My PSA at diagnosis was relatively low at 21 and scans showed multiple bone mets.
My oncologist said that puts me at a greater risk of the cancer morphing Into a more aggressive one in the future compared to someone who had come with a psa of 400-500. Is this correct ?
Would doing chemotherapy in addition to ADT plus ARPI reduce the chances of the morphing from happening or that has no correlation ?
Since taking orgovyx since 6 weeks I have no symptoms as such and psa has come down to 1.175
Reducing cancer load has a much greater effect than any increase due to selection pressure.
Thank you very much for your guidance.
Is it true what the doctor said of my case being at greater risk due to the reason he gave ?
I am afraid I did not understand what you meant by selection pressure - is it possible to say that in a simpler way please.
Hoping you will explain. Is it true what the doctor said about the greater risk for aggressive small cell cancer etc in the future and what does “ increase due to selection pressure mean ?”
Considering that it's virtually impossible to kill all the cancer cells, there is a chance that the surviving ones are resistant to the treatment, and that they will reproduce clones of themselves, creating a treatment resistant population. That's what he meant with selection pressure. That's how evolution works: survival of the fittest. For example, in a forest with a brown floor, brown beetles are less visible to predators than green beetles. As a result, more brown beetles survive and reproduce, passing on their color to their offspring. Over time, this leads to an increase in the brown beetle population. Now think about someone finding a way to make the forest floor green. The beetles population will revert the trend and green beetles would become dominant. In our prostate cancer, every treatment puts a form of selection pressure on cancer cells.
If I have been 6 weeks on Orgovyx only and not on any ARPI , do I still have the window open to do chemo or is it too late
I started chemo at 6 weeks with my triplet therapy.
What had you taken before chemo ?
It's not too late. Chemo and ARPi must be started now at the same time.
good morning warrior. My oncologist did something unusual in 2016 when I was diagnosed at the age of 66. We decided since I was in good physical shape we would go directly to chemo then to the pills as backups. 6 rounds of Taxotere ,with a Neupohen shot the following day. Plus we started monthly Eligard and Xgeva shots as well. When the chemo was done he put me on Xtandi 120mg ? August the 6 th will make 8 years for me. Keep up the fight Warrior
wow. so are you still on adt ?
Chemically castrated 😢😢😢
What was your Gleason score and what mets did you have ?
Well they didn’t tell me my Gleason that I remember. Had Mets in lymph nodes throughout the mid section of my body, bone Mets in my neck,sternum,and hip . I light up like a Christmas tree when they did the scans and my alkaline phosphate number was off the chart , wife tells me they went in and did the biopsy but I was so out of it I don’t remember it. Does this help
Thank you. I wish I were younger. I realise the benefits of chemo but am scared to take it at my age too
If you start chemo and don’t like the side effects, you can stop. I don’t think that stopping puts you in a worse situation than not starting?
Triplet therapy ante literam!
Simpson80 said: “PSA at diagnosis was 21… multiple bone mets… oncologist said that puts me at a greater risk of the cancer morphing Into a more aggressive one in the future compared to someone who had come with a psa of 400-500. Is this correct ? … taking orgovyx since 6 weeks… psa has come down to 1.175. Would doing chemotherapy in addition to ADT plus ARPI reduce the chances of the morphing…?”
To which Tall_Allen replied: “Reducing cancer load has a much greater effect than any increase due to selection pressure.”
I think your oncologist was referring to cancer “morphing” into castrate-resistance. And you asked if chemo would reduce that.
I think Tall_Allen may be saying your drop in PSA is from hormone therapy reducing the cancer load by making cells senescent, which has greater effect than adding chemo to actually kill cells before they selectively develop castrate resistance.
In any case, chemo works on growing cells, and should be started with ADT/ARPI, before those drugs have made the cells senescent. You being 6 weeks into ADT with PSA drop, have probably missed the window for chemo to be effective on the cells.
Our doctor said - show me the data. There's zero data comparing doublet therapy to triple therapy head to head. Get your generic screening of the biopsy tissue done if you haven't already. That helps determine if chemo is needed if you have an aggressive marker pop up.
I do not think that a head to head trial between triplet and doublet (ADT + ARSI) has ever been done, with ADT + docetaxel yes.
But there are some retrospective studies: pubmed.ncbi.nlm.nih.gov/360...
In high volume metastatic hormone sensitive setting, triplet seems always superior. But a lot depends on factors like Gleason score, patient fitness level and age, volume and so on. That's what we have talked about with my MO before going for the triplet. But yes, it's not proven that triplet is always better.
I didn't see where you said how many bone mets lit up on PSMA PET CT.
The Perils and Pitfalls of "Treating PSA" in Advanced Prostate Cancer
Does the effect of Docetexal goes away after 2 years in this case? 
PSA teating or wait it out?
Does a big drop in PSA a month after the start of hormone treatment possibly represent a higher chance of cure? 
What does the cancer in your back feel like? 
