PSMA scan

[Howard53545]

I spoke with RO and we are going to radiate the autocaval lymph node lit up per the above scan. My PSA was .027. I hope this knocks it out. I am also contemplating ADT but unsure which would work first or second generation.

[Tall_Allen]

2 years of abiraterone and 3 years of ADT in this trial:

ncbi.nlm.nih.gov/pmc/articl...

Ongoing trials are testing 2 years of ADT+ apalutamide/darolutamide.

[Hawk56]

Well, it would seem either or both would "work."

The EMBARK trial pointed to the possibility of monotherapy using an ARI.

The question is which, how long...

TA points to one answer.

I'll give you my experience.

Attached is my clinical history.

In March 2022 when my PSA began to rise we finally pulled the trigger on the Plarify scan a year later with three consecutive increases and PSa between .5-1.

That showed a single PLN though we know there was micro-metastatic PCa elsewhere.

The SBRT was a no brainer.

ADT was a no brainer too. Question was, with what, whether to add an ARI and for how long.

Some of my literature search indicated six months, others 12. Some suggested adding an ARI.

My radiologist thought for MY clinical history, six months of ADT was too short and favored 12 months.

My oncologist's original thought was 24 months ADT + ARI, thinking "curative."

I challenged him on the "curative." I said, tried that three times before and never gotten the "gold ring." He pondered and said ok, agree, how about this, let's do 12 months, Orgovyx, add Xtandi if Orgovyx doesn't drop PSA to undetectable within first three months and keep it there. We'll do labs and consults every three months and at 12 months, decide whether to come off treatment and actively monitor or continue. Ok, I said!

On 2 April, labs came back clear. He was advocating for another six months at our 4 April consult, radiologist was fine stopping at 12 with the proviso I would do labs and consults every three months, same decision criteria (though she lowered the trigger for imaging to .4). Easy I said.

Oncologist and I discussed the risk-benefit of the additional six to twelve months. He had nothing data wise he could point to about the benefit - PFS, RPFS, OS while I had nothing I could point to about the risk, becoming castrate resistant. He acquiesced with the same proviso as my radiologist.

Was this the "right" decision, time will tell. It was a good decision for me, balancing quality and quantity of life which so far in these 10+ years of this disease, has worked for me. There is no guarantee in our decision, we weigh the data from clinical trials, guidelines from NCCN, AUA and others - the "science", endeavor to apply those - the "art" - to our specific clinical history and data and then see what the outcome is.

I think a mitigating strategy for a decision involving a defined period of treatment is to actively monitor when you come off, never let it get out of control.

Study of one.

Kevin

Clinical History