Dad,83 - is biopsy necessary ?

[Tinkudi]

My dad , 83 had an elevated psa at 18. Dr ordered MRI which showed a pirads 5 with 2-3 bone metastases in the pelvic region and femur.

Went to an oncologist who said to do a PSMA and then to start him on Lupron and bicalutamide. And maybe radiation for the bone met pain.

He said he did not really need him to do a biopsy as treatment would not change but if WE wanted to we could.

We did a PSMA today and it basically confirmed much of what the MRI said. Cancer seen in prostate and a few bone mets - no organ involvement.

My question is - would there be any added benefit in doing a biopsy now and if so what ? Also , what are the realistic risks of doing it

I am in India.

[Justfor_]

Biopsies are a steady income for urologists. So, if you talk to any of them, they will push firmly on getting one. Medical oncologists, on the other hand, say Lupron in place of Good morning. Do your dad a favour and start him with Bicalutamide monotherapy alone and if this doesn't prove enough, upgrade to a second gen. *lutamide monotherapy. He is 83 y.o, the odds of dying from prostate cancer are comparable with dying from heart damage caused by Lupron.

[Tinkudi in reply to Justfor_]

What is lutamide mono therapy ?

[Justfor_ in reply to Tinkudi]

Lutamides are a family of anti-adrogen drugs. They don't stop the body production of Testosterone, like Lupron, Firmagon, Orgovyx etc do, but they sit between Testosterone and androgen consumer cells to block the road. This actually makes the body produce more Testosterone, somewhere between 50-100% more, as total consumption is lowered and also the androgen consumer cells keep sending "SOS" signals to the brain. The latter, not knowing the reason for which the normal Testosterone supply has been interrupted instructs the testes, via the pituitary gland, to "work overtime". Consequently, cells that use Testosterone for their functioning but aren't androgen consumers, don't take a hit, in fact they may source more than before. Typical example are the brain cells. Lupron and Co, just shut down Testosterone body production and by doing so, a very common side effect appears called "brain fog". The name is very descriptive and doesn't need any further explanation.

Mono therapy is the term that denotes single drug treatment. From the 1st gen. lutamides only Bicalutamide has survived today and there are three, more potent, 2nd gen. lutamides namely: Enzalutamide, Darolutamide and Apalutamide.

[Tinkudi in reply to Justfor_]

Thank you. So why do oncologists push for lupron etc and not just bicalutamide etc ?

[Justfor_ in reply to Tinkudi]

Because individualized treatment is a practice to be evaded:

1) It takes much more effort than the 15 min every 3 months that the average oncologist allocates to their patient.

2) It requires mental processing and plan development from the oncologist to draw up an optimal treatment at the start and make adjustments during follow up on a patient by patient basis.

3) Removes the SoC safety net, exposing the oncologist to risks in terms of legal claims for maltreatment, negligence, incompetence, etc.

For all of the above reasons, "one size fits all" recipes are the preferred modus operandi of the average doc.

[Tinkudi in reply to Justfor_]

Thank you 🙏🏻 So currently he has started bicalutamide 100 mg a day. To figure if that alone is enough one would need to test psa after some time ? Any thoughts on Orchiechtomy ?

[Justfor_ in reply to Tinkudi]

There are no "magic" numbers. The sensitivity of the individual to some drug, varies hugely from patient to patient. For your info, my current Bicalutamide dosage that contains PSA to the limits of detectability, is 150 mg per month (yes, per month no typo). Of course, I am at a much earlier stage than your dad, recurrent after RP, no metastases and 8 years younger. But, I am also Greek and there is a proverbial phrase in my language that has survived about 25 centuries now: "ουκ εν τω πολλώ το ευ" (Google translates it as: "plenty does not mean good", I would freely translated it as: "more isn't better", in English there is the reciprocal: "less is more").

You may check what I am doing for 2.5 years now:

healthunlocked.com/prostate...

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

As Spiros said to Eleni...... Αγάπη μου, Λίγο τώρα, λίγο αργότερα....

Good Luck, Good Health and Good Humor.

j-o-h-n

[GP24]

The main risk of a biopsy is an infection. You get an antibiotic to avoid that. The advantage is that you will know the Gleason score, which tells you how aggressive the cancer is. As you father has bone mets, there is no real advantage from knowing that.

If you get radiation, I would radiate the prostate plus the bone mets. For systemic therapy he should get Lupron or Orgovyx tablets plus e.g. Abiraterone. This combination works better than Lupron alone.

[pd63 in reply to GP24]

Minimal infection risk with transpirineal

[Tinkudi in reply to pd63]

It’s not there in India

[Tinkudi in reply to GP24]

Thank you.

Doc has started him on bicalutamide tablets and later will be giving lupron Is there a different in efficacy between lupron and the oral pills ?

How is it decided who to give abiterone ? Is it well tolerated ?

[GP24 in reply to Tinkudi]

Orgovys tablets are more effective than Bicalutamide. You take Bicalutamide about two weeks before Lupron. Orgovxs tablets can be taken instead of Lupron and need no Bicalutamide before.

As mentioned below, there is triplet therapy, Lupron+Abiraterone+Chemo. If your father wants to avoid Chemo, he can just take Lupron+Abiraterone.

[God_Loves_Me]

I would say do it, As you are in India

There is one treatment available in India called "Dendritic Cell Therapy" by APAC BIOTECH.

They will take biopsies and create the T-cell from cancer cell. many patients in this group went there for same. Zero Side effect

[Tinkudi in reply to God_Loves_Me]

Are you in India ?

