After approx. month of Doublet therapy with Firmagon & Nubeqa PSA (Oct 2024)down from last test in August 2024 335 to 32 and T down to 13. When I started I was ADT naive.
SE: some tolerable night hot flashes, some insomnia that was prescribed Seroquell which zonked me out the next day but helped a bit.
Generally when is it appropriate time wise for a follow up PET or bone scan to see how bone and lymph node mets are fairing?
Much thanks.
You should do a PET scan when PSA rises to see if it is time to change your therapy.
What about annual PET scans to monitor Mets even with PSA in decline?
A test should only be done if a treatment change is possible.
So if PSA decreasing assume improvement? Mets will not proliferate in this case?
If PSA is decreasing, and you have no reason to suspect a low-PSA subtype, there is no reason to change therapy. Metastases are always proliferating, sometimes less, sometimes more, usually invisibly.
His PSA has never been above 10 but has the bone mets. Confused how some have PSA in the hundreds but similar issue with cancer spread. So when you say low-PSA subtype could this be the case here and what does that mean? Thanks!! Trying to keep up with all this info!!
It could be. If so, metastases may also not express PSMA either. I suggest an FDG PET/CT to be safe.
Thanks! Will ask about this at Mayo appointment next month. He did have both gene and genome testing and nothing there.
Histology and IHC of tumor tissue is more revealing than genomic testing for that.
Why not triplet therapy?
Recent study (9/2024) I believe available on this site that came to conclusion that Nubeqa and ADT Therapyl (Firmagon for me) as effective for mHSPC low/high volume as Triplet therapy.
Article: "Darolutamide in Combination with Androgen-Deprivation Therapy in Patients with Metastatic Hormone-Sensative Prostate Cancer from the Phase III ARANOTE trial. Fred Saad, et. al.
" Thus, the ARANOTE and ARASENS trials demonstrate efficacy benefits with darolutamide plus ADT with and without docetaxel for patients with mHSPC."
Thats my interpretation, anyhow. Ive provide this Global Phase 3 trial to my MO and urologist.
The ARASENS trial was ADT plus chemo vs ADT plus Nubeqa plus chemo. The ARANOTE trial was darolumide plus ADT vs ADT plus chemo. Not the same as doublet vs triplet.
This was June/24.
The addition of darolutamide (Nubeqa) to androgen deprivation therapy (ADT) and docetaxel led to improved overall survival (OS) and prolonged the time to metastatic castration-resistant prostate cancer (mCRPC) vs placebo plus ADT and docetaxel in patients with metastatic hormone-sensitive prostate cancer (mHSPC), according to post-hoc findings from the phase 3 ARASENS trial
From the ARANOTE trial Sept./24 article:
Purpose: For patients with metastatic hormone-sensitive prostate cancer (mHSPC), delaying progression to castration-resistant disease is important not only for overall survival (OS) but also for patients' quality of life. Darolutamide plus androgen-deprivation therapy (ADT) with docetaxel improved OS versus ADT and docetaxel in patients with mHSPC. The ARANOTE trial evaluated darolutamide and ADT without chemotherapy in patients with mHSPC.
Sept./24
The ARANOTE trial included a total of 669 patients randomly assigned 2:1 to receive either darolutamide plus ADT (446 patients) or ADT alone (223 patients). Fred Saad, MD, of the Montreal Cancer Research Institute and the University of Montreal, was the study’s lead investigator, and he said that although ADT monotherapy is no longer considered a standard of care, at the time of ARANOTE’s design and still today, it is used alone in “a significant proportion of patients.”
there is no info on chemo added to this, so it’s not comparable.
Appropriate times for me are to affirm, with multiple imaging methods and liquid blood biopsy testing, that current strategy is correct. I see no reason to wait and give this beast time and obscurity.
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