Next step after completed Oligometastatic prostate cancer treatment..

[Maxi54]

In 2022 I completed six weeks of RT to three periaortic metastatic lymph notes and two lesions on ribs and started Lupron and Erleada in April 2022 till now.

Because numerus SEs including progressing spine arthritis I'd like to stop HT and watch my PSA.

For now PSA <0.02. Any advise greatly appreciated. BTW my cancer journey started in 2013.It's in my Bio. The goal of last treatment was cure. Is it still possible in my case?

[Tall_Allen]

Miracles happen, but as a rule, when there are bone metastases, cure is not possible with current medical technology. That's because the metastases on your ribs got there via your bloodstream. Thousands of cancer cells are in systemic circulation and have implanted themselves in tissue reservoirs everywhere. Only systemic therapy can keep them in check, hopefully for a very long time.

[Maxi54 in reply to Tall_Allen]

Thanks TA for your response . I follow your comments you giving to all other PCa warriors for many years now.

I want to stop Lupron-Erleada for a while to recover from SEs. My MO wants to do another PETCT F18 and if "things looks OK "than I could take a break. My PSA is <0.02.

What do you think.

Thank you.

[Tall_Allen in reply to Maxi54]

You have to decide if it's worth the risk. I think a PET/CT is prudent. A fluoride PET scan only shows bone metastases.

prostatecancer.news/2023/04...

[Maxi54 in reply to Tall_Allen]

Thanks TA for your advise.

It's Catch-22 situation. No best option.

[Maxi54 in reply to Tall_Allen]

TA thanks again for your response. In the link about "Intermittent ADT" prostatecancer.news/2023/04... if I'm correctly understand I'm in number 5 category:

Metastatic Hormone Sensitive PCa (mHSPC)

Reported results of the SWOG-S9346 RCT after a median follow-up of 10 years:

_Overall survival was 5.8 years for cADT vs. 5.1 years for iADT

_Castration-resistance started after the same amount of time in each group

_There were no significant differences in bone, endocrine, or cognitive events

In my opinion its not much difference between cADT and iADT (in my case) and one might have much needed break from ADT SEs.

Your thoughts?

[Tall_Allen in reply to Maxi54]

I hope it gives you the break you hope for.

[Maxi54 in reply to Tall_Allen]

Before I go intermittent adt for metastatic prostate cancer my MO want to do PET CT F18. I had it done back in March 2022 (show three right periaortic lymph nodes 0.4cm and right second rib and left seventh rib lesions).During 24 months since than my PSA stayed <0.02. With PSA that low can it show any new mets. My copay for this is around $3,000.

[Tall_Allen in reply to Maxi54]

Did you mean F18 or did you mean Pylarify (which also uses F18). A fluoride scan only shows bone metastases.

[Maxi54 in reply to Tall_Allen]

I meant F18 Pylarify. Thank you.

[Maxi54 in reply to Tall_Allen]

T A, I got more accurate description of that scan its F18-DCFPyl PET/CT.

Thank you again.

[Gabby643 in reply to Tall_Allen]

Thanks for your honesty T A!

[GP24]

You could follow the example of the EMBARK trial. It did intermittent ADT and stopped with ADT + Enzalutamide when the PSA value was below 0.2 ng/ml. I would expect that you can also do this with Erleada instead of Enzalutamide.

urotoday.com/conference-hig...

[Maxi54 in reply to GP24]

Thanks GP.

EMBARK trial was for "Patients had no evidence of metastasis on conventional imaging " my MRI scan show: "A 0.6 cm short axis right para-aortic lymph node had demonstrated abnormal radiotracer activity on the recent PET/CT scan from March 21, 2022" so I'm already mHSPC and I not sure if EMBARK trial apply to my situation.

[GP24]

You wrote: "I'd like to stop HT and watch my PSA". I cannot come up with a study for patients with "a 0.6 cm lymph node". Embark comes very close. The alternative for you would be intermittent ADT if you want to stop HT.

[Shamrock46]

We learned early on that there is simply no cure yet for prostate cancer. Our oncologist also told us that the drugs work until they no longer work because eventually the cancer outsmarts them all. My husband was treated with Lupron and Xtandi, and while he suffered many side effects, I believe they bought him more time than he would have had w/o them. Choosing treatment has to do with what you are willing and able to endure. You should also know that after using these drugs and have a recurrence, the cancer at that time comes back more aggressively. He was 1st diagnosed in 2014, had his 1st recurrence in 2018 when he started the 2 drugs, and then had his 2nd recurrence in April 2023, when he stopped all treatments due to worsening side effects. The Lupron was beginning to affect his memory and the Xtandi was causing mobility and many other issues, both while the PSA was doubling/tripling. Other options were determined to be potentially worse while only expected to provide a short life extension at a high price. The MO said w/o treatment his prognosis would be about a year and he, in fact, died 2 wks. ago. Some patients will try anything and everything while others weigh the quantity/quality of life. Only you can make that choice, but please make it an informed one.

[Cancer2x in reply to Shamrock46]

Sorry to hear. Sounds like you stood with him through it all. Please take gentle care of yourself during this life transition.

Pax

[Maxi54 in reply to Shamrock46]

Shamrock, Sorry for Your Loss and what you've been through. I try to navigate between possible options before my PCa become "roaring tiger" and I want to keep it in check as long as possible. Thanks again for your story and advise.

[j-o-h-n in reply to Shamrock46]

Thank for for staying with us.........You're an inspiration and a Blessing.........He is so proud of you....

Good Luck, Good Health and Good Humor.

j-o-h-n

[garyjp9]

My sincere condolences for your loss.