Are we on the right track?

[Kathyford]

Hi All,

My husband, Pat (61) was diagnosed in late February with low grade metastatic PC.

Gleason 9 grade 5. PSA 32.

In a few small pelvic lymph nodes and a couple pelvic lesions. No other spread. PSMA pet scan detected this.

We are working with a team and when we were told his diagnosis from his cancer doctor he said the Oncologist would probably do triplet therapy. She did not. He is doing doublet therapy. 1 Degarlix injection, 1000mg Abiratone with 5 mg Prednisone , 3 month Lupron injection and starts IMRT radiation this coming Thursday. (28) days.

Are we on the right track?

my head is spinning with so much information.

Thank you so much.

[Tall_Allen]

I think some oncologists avoid triplet therapy based on erroneous interpretation of the data:

prostatecancer.news/2021/05...

The error is that they mistake the lack of maturity of the data on the subgroup of patients with low metastatic burden to mean it is not necessary for that subgroup. Let me explain:

The two trials on triplet therapy (PEACE1 and ARASENS) found that the triplet increases survival (compared to docetaxel+ADT) for all patients who are newly diagnosed with bone metastases. They also found that triplet increases survival in the subgroup with high metastatic burden. They have not yet found that triplet increases survival in the subgroup with low metastatic burden. The reason is that the "low" subgroup lives so long that they won't be able to detect a survival difference for several more years (this is called "immature data"). Meanwhile, we know that triplet works in total, and our best practice is to treat with triplet all men with metastases.

Also, PEACE1 and ARASENS compared triplet to a doublet with docetaxel. They didn't compare it to a doublet with abiraterone/darolutamide. We think it performs better than the doublets based on monadic (not randomized) comparisons, but we can't be sure.

[85236442968]

Kathyford

I cannot speak for Triplet Therapy, however the course of treatment that your Husband has been put on is similar to mine.

I had 6 of 12 core that tested positive on the biopsy. Pet Scan showed a number of pelvic lymph nodes positive for PSMA, and 2 nodes at periaortic level positive for PSMA.

Immediately started Lupron and Abiraterone, followed by 28 IMRT session and 3 SBRT session for the Periaortic. This was all done in Nov thru Jan 2023 time frame.

April 8, 2nd PET scan showed no PSMA on the Prostate gland or in the Periaortic nodes. all but one of the pelvic nodes also showed no PSMA. The one node that remained with PSMA activity had an uptake value of 2.5 comparer to 16.3 in October.

So for now I can say at least for me the "Course of Treatment" has appeared to be very positive.

Still on Lupron and Abiraterone, The MO says I will be 2 years on it, then we will reevaluate.

Please share this Post with your husband

[Jewelrylady in reply to 85236442968]

My husband’s treatment the same, Lupron, abiraterone, prednisone and two rounds of SBRT for bone mets. Doctor also said will reevaluate hormones in two years. Doctor never suggested chemo. After one year, PSA and testosterone are undetectable.

[NanoMRI]

IMO right track with this beast is an individualized decision - we have many options. All the best!

[85236442968]

Kathyford

Correction on the previous post. time from of IMRT and SBRT was Nov 2023 thru Jan 2024.

[God_Loves_Me]

one request listen to Tall_Allen

[Heykm01]

Here are my collected doublet (ADT+ARSI) vs triplet links (a couple may be behind a paywall for the complete article):

urotoday.com/conference-hig...

onclive.com/view/dr-hussain...

urotoday.com/transformative...

jamanetwork.com/journals/ja...

jamanetwork.com/journals/ja...

journals.lww.com/ajandrolog...

dailynews.ascopubs.org/do/w...

ascopost.com/video-roundtab...