10 years

[LB100]

Quick update

10 years now since my husbands diagnosis of stage 4

PSA has crept up this year, latest 13 but scans still stable, will do them next month and then decide on next treatment

No pain, still active

Life is still good

[Steel67]

awesome!! Many many more years to you!! One question - his PSA is 13?

[LB100 in reply to Steel67]

13 yes

[Kaliber]

congratulations for both of you. Due , no doubt , at least in part to the great care and love you give him. Here’s hoping for at least 10 more years.

❤️❤️❤️

[KocoPr]

try to get a liquid biopsy guardant360. This will help determine next treatment

[dhccpa in reply to KocoPr]

Those are covered by Medicare?

[KocoPr in reply to dhccpa]

Yes

[dhccpa in reply to KocoPr]

Thanks!

[LB100 in reply to KocoPr]

won’t get that in the UK

Chemo will be next

[dhccpa]

Great post. Hang in there!

[dhccpa]

Thanks, didn't realize that.

[NecessarilySo]

If he's on ADT, then maybe PSA 13 is not good. Keep tracking it.

[Yzinger]

Sorry if this is offside in any way but does stage 4 mean metastatic?

[Mascouche in reply to Yzinger]

Stage 4 means that the cancer has spread beyond the prostate to other parts of the body, such as the bones, lymph nodes, liver, or other organs. So yes, metastatic.

[LB100 in reply to Yzinger]

Yes, had already spread to the bones when diagnosed

[Yzinger in reply to LB100]

Such great news and update. Many more too!!

[j-o-h-n]

Hint on how last another 10 years - Keep the same wife........

Good Luck, Good Health and Good Humor.

j-o-h-n

[NanoMRI]

humm, 5 and 10 are such average numbers. My medical team supports liquid blood biopsy at my very low stable 0.03X range.

[Seasid in reply to NanoMRI]

Here is a research article which shows that the liquid biopsy is meaningless if the PSA is under 5 etc.

pubmed.ncbi.nlm.nih.gov/352...

Prostate

. 2022 May;82(7):867-875. doi: 10.1002/pros.24331. Epub 2022 Mar 14.

Clinical and pathological features associated with circulating tumor DNA content in real-world patients with metastatic prostate cancer

Emmanuel S Antonarakis 1, Marni Tierno 2, Virginia Fisher 2, Hanna Tukachinsky 2, Sonja Alexander 2, Omar Hamdani 2, Matthew C Hiemenz 2, Richard S P Huang 2, Geoffrey R Oxnard 2, Ryon P Graf 2

Affiliations Expand

PMID: 35286728

PMCID: PMC9314037

DOI: 10.1002/pros.24331

Full text linksCite

Abstract

Background: Liquid biopsy is a powerful tool that can enable treatment decisions for metastatic prostate cancer patients with difficult-to-biopsy tumors. However, the detection of genomic alterations via liquid biopsy is limited by the fraction (tumor fraction [TF]) of circulating tumor DNA (ctDNA) within the total cell-free DNA content. While prior work has preliminarily correlated TF with clinical features of prostate cancer, we sought to validate and provide additional resolution, such that a clinical practitioner might anticipate the probability of successful liquid biopsy profiling leveraging commonly assessed clinical and laboratory features.

Methods: A total of 813 liquid biopsy specimens were assessable, with 545 associated with a PSA prostate specific antigen measurement, collected in standard-of-care settings across approximately 280 US academic or community-based cancer clinics from September 2018 to July 2021. Deidentified data were captured into a real-world clinico-genomic database (CGDB). Comprehensive genomic profiling (CGP) was performed on extracted cell-free DNA from liquid biopsy samples.

Results: In multivariable models, higher PSA level, lower hemoglobin, lower albumin, higher alkaline phosphatase (all p < 0.001), and collection of liquid biopsy blood draw within 60 days of new treatment initiation (p = 0.002) were the most strongly associated features with higher TF. At PSA levels of <5 ng/ml, 43% of patients had a TF of <1% indicating an increased likelihood of unevaluable results. Conversely, at PSA levels of >5 ng/ml, 78% of patients had a TF of at least 1% and 46% had a TF of ≥10%, suggesting improved sensitivity for detection of targetable alterations.

Conclusions: Universal genomic profiling of prostate cancers will require complementary use of liquid biopsy and tumor tissue profiling for suitable patients. The likelihood of adequate ctDNA shedding into plasma is one consideration when deciding whether to pursue CGP via liquid biopsy versus tumor profiling. Our real-world data suggest that PSA < 5 ng/ml is associated with lower ctDNA yield on liquid biopsy, potentially increasing the incidence of negative results or a need for confirmation with tissue testing.

