Looking for support in supporting my husband

[Smmac15]

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

[Sunnysailor]

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.

Sunny

[Smmac15 in reply to Sunnysailor]

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!

[Tall_Allen]

It is not a diagnosis anyone wanted, but the treatment he is getting at MSK is among the best in the world.

One question - did you discuss triplet therapy?

prostatecancer.news/2021/05...

[Smmac15 in reply to Tall_Allen]

His medical oncologist reported that in her experience young men do not handle chemo as well as the older men she has treated.

We are awaiting for radiation to start. She said at the last appointment that if it was up to her, she would start radiation right away.

I’m not sure when exactly radiation should start. She did say 2 years of ADT. We are 5 months in.

Thanks for your response!

[MJCA]

Hi,

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.

Best of luck. Please keep us posted.

[Smmac15 in reply to MJCA]

Thank you!

Genetic testing showed no mutations.

[MJCA in reply to Smmac15]

Okay that’s good I believe. Then follow Tall_Allen’s advice. He’s the Prostate Cancer Expert.