Waiting for the Other Shoe to Drop

[TheLarch]

61 with oligometastatic prostate cancer. PSA is currently down to 0.02 today after 6 months of Lupron and Erleada from PSA 150 in late Dec. '23. Started on Megestrol Acetate back in April, really reduced the side effects of ADT for me. My figure also looks about the as before treatment. I had a trans-rectal prostate biopsy (Nov. '23) that revealed Gleason score 4+3 = 7, 4+4 = 8 and 4+5 = 9 involving 12 of 12 cores, adenocarcinoma.

A bone scan about the same time showed solitary uptake in right fifth rib correlating with a healing fracture at the fifth costochondral junction. It's the same spot I had injured last summer when I was bending a piece of metal with my bare hands. Did cancer make itself home at the rib after the injury or was the cancer already there and the reason it snapped under stress? I was told a rib biopsy is difficult and "we will just assume it's a lesion".

A PSMA-PET using Flotufolastat_F-18 in Dec. '23 revealed uptake in the prostate, bilateral external iliac and inguinal lymph nodes, and right fifth rib.

My prostate size on ultrasound was noted to be: 62 ml. (Nov. '23).

Testosterone Total has been under 10ng/dl since late Feb. '24.

Genetics tests all came back normal.

Nov. '23 and July '23 CT scans of the abdomen and pelvis showed no evidence of disease.

Finished my 6 weeks of IMRT about 6 weeks ago. 3,000 cGy / 3,000 cGy (5 of 5 fractions) to rib, 7,000 cGy / 7,000 cGy (28 of 28 fractions) to prostate and pelvis. PSA was 0.14 the day before treatment began.

My MO thinks I'm doing great and will keep me on ADT for another two years.

My PSA is ~7500 times lower now than it was 7 months ago. Plans are to check every 90 days on the day of my next Lupron injections.

My lower back pain looks like bone spurs (several recent x-rays) and hip pain looks like arthritis (more x-rays). DEXA scan showed mild Osteopenia.

My PSA was 36 about 8 years ago but the ER doc was focused on a different issue and thought "there would be other signs" if it was prostate cancer. PSA was near 150 last year but it took months to see a urologist, nobody seemed to think it was urgent.

Are we missing anything now? Did I get as close as possible to falling off a cliff before just being saved?

[j-o-h-n]

Hell, you are in your snanzy car hidden by the Larch trees with that cute thing in the back seat and many feet away from the cliffs edge. Now that's heaven before heaven.

Good Luck, Good Health and Good Humor.

j-o-h-n

[103532]

I think you are receiving the best care. You are hitting the oligometastatic condition with the doublet therapy as is now the SOC, and you have reduced the burden by also zapping the rib, pelvic nodes and prostate. I am curious why Erleada was recommended for you as opposed to Lupron combined with Zytiga (Abiraterone) with prednisone. Was it part of a clinical trial? When my husband went Oligometastatic M1a in clinical recurrence, I did not ask about apalutamide, but have seen similar cases where it was added to the treatment protocol. I am sorry it took so long for them to diagnose your pca, but I feel with this treatment you will have a long durable remission and may even be potentially cured.

Stephanie

[TheLarch in reply to 103532]

It was my urologist that started me on the Bicalutamide then Erleada along with the Lupron. My first MO agreed with combo and didn't recommend any chemo based on "There is no radiographic evidence of high-volume disease, and therefore the addition of docetaxel was not recommended."

I have only been on one 60mg of Erleada per day vs the usual four 60mg per day for the past few months since my blood pressure started rising. MY BP a year ago was ~220/120 now it's ~118/83 and lower but I'm on four BP meds. My current MO doesn't want to change anything at this time. I'll see him again in 80-something days when I get more Lupron. There were lots of discussions around finding a combo for the PC as well as the hypertension.

[103532]

Sounds like an excellent combo for you. I pray you continue to have excellent results and the bp stays under control. Abiraterone is known to elevate bp, and my husband had to double his blood pressure meds and is now also doing fine. Best wishes!

[TheLarch in reply to 103532]

Thank you for your kind words. Best to you and your husband.