[God_Loves_Me in reply to Tinkudi]

Nope I live in USA and also planning to get Dendritic Cell Therapy in India. Already talking to doctor for travel plan in delhi.

there are very few immunotherapy that build from tumor cell. I heard great results in this group. Just search Dendritic Cell in the group search and read different feedback

healthunlocked.com/search/p...

[Tall_Allen]

No, there is no benefit in getting a biopsy. After there are metastases, a biopsy would make no difference in his treatment.

[Tinkudi in reply to Tall_Allen]

What would the standard treatment be at this age

[Tall_Allen in reply to Tinkudi]

Triplet Therapy:

prostatecancer.news/2021/05...

[Tinkudi in reply to Tall_Allen]

Thanks 😊. Is chemo given even at 80 plus ages ?

[Tall_Allen in reply to Tinkudi]

Yes, as long as he's got good performance status and bloodwork.

[Tinkudi in reply to Tall_Allen]

Thanks. So even without a biopsy - seeing the PSMA with bone mets , a good oncologist could think of triple therapy or would Gleason score be necessary

[Tall_Allen in reply to Tinkudi]

I don't know how to be more clear.

[maley2711 in reply to Tinkudi]

Not necessary...to be clear.

[Tinkudi in reply to maley2711]

Thank you 🙏🏻

[maley2711 in reply to Tinkudi]

More than welcome! I would think it is the PSMA PET result that is key...more than the MRI, which I believe has many more false positives. Best of luck...after the bad luck!!!

[Tinkudi in reply to maley2711]

Wish you the same 😊🙏🏻 Thanks again !

[Rickmartin1948]

Hi Tinkudi, beyond the knowledgeable advice of some of the super learned participants, my only reccomendation if the bone mets are few, see if its possible to do SBRT radiation treatment to zap them because the pain totally goes away and at 83 you do not have all that energy to spare. It will not cure him but will improve quality of life and he will be more optimistic, and this can be done independently from whatever systemic treatment you follow

[Tinkudi in reply to Rickmartin1948]

Thank you so much. He has bone pain at one spot on his pelvic bone. Are many sittings of radiation usually required or a few

[Rickmartin1948 in reply to Tinkudi]

Tinkudi SBRT generally resolves in no more than three sessions of about 45 minutes 80% preparation and 20 percent actual radiation

My first session for the hip bone couple of Mets at mid morning was followed by a tennis match at 3 PM where I won because now I could hit my backhand properly, which I had not been able for months because of mi hip bone pain

Side efects are normally minimal and after three sessions I only had some tender spots on my skin where I applied moisture g cream for a couple of weeks

[Tinkudi in reply to Rickmartin1948]

Thank you. did you have any side effects with the radiation

[Rickmartin1948 in reply to Tinkudi]

None really just a little itching on the side of the hip but nothing you would consider significant

Actually I had an accident one day after I finished the three session , my room caught fire, I had to walk in fire and molten plastic in the dark and I spent a here months in bed and thanks God recovered from 3rd degree wounds on the soles of both feet, and I do not know how I would have mange’s it if I had not eliminated the hip bone pain

It did not cure me, but I am still around finishing a 10 month vacation after my last ADT bout

[wvdmb]

My husband was diagnosed in 2021. The cancer had already spread to his ribs and spine. We opted not to have a biopsy. As stated in previous comments the treatment would be the same regardless if the biopsy report. He is now 67.

[Tinkudi in reply to wvdmb]

Thank you. What treatments did he do ?

[wvdmb in reply to Tinkudi]

He has been on Erleada and Lupron shots. The shots are every 3 months. He had radiation to his spine. This is where most of his cancer had metastasized and he had a lot of pain. Once the hormone therapy showed signs that it wasn't working he had 6 sessions of chemo. This didn't prove to be very effective so he is now receiving 6 treatments of Pluvicto. He has had two treatments. They are scheduled every 6 weeks.

[Tinkudi in reply to wvdmb]

Thank you and I pray pluvicto will work for him. For how long did the lupron and erleada work for him ? Did the spine mets pain reduce with Radiation - did it need many radiation sessions ?

[wvdmb in reply to Tinkudi]

The Lupron and Erleada worked for a year and a half but keep in mind each person responds differently. I know a lot of people this combination has worked for years. The radiation totally eliminated his pain. He had 5 treatments in one week. It was a stronger dosage. My husband did experience a good deal of nausea with radiation. There is medication to help with this. A lot of people don't have any nausea though.

[wvdmb in reply to Tinkudi]

The Lupron and Erleada worked for a year and a half but keep in mind each person responds differently. I know a lot of people this combination has worked for years. The radiation totally eliminated his pain. He had 5 treatments in one week. It was a stronger dosage. My husband did experience a good deal of nausea with radiation. There is medication to help with this. A lot of people don't have any nausea though.

[RoseDoc]

At 83 years old, I would follow your doctor’s advice. No need to be too aggressive here as it will adversely affect his QOL. He has prostate cancer. The treatment prescribed will do the least harm and slow the progression.

[Tinkudi in reply to RoseDoc]

did you mean no need to be too aggressive ?

[RoseDoc]

sorry, yes. No need yo be too aggressive

[j-o-h-n]

From your first post of two days ago:

Lupron shot without delaying , and then after that we can think of the Orchiechtomy.

Im'87 and I have one Hindi word for your dear Father, Nahin Nahin.

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Hi John 😊. Nahin means no in Hindi. What are you saying not to do ?

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

83 and having your balls cut off? I don't think so Doc....(maybe in my next life)....

Good Luck, Good Health and Good Humor.

j-o-h-n