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!