Olaparib May Be Effective Without Hormone Therapy in Some Men With Biochemically Recurrent Prostate Cancer

[street-air]

quite a large sub group of men with recurrent prostate cancer were able to put off psa rises and put off mets developing and reduce psa with no hornone treatment just Olaparib - LYNPARZA

in short, the responders, who can be tested by gene typing, had median time of almost 4 years without adt vs the non responders who only managed 12 months - AFTER recurrence. One of the gene types is BRCA.

ascopost.com/news/august-20...

[GP24]

Olaparib monotherapy is very effective for metastatic castration-resistant prostate cancer. ascopubs.org/doi/full/10.12... I see no reason why it should not be effective for hormone sensitive prostate cancer patients, provided a BRCA mutation has been determined. I think you can remove the "may be" in the headline of the report. However, Olaparib has no FDA approval for hormone sensitive prostate cancer patients yet.

[allmo]

This PARP inhibitor study regards Biochemical Recurrence (BCR) stage. The next study should be combination therapy, Parp + the standard (EMBARK study) for high risk BCR, double hormone blockade (ADT {Lupron} + ARSI{Enzalutamid}) vs. double hormone therapy in the control arm.

[Hidden]

I'm BRCA2 and this is good and bad news. I'm on a Facebook group for the drug and 90% of the women are beyond miserable. That being said, I'm thankfull that I got the blood test from the beginning.

[street-air in reply to Hidden]

the more serious side effects sound brutal

[Seasid]

And you may develop resistance to parp inhibitors at early stage with side effects like red blood count etc. Losing olaparib for a final stage. Maybe there is a better way to stop the recurring cancer progression? I would not do it at that stage. I am not doing it now, I am on bicalutamide plus ADT.

[Seasid in reply to Seasid]

ChatGPT said

Radiation therapy is a widely used and effective treatment option for prostate cancer, including cases of biochemical recurrence. It can be tailored based on the stage of the disease, prior treatments, and individual patient factors. Here’s a breakdown of how radiation might fit into your treatment plan:

1. Types of Radiation Therapy:

Salvage Radiation Therapy (SRT):

Used after prostatectomy if PSA levels begin to rise, suggesting a recurrence. It targets the prostate bed to eliminate residual cancer cells.

Stereotactic Body Radiotherapy (SBRT):

A precise, high-dose radiation therapy delivered over fewer sessions. It may be used for localized recurrence or oligometastatic disease (limited metastatic sites).

Palliative Radiation:

Used in advanced stages to alleviate symptoms, such as bone pain from metastatic lesions.

2. When to Consider Radiation:

PSA Rise Post-Surgery:

Salvage radiation is often considered if PSA levels rise after a prostatectomy but before visible metastases appear.

Localized Recurrence:

If imaging shows cancer is confined to the prostate bed or nearby lymph nodes, radiation can target these areas effectively.

Combination with ADT:

Radiation is often combined with androgen-deprivation therapy (ADT) for better outcomes, particularly in high-risk cases.

3. Potential Benefits:

Localized Control:

Radiation can eradicate cancer cells in specific areas, delaying progression.

Delay Systemic Therapy:

Successfully treating localized recurrence might allow you to postpone systemic treatments like ADT or chemotherapy.

Improved Survival:

In some cases, salvage radiation therapy has been shown to improve overall survival in men with recurrent prostate cancer.

4. Risks and Side Effects:

Short-term: Fatigue, bowel or bladder irritation, and urinary symptoms.

Long-term: Erectile dysfunction, changes in bowel habits, or rare risks of secondary cancers.

5. Imaging Advances for Planning:

Modern imaging techniques like PSMA PET scans can help precisely locate cancer recurrence, ensuring that radiation targets the right areas.

If radiation therapy is being considered, discussing the timing, potential benefits, and risks with your oncologist is essential. It can be a highly effective tool, particularly when used in combination with other therapies or for specific recurrence scenarios.

ChatGPT said

[Seasid in reply to Seasid]

ChatGPT said

Your concern about the potential for resistance to PARP inhibitors like olaparib and their side effects is valid. The decision to use such treatments early in the disease progression versus reserving them for later stages is complex and should be personalized based on multiple factors, including genetic testing, overall health, and treatment goals.

Points to Consider:

1. Resistance Development: Prolonged use of PARP inhibitors can lead to resistance, which might limit their effectiveness in advanced stages. If olaparib is used early, it may not remain a viable option later.

2. Side Effects: Common side effects like anemia (reduced red blood cell count) and fatigue can impact quality of life. These should be weighed against the potential benefits of delaying disease progression.

3. Current Therapy: Bicalutamide with ADT is a well-established approach for managing prostate cancer. Combining anti-androgen therapy with ADT has been shown to reduce PSA levels and delay progression.

4. Alternative Strategies: Other strategies, such as intermittent ADT, immunotherapy, or newer anti-androgens, might be considered. Additionally, clinical trials may offer access to novel treatments tailored to specific genetic profiles.

5. Monitoring and Genetic Testing: Regular PSA monitoring, imaging studies, and genetic testing can help guide decisions on when to escalate treatment or explore other options.

Your current approach of combining bicalutamide with ADT reflects a preference for a tried-and-true strategy that balances efficacy with quality of life. If you're unsure about future steps or alternative options, discussing your case with a multidisciplinary team or seeking a second opinion could provide additional clarity.

ChatGPT said