Question for Oncologist

[103532]

Tall_Allen, if you are around, I would especially appreciate your thoughts…….my husband, Dave is still on Lupron/Zytiga/Pred for M1a pc. only in a few abdominal nodes per PSMA scan. He just completed IMRT and was undetectable two weeks ago. Have you ever heard that the progression of soft tissue mets like my husband’s is more lethal after eventual castrate resistance from Zytiga when the original tumor had perineural invasion? It was also mentioned that the length of time to resistance is shorter. A poster here shared a Chinese study a few days ago, and it worried me. Do you have an opinion on whether we should ask to stop the Zytiga and switch to a different 2nd Generation like Xtandti? I wasn’t aware of this situation before. We have not been offered chemo. The bio is updated. Thanks for any suggestions or opinions.

Stephanie

[Tall_Allen]

I really don't follow you. And the profile answers none of my questions. As I understand you, he's had some abdominal metastases (where exactly?) for which he had IMRT (where exactly?) and is taking Zytiga. Did he also have a prostatectomy, and salvage IMRT? Was the PNI from his biopsy or after his prostatectomy, if he had one? Why would you stop Zytiga? What Chinese study?

[103532 in reply to Tall_Allen]

Here is the link for the study:sciencedirect.com/science/a...

So 4/22 my husband was dx with Gleason 9 pc with after fusion biopsy from 3T MRI. His MRI showed PIRADS 4 and 5 lesions that looked contained to prostate. Biopsy showed cribriform and PNI. Prostatic Acid Phosphatase 3.6. He was placed on Neoadjuvant 3 mo. Lupron with Casodex. RP was 9/22, stage 3b with cribriform and PNI still present. Final path not given due to treatment artifact. All ADT was stopped until 11/23 when a confirmed bio recurrence at .273. Immediate PSMA scan showed four subcentimeter, moderately PSMA avid retroperitoneal lymph nodes. Immediate Casodex followed by Lupron then Zytiga/Pred followed two weeks later. Salvage extended pelvic IMRT (extended above bifurcation) was completed between 3/24 and 4/24 with plan to continue doublet therapy for at least two years. Currently undetectable. The study alarmed me due to the fact that he was M1a (distant lymph- which is soft tissue) and has PNI. We do think he is still hormone sensitive and not Neuroendocrine, but based on this paper, would you see any reason to switch from Zytiga to Xtandi or other? Thanks for any opinions or suggestions. I apologize for the confusion.

Stephanie

[Tall_Allen in reply to 103532]

Thanks for the explanation and article.

The article is a retrospective study about men with castration resistance who are also abiraterone resistant and has nothing to do with your husband's situation. It found that PNI was associated with eventual soft-tissue progression in such men.

Your husband received possibly curative salvage whole pelvic radiation for his recurrent hormone-sensitive PCa. The SOC includes 2 years of Zytiga and 3 years of ADT. After that, all mediation is stopped and testosterone is allowed to rise. Hopefully, there will be no further rise in PSA or evidence of disease.

People post all sorts of irrelevant things trying to be helpful.

[103532 in reply to Tall_Allen]

Thank you!! I appreciate the understanding!

[DLimey]

Hi. Did you learn anything further about the soft tissue mets? Hubs latest scan shows uptake to soft tissue and I’m worried.

[103532 in reply to DLimey]

Hi,

I have not discovered anything further regarding soft tissue mets. My husband has been undetectable, and it is a bit over one year since his recurrence with spread to his retroperitoneal lymph nodes. He has very high risk pathology, but we are vigilantly watching his labs and psa. He completed targeted and salvage radiation last spring. We head back to Yale for his next 3 month oncology visit in a few weeks. We are starting his second year on the same Lupron/Abi/Pred regiment. If there are any questions we can ask our oncologist that would be helpful to you, please advise. Please keep me posted on how your hubby is doing.

Stephanie

[DLimey]

His latest psma scan shows uptake to his sciatic nerve and iliac bone. Also, recurrent metastatic PC. Had salvage radiation 3 years ago. PNI was NOT noted in RP pathology, but he has an aggressive low PSA cancer type. Limited on treatments now due to blood cancer from pelvic radiation.

He has an amazing MO who will explain treatment options once he returns to the office. Meanwhile my anxiety and need to learn what I can has kicked in.

[103532 in reply to DLimey]

I know how you are feeling. I shook and trembled in bed all night with worry and anxiety. I know you will be on top of the latest for the low psa mixed ductal type of metastatic pca. I will reach out if I find anything that relates to what you have told me and your husband’s bio. Please let me know what your Onco plans when you see him soon. Sending prayers and hugs!

Stephanie