Hello I'm looking for some answers and information for a member of my family. He was diagnosed 4 years ago with oligometastatic pca,went through radiation, adt+abirateron and chemo.
In some point abirateron has failed so went for chemo,one year later when psa is still low as 0.014 new bone metastases popped up on pet psma scan.
His mo says it's very rare and suggests starting plovicto, another mo he went for second opinion thinks it's time to change to xtandi and go for sbrt zapping the mets.
Is there any member of the group who deal with the same situation?
I'll be thankful to hear some comments and thoughts.
Thank you.
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Niso
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- Yes many member in this group dealing with low PSA and progressive mets
I think it is time for systematic therapy. I agree with second opinion do SBRT and treat the METS and participate systematic therapy in clinical trials like ADC or AMG 509. Keep the options open for pluvicto in future. In next couple of months or week, may be MO will tell you xtandi is not working for him.
Many clinical trials that focus on systematic therapy with min side effects that's something immediate consideration after SBRT treatment.
Good Questions - When low PSA means PSMA may not able to detect the or accurate results. So FDG get you best results when you have low PSA and Bone Mets Progression
I remember that you wrote a positive comment on combining xofigo with provenge if I'm not wrong.What do you think about this combination for this case?
I’ve had my PSA go from undetectable to 0.2 twice, each time I’ve had a PSMA scan that showed a met on a rib. I had SBRT both times and each time PSA has fallen back to nearly undetectable. These events occurred about a year apart. I’ll continue to play whack a mole as long as possible before moving on to other treatments that have more significant SE’s.
I was diagnosed with Ductal Prostate Cancer and my PSA never was higher than 4.3, Mayo called it an angry cancer and a rare form. So I am preaching to all men not to rely just on PSA but also the DRE, digital rectal exam or the physical exam of the prostate by your MD.
Yes indeed! To many providers are only using PSA and not doing DRE's. I would be in a much worse situation if not for my Dr doing a physical exam. My PSA went from 4.2 to 3.9 which some may consider good news and leave it at that.
Yes, DRE's have their purpose as prostate cancer is not the same and does not all present the same!
I know a man at a local group who had undifferentiated prostate cancer and his PSA was never over 2.0. It was a smart and diligent GP who added up his symptoms over the last 5 - 6 years and asked if he would be open to a DRE since it had been 6 to 7 years since his last DRE. A very hard prostate revealed G10=5+5 with mets all over his body. He lived a couple of years and just passed in May 2024. So, yes, DRE's have a purpose!
I am one of those with low or undetectable PSA and bone mets. From what I can tell, the mere fact that the PSA is low or undetectable does not change the treatment options. The treatment options depend on the individual patient.
In my case, I have received spot radiation on tumors as they appear. I know, however, that if the tumors spread more I might have further chemo or pluvicto or whatever else is coming down the research pike.
PCRI has a video with Dr. Kwon on treatment options for advanced prostate cancer at: youtu.be/-RVVq0uDAEE?si=vfB.... He mentions that many who fall into this category have non detectable PSA.
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