First steps for treating bone mets

[Keno2087]

Just a worried son making sure I can help my father determine the best course of treatment.

My father's prostate cancer was recently (3 weeks ago) found to have metastaticized. The 2 spots on his spine (C2 and L5) were found from a PSMA PET scan that was ordered after a rising PSA over 3 blood tests (.02 to .2 to .5 respectively). He has had a prostatectomy and salvage radiation in the post surgical bed as well as intermittent hormone therapy a couple of years ago (Eligard).

After our first appointment with our medical oncologist, I believe he wants to put him back on Eligard and Erleada or Nubeqa and do spot radiation treatment once we talk with a radiation oncologist and gets an MRI on both spots.

From what I've read, would it be beneficial to engage in triplet therapy and introduce docetaxel into his treatment? He is 65, a little overweight but we're addressing it well with diet and exercise.

[Tall_Allen]

His PSA and his metastases only on a PET scan are too little for chamo at this point.

[swwags in reply to Tall_Allen]

Hey TA. I appreciate all you do and follow much of it but can you please elaborate a bit on your comment? Why not chemo and what instead? Thanks for the insight.

[Tall_Allen in reply to swwags]

prostatecancer.news/2019/02...

[Keno2087 in reply to Tall_Allen]

I do see where it may be of benefit to low PSA and high grade which my dad is (Gleason 8).

[Keno2087 in reply to Tall_Allen]

Thank you Tall_Allen for the quick response. Hopefully we have a multitude of options to fall back on including chemo should we need it. Definitely anxious but ready to start tackling this with the ADT and spot radiation.

[j-o-h-n]

Greetings Keno2087,

You came to the right place..... You're a great son..... God Bless all of you...

Good Luck, Good Health and Good Humor.

j-o-h-n

[InqPers]

TA is right about the research not showing any benefit of adding chemo for Oligio mets. I was 59 at diagnosis and no mets were detected so I had RP done and had an immediate reoccurrence with PSA of 3 following surgery. PSMA was not yet available yet (this was late 2021), but Axumin PET showed bone and lymph node met .

I had the conv with my MO. He said that we could 1) go with doublet (Abi/Pred+ADT) and IMRT radiation; or 2) triplet (Chemo+Abi/Pred+ADT), followed by radiation. I went aggressive partly because I felt my cancer was a bit more aggressive, unless they just missed it with the pre-surgery bone scan, and felt I'd be OK with SEs due to my age and fitness.

I've been undetectable for over 2.5 years and went on ADT holiday almost 12 months ago and counting. For me the SEs were all tolerable, but 24 months on ADT was taking it's toll in several areas. Yeah, I know, it's all a judgement call...

[GP24]

I think you should just observe until the PSA gets e.g. above 2.0. Avoid the side effects of overtreatment.

[MateoBeach]

Two bone mets On scan = oligometastatic is a favorable situation for spot treatment SBRT with at least short term adjuvant ADT. Six months may be sufficient and adding Nubequa seems Wise.

Docetaxel chemo does not cure advanced PC and can only slow it down for a time. I would skip that.

[Keno2087]

Would Eligard + Erleada be the better starting combo then since we may wait a bit for chemo or can Nubeqa be useful without chemo for a bit?