Keywords: ctDNA; genomic profiling; liquid biopsy; mCRPC; tumor fraction.

© 2022 The Authors. The Prostate published by Wiley Periodicals LLC

Full text link:

pmc.ncbi.nlm.nih.gov/articl...

[NanoMRI in reply to Seasid]

Until recently, HealthUnlocked had a guideline for commenting based on personal experiences. I have had two (2) liquid biopsies; a cornerstone in my trifecta of investigation methods to stay ahead of lingering prostate cancer.

Am I correct that you deleted your initial comment which I offered a general reply to?

Seen through the lenses of inexperience and perhaps 'population/evidence based medicine', ya, I guess I can see why one might think these are "meaningless" for the 43%. As you know from our dialog in a posting of mine, my second test, done this past July, identified a TP53 mutation that turned out to be a very surprising metastatic melanoma.

Citing the namesake of this forum, health unlocked, I look beyond articles such as you have cited and find liquid blood biopsy testing very meaningful.

[NanoMRI in reply to Seasid]

A follow-up detail question; is this finding for all men regardless of age, diagnosis, treatment status, disease progression?

For example, post RP, if my PSA was 5 or 10, I would consider myself in very serious trouble. This is why I use this investigative method beginning at 0.03X as part of my trifecta investigative effort.

[Seasid in reply to NanoMRI]

Full text link:

pmc.ncbi.nlm.nih.gov/articl...

[Seasid in reply to Seasid]

This study by Antonarakis et al. investigates the clinical and pathological features that correlate with the content of circulating tumor DNA (ctDNA) in patients with metastatic castration-resistant prostate cancer (mCRPC) using liquid biopsies. Here’s a summary of the key points:

Background

Liquid biopsy is a minimally invasive technique that extracts cell-free DNA (cfDNA) from plasma for genomic profiling. It is particularly useful for patients with metastatic prostate cancer (mPC) who have challenging-to-biopsy tumors.

The utility of liquid biopsy depends on the tumor fraction (TF), the proportion of ctDNA within the total cfDNA.

The study aims to identify clinical and laboratory features that predict ctDNA yield in real-world settings.

---

Methods

Population: 813 liquid biopsy specimens from patients with metastatic prostate cancer were analyzed, with PSA data available for 545 samples.

Data Collection: Samples were collected between September 2018 and July 2021 from ~280 cancer clinics across the U.S.

Comprehensive Genomic Profiling (CGP): Performed on cfDNA to assess genomic alterations.

Clinical Features Analyzed: PSA levels, hemoglobin, albumin, alkaline phosphatase, and timing of blood draw relative to treatment initiation.

---

Results

Factors Associated with Higher Tumor Fraction:

Elevated PSA levels.

Reduced hemoglobin and albumin levels.

Increased alkaline phosphatase levels.

Blood draws performed within 60 days of initiating new treatment.

PSA as a Predictor:

PSA <5 ng/ml: 43% of patients had a TF <1%, suggesting lower ctDNA levels and greater likelihood of unevaluable liquid biopsy results.

PSA >5 ng/ml: 78% of patients had a TF ≥1%, and 46% had a TF ≥10%, improving the chances of identifying targetable genomic alterations.

---

Conclusions

Clinical Implications:

Higher ctDNA yield is linked to specific clinical and laboratory factors, notably PSA levels and systemic health markers.

At PSA <5 ng/ml, liquid biopsy sensitivity decreases, necessitating alternative methods like tumor tissue profiling.

Recommendations:

A dual approach (liquid biopsy and tumor tissue analysis) is recommended for universal genomic profiling of prostate cancers.

Clinical decisions on using liquid biopsy should consider PSA levels and other markers to optimize the likelihood of successful ctDNA detection.

This study underscores the importance of patient-specific features in tailoring liquid biopsy applications for prostate cancer genomic profiling.

ChatGPT said

[Nusch]

Congrats and keep enjoying your life. The next 10 years are just starting now! Great fight warrior!

[NanoMRI]

Interesting that US Medicare paid for mine. Pricing schemes are a fascinating study.

The status of our disease is very different - this may be one reason I see benefit to this testing. All the best!

[Seasid in reply to NanoMRI]

I had early upfront chemotherapy and radiation to my prostate and my cancer is pushed into a senescent state. I believe that for my own situation liquid biopsy is too much. Of course you could have a better sleep because you are avoiding ADT and that is great.

[NanoMRI in reply to Seasid]

I am most gratefulI I have been able to defer ADT and chemo too; so far. Looking back to my Dx ten years ago, I failed myself in my years of self-directed early screening, overlooking the very thing we were screening for - prostate cancer. I am fortunate that my flavor of PC has not been too aggressive nor traveled farther than my para-aortic lymph nodes; so far.