Update recent PSMA

[kainasar]

Docs did it to me again with the usual bad news.

Uptake in new lymph node locations in pelvis. the radiotherapy failed, and preclude more treatment on new nodal areas. (according to Docs.)

So expect to add to ADT, abi or enza or darolutamide in a short while, with PSA going up on a fast double.

Trying to find out if Nubeqa is worth it regarding technical difference in progression and overall survival, compared to abiraterone. Abi may be better in some ways.

thanks.

[Tall_Allen]

Could you please fill out more info in your profile? What exactly was previously treated with RT? Where were the lymph nodes on PSMA and how many? Any bone metastases?

Nubeqa is not approved for recurrence, although your MO may be able to get it approved.

[kainasar in reply to Tall_Allen]

Thanks TA. In 6/2012 had IMRT then BR 10/12. May 2018 had salvage min invasive robotic prostate removal, in August BR was obvious. Began Degarelix 3/19. After PSMA 7/23, and PSA doubling, I was given SBRT to 3 lymph nodes on my right leg-hip juncture, 12/23. On continuing ADT, PSA went down to .96 in 1/24 then doubled up to 2.14 (3/12/24) . New PSMA ordered showed 3 LN on my left side - 2 at iliac then then another on left at hip- leg juncture. All 3 have prominent uptake. One of the 3 zapped with SBRT (on my right) also showed uptake, and a fourth seems to be emerging at that region. Rad Onc said no to further SBRT, since then. No bone mets indicated. No visceral. Pursuing second opinion on scan. Meeting with MO at DFCI for next steps.

[Tall_Allen in reply to kainasar]

Chasing after single pelvic lymph node metastases was certainly a bad idea, but because it has spread to your inguinal LN, it is out of the area where radiation can be curative. Intensive hormone therapy is your best option. 2 recent trials (EMBARK and PRESTO) have proven the benefit of a limited run of Erleada or Xtandi.

prostatecancer.news/2022/09...

prostatecancer.news/2023/05...

[kainasar in reply to Tall_Allen]

Thank you. Will study those. Ive read Enzalutamide has an advantage over Nubeqa.

[Tall_Allen in reply to kainasar]

There has never been a randomized comparison.

[kainasar in reply to Tall_Allen]

Found study that seems to confirm effectiveness of Darolut vs mHSPC, but have found none yet that nail down Daro vs mCPRC, or CPRC.

[Tall_Allen in reply to kainasar]

Please show what you found. To my knowledge the only published trial using darolutamide in mHSPC was a triplet trial (ARASENS) where it is only combined with docetaxel. The only other trial (ARAMIS) where its use has been approved was for non-metastatic CRPC.

[kainasar in reply to Tall_Allen]

This is one from 2020 of Daro on nmCRPC vs placebo (with ADT) Darolutamide in Nonmetastatic, Castration-Resistant Prostate Cancer - PubMed

[Tall_Allen in reply to kainasar]

nm=non-metastatic

[kainasar in reply to Tall_Allen]

yes

[kainasar in reply to Tall_Allen]

Looked at ARASENS. This one is interesting, that could show useful combination for mcprc also. Impact of disease volume on survival efficacy of triplet therapy for metastatic hormone-sensitive prostate cancer: a systematic review, meta-analysis, and network meta-analysis - PubMed

[Tall_Allen in reply to kainasar]

ONLY with docetaxel.

[kainasar in reply to Tall_Allen]

Yes. This is interesting regarding Daro - Doca pubmed.ncbi.nlm.nih.gov/380...

[kainasar in reply to kainasar]

This study is part of Arasens, with evidence of Darolutamide effectiveness against CPRC metastasis.

pubmed.ncbi.nlm.nih.gov/360...

Efficacy and Safety of Darolutamide in Patients with Nonmetastatic Castration-resistant Prostate Cancer Stratified by Prostate-specific Antigen Doubling Time: Planned Subgroup Analysis of the Phase 3 ARAMIS Trial - PubMed

[PaxNova]

Kainasar, your doctors failed to inform you that SBRT and Proton Beam can both be used on patients that had prior radiation. Are you in the States or elsewhere?

[kainasar in reply to PaxNova]

Yes I am seeing docs at DanaFarber/Brigham Womens in Boston

[kainasar in reply to PaxNova]

Expert said radiotherapy would not completely shutdown all the cancer.

[God_Loves_Me]

one advice listen to Tall Allen

[kainasar]

Darolutamide linked to longer time to treatment discontinuation.

urologytimes.com/view/darol...