RT or boost the immune system after RT or chemo? I've heard super 'shrooms or rybrax is worth a go.

[GP24]

1. The PSA has dropped to a very low value and the testosterone is low too, degarelix works.

2. Ask your MO

3. It can take up to a year. Usually you monitor the PSA value following RT but you can get a scan too. The PSA value may go up temporarily but should drop during the first year. I assume radiation of the prostate is planned. Or will they radiate the met as well?

4. If diagnosed with a PSA value of 50 and a bone met, there is no cure. Your objective should be to live many years with the tumor, which is very likely. Avoid side effects from overtreatment, these will reduce QoL. A chemo after the radiation is not the gold standard and will be ineffective in the current situation.

5. I do not believe in alternative therapies.

[Lovecherries in reply to GP24]

Thank you for your helpful reply GP24. Radiation to the prostate and bone met is the plan as I understand it. I have only been to one of his appointments with the MO, I wasnt at the RO appointment so I am not sure the details.

[Tall_Allen]

1. It is good. Now he is ready to layer on the therapies.

2. Yes, if too low, it can preclude some therapies. So, it's important to understand why they are low.

3. Prostate RT either kills cancer cells immediately, or cripples them so they permanently die when they try to replicate (they may try to replicate several years later). In your partner's case, he is taking ADT so PSA is not a good tool for assessing its effectiveness. The goal is slowing down the cancer by "debulking" the main source of it. You can read about debulking here:

prostatecancer.news/2018/09...

4. The SOC for newly diagnosed men with distant metastases is "triplet therapy." Triplet therapy consists of ADT+docetaxel+ abiraterone (or darolutamide). They have to be done simultaneously, not sequentially. You can read about it here:

prostatecancer.news/2021/05...

It is troubling that your oncologist did not discuss this. Consider finding an oncologist at an NCI center of excellence.

Unfortunately, once the cancer has produced bone metastases, it is not curable with current medical technology. Resistant clones will eventually predominate. But progression can be delayed for a long time with triplet therapy.

5. Supplements and diet help patients feel better because they believe they are wresting at least some control over a disease that has deprived them of all control over their own body. Nothing has any good proof behind it, but if he does take anything, let his doctors know. Some supplements interfere with therapies or tests.

[Lovecherries in reply to Tall_Allen]

Thanks TA. Helpful references. I realised I made a mistake in my post, he started on Firmagon, then darolutamide was added. I will ask about triplet therapy tomorrow. We are in Australia so SoC may be different but obviously it should still be based on evidence. I thought I read somewhere recent evidence that a vegan diet slows the progression of prostate cancer, animal protein and fat accelerate it ... maybe it was a Norwegian study. You are saying there is no good evidence for diet though?