This community has been so informative and I truly appreciate the information I have received from so many incredible people. Thank you! This is the first time I am posting to this group.
In October 2023 my husband noticed more frequent use of the bathroom. He had his PSA tested in January which was 41.4 with repeat PSA on 1/22/2024 48.5. MRI from 1/24/2024 showed a suspicious lesion in the left lobe with ECE and possible seminal vesicle involvement in addition to a left mesorectal lymph node measuring 0.6 x 0.7 x 0.7cm with bone lesions in the right posterior acetabulum, left pelvic symphysis, anterior acetabulum and sacrum.
A transperineal fusion prostate biopsy performed on 1/29/2024 showed Gleason 4+4(8) prostate cancer in 4 cores involving 65-100% of the cores in addition to Gleason 3+4(7) in 705 of a single core and Gleason 4+3(7) in 4/4 cores ranging from 65-95% of the cores. Cribriform and intraductal patterns were seen along with lymphovascular invasion. DEXA scan on 4/03/2024 that showed osteopenia. IMPACT testing did not reveal any actionable germline mutations.
PSMA PET Scan on 2/20/24 confirmed PSMA tracer avid, subcentimeter neck, mediastinal and abdominopelvic nodal metastases and PSMA tracer avid, CT-occult osseous metastases. Bone lesions were oligometastatic.
PSMA PET Scan on 7/2/24, since February 20, 2024, majority decreased and several unchanged PSMA avid osseous lesions, all with increased sclerosis, consistent with metastases, few are slightly increased in extent or uptake. Markedly decreased and resolved PSMA avid lower cervical, thoracic and abdominopelvic nodes, consistent with metastases.
PSA from 3/06/2024 was 106.77. PSA on 7/10/2024 0.06. Currently he is on daily abiraterone 4 -250 mg with Lupron injection. He is being treated at MSK in NYC. We are waiting to start radiation treatment. It has only been a couple of months on ADT.
For the most part he is handling ADT very well. Some hot flashes and fatigue. We have two little girls 5 and 7 years old. He is 42 years old. His father had prostate cancer in early 2000 with no reoccurrence and treated with radiation. My husband eats pretty healthy and overall healthy guy besides the cancer.
My question is from your experiences and knowledge, is there anything that we should be looking into or asking our doctor about? Any advise would be greatly appreciated. Thank you in advance for taking the time to read this post and respond.
Sincerely, Stephanie
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Smmac15
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Stephanie, I am sorry you and your husband are going through this. I don’t have any pearls of wisdom. My husband is 62 and has several Mets to bones and lymph. Diagnosed in February. He got Chemo immediately and it was really a bad experience, but everyone is different and some breeze through it. The only thing I suggest is to make sure you are seeing a medical oncologist that specializes in urology. MSK is a great place. If you’re not I would seek a second opinion. I hope you get some responses from other folks more knowledgeable in this group. I hope your husband responds to all his treatments well.
Thank you Sunny for your kind words. Yes, we do have someone specializing in urology at MSK. I wish you and your husband all the best as well. Keep fighting!
I found that weird as well so I've asked the Perplexity AI and it does not seem like younger men handle chemo less well than older men. Actually its probably the opposite. Here is its answer:
"Based on the available research, there is no clear evidence that docetaxel for prostate cancer is tolerated better in older men compared to younger men. However, studies suggest that carefully selected older patients can tolerate and benefit from docetaxel treatment. Here are the key points:
Toxicity concerns: In elderly patients, there are significant concerns about the risk of toxicity with docetaxel chemotherapy, particularly myelosuppression and sepsis.
TAX327 subgroup analysis: In the landmark TAX327 trial, men aged ≥75 years had significantly higher rates of infection and required more frequent dose reductions than younger patients.
CHAARTED trial analysis: A post-hoc analysis of the CHAARTED trial found:
Similar rates of grade 3-5 adverse events between older (≥70 years) and younger (<70 years) men (36.8% vs. 26.8%, p = 0.069).
No significant difference in grade 4-5 adverse events between older and younger men (14.9% vs. 11.9%, p = 0.46).
A similar proportion of older and younger men completed six cycles of docetaxel (82.6% vs. 87.1%, p = 0.28).
Efficacy in older patients: Studies have shown that carefully selected older patients can derive clinical benefits from docetaxel treatment, with similar survival benefits compared to younger patients.
Patient selection: Comprehensive geriatric assessment is likely to be helpful in identifying patients at risk of increased toxicity.
Dosing considerations: Some studies used initial dose reductions or alternative dosing schedules in older patients to improve tolerability.
In conclusion, while docetaxel is not necessarily better tolerated in older men, carefully selected fit elderly patients appear to tolerate the treatment similarly to younger patients and can derive clinical benefits. However, careful patient selection, potential dose adjustments, and close monitoring are important when treating older patients with docetaxel for prostate cancer."
I am sorry to read what your husband is experiencing at such a young age. The one thing I would suggest is requesting genetic testing to see if there are any genetic mutations that may be responsive to a biologic such as Keytruda. Given that your husband’s father had prostate cancer, there is a good chance that a genetic mutation may have been passed onto your husband.
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Stage 4 A Prostate cancer
Failed RP & SRT; Negative PSMA PET
looking for advice. 
The shadows of my spine...
