optimal curative therapy?

[NickKnick]

Very fortunate still to have a chance for cure — Gleason 9 with post surgery LN involvement, but no distant mets detected. Received RT and about half way through a 2-year course of Lupron. PSA undetectable; tolerable SEs. Would adding Abiraterone or Apalutamide now maximize chance of cure or is it better to save those drugs for later if needed? Appreciate thoughts and many thanks to all who contribute to this valuable forum.

[6357axbz]

add Abi now

[NickKnick in reply to 6357axbz]

Noted and appreciated.

[NanoMRI]

Not sure my thoughts will be appreciated - your post RP PSA of 2.7 would have me very concerned as to whether all the remaining cancer was confined to the RT field, My post RP nadir was 0.050 and two years later I faced cancer as far as common iliac and para-aortic pelvic lymph nodes, at 0.13. All the best!

[NickKnick in reply to NanoMRI]

Agree that is certainly a concern. Appreciate your taking the time to assess and flagging the issue. Cheers.

[OzzieJ]

I had similar to yourself. My post op PSA was 0.6. Two pelvic LNs identified by PSMA scan. I did chemo and then radiotherapy with ADT plus apalutamide. Coming up on 2 years into a 3 year regime. My oncos approach was to hit it as hard as possible with everything up front. I'm a bit skeptical that all mine was contained given the poor outcome from the RP but time will tell I guess. Best wishes with whatever you do.

[NickKnick in reply to OzzieJ]

Thanks for your response and sharing your history. Wishing you well.

[Tall_Allen]

For LN involvement, 3 years of ADT and 2 yrs of abi are used.

[Chadsdad in reply to Tall_Allen]

Allen, are distant lymph nodes harder to treat than local nodes using 1st and 2nd generation treatment?

[Tall_Allen in reply to Chadsdad]

It depends how distant - anything in the mediastinum or groin is out of target range for curative therapy.

[NickKnick]

Thank you - are ADT and Abi typically taken concurrently or over consecutive periods? Will be useful for my discussion with my MO.

[vintage42 in reply to NickKnick]

ADT and Abi are typically taken concurrently as doublet therapy.

[NickKnick in reply to vintage42]

Got it. Thank you.

[spencoid2]

I don't want to be negative but I think there is little chance for a cure. Gleason 9 is likely to have metastasized to other locations than the lymph nodes. It is also surprising that surgery was the choice of treatment. Sounds like your urologist thinks surgery is for everyone?

[despurato in reply to spencoid2]

Like myself. He was probably not a G9 until after surgery pathology report. It’s much more accurate when they can dissect the entire prostrate.

[SimMartin in reply to despurato]

Yes I was g7 and 2 biospies in left side over 18 months showed no positive cores then osa jump after HIFU on positive g7 side and 3rd biopsy showed G9 with 20% 5 on the earlier twice biospies clear side ! Slippery customer this PCa

[NickKnick in reply to despurato]

Yep, G7 pre-op

[spencoid2 in reply to NickKnick]

wishing you the best my gleason 9 from 11 years ago is now metastatic castrate resistant. your diagnosis being 11 years later there are likely to be more options available to yo when you need them.

[NickKnick in reply to spencoid2]

Thank you - hoping for both of us and everyone else here.

[bdrakes in reply to despurato]

I concur. I went in four months ago Gleason 7 and came out Gleason 9.

[NickKnick in reply to spencoid2]

oh I get it - just keepin the faith.

[spencoid2 in reply to NickKnick]

there are al sorts of trials in the works some of which might be available when and if you need them. i was hoping for one myself but the next "cohort" recruitment is uncertain and my MOs are saying i need to act sooner. so it is probably more pluvicto for me to keep me alive long enough to try something else when available. who knows, with your 11 year advantage there might actually be a cure

[Spinel_Cutter]

Good question. The old adage, "what doesn't kill us, makes us stronger," might relate to cancer too. Adding one of the drugs to quench that last % of T seems rational, but it is so very complex. Next week I'll be asking Alyssa Morgans of Dana Farber that very question. I so fear ADT. At age 74 three years of ADT and there is a good chance that T will never come back. I like the idea of Orgovyx w/ reduced cardiac issues, and much faster bounce-back than Lupron. I mentioned this to one of the Radocs I interviewed recently and he did not seem to be very aware that it exists. (Not to be critical, as most radocs do not deal w/ ADT).

Try to find a good Medonc (Medical Oncologist) at a center of excellence who deals exclusively or mostly with PaC. Alyssa Morgans at Dana Farber is one, and I know of a fellow that I met at Reluctant Brotherhood who stated that he flew to Boston just to ask her questions and he was very happy with resultse.

[Pjford]

I’m 4+5 low volume in Lymph/ pelvic area . They put me on both Lupron and Aberaterone/ prednisone right away . 28 rounds of radiation as well . It’s a lot of fun. Not sure why I wasn’t recommended chemo with it , but so far not doing to bad .