Darn - did I put Coreg rather than Casodex? I had Casodex with initial radiation and for 2 years after. PSA undetectable that entire time. So I can still use ADT again.
Also, my new oncologist suggested I may be able to use Rubraca again. Apparently a fair number of people have horrible side effects. It only made me a bit tired.
start with another PSMA scan. Depending upon the results from that, may want to consider triplet therapy. Discuss with your oncologist. Casodex alone is not the best treatment for you.
Yes, agree with RoseDoc. You need a scan to see if there is any spread to pelvic lymph nodes or bones, other. From what I've read, Doublet therapy (1st generation ADT + 2nd generation like Abiraterone, etc.) could be called for if only pelvic lymph nodes, and Triplet therapy (ADT + 2nd gen ADT + Docetaxel chemo) would be an option if any spread to bone or other areas. Triplet is more aggressive, but may be more effective than doublet plus a non-systemic treatment like SBRT or IMRT radiation. Definitely hash these options out with a highly regarded GU Oncologist and keep us posted!
Triplet therapy for prostate cancer refers to a treatment approach that combines three different therapies to manage advanced or metastatic prostate cancer. This strategy typically includes:
1. Androgen Deprivation Therapy (ADT)
Purpose: ADT is the cornerstone of treatment for advanced prostate cancer. It reduces the production or blocks the action of androgens (male hormones like testosterone), which fuel the growth of prostate cancer cells.
Orchiectomy (surgical removal of the testes, rarely used)
2. Androgen Receptor Pathway Inhibitor (ARPI)
Purpose: Enhances the effect of ADT by further blocking androgen receptor signaling, even in low-androgen environments.
Examples:
Enzalutamide
Apalutamide
Darolutamide
Abiraterone (often paired with prednisone or prednisolone to manage side effects)
3. Chemotherapy
Purpose: Targets rapidly dividing cancer cells, providing an additional mechanism to control the disease.
Example:
Docetaxel, often administered every three weeks for six cycles.
Indications for Triplet Therapy
Triplet therapy is typically recommended for men with high-risk metastatic hormone-sensitive prostate cancer (mHSPC), especially those with a heavy disease burden or other aggressive features. Studies suggest that combining these treatments can lead to improved survival and delayed progression compared to dual therapy (e.g., ADT plus chemotherapy or ADT plus ARPI).
Potential Side Effects
Due to the intensity of this approach, patients may experience side effects related to each component of the treatment, such as:
ADT: Fatigue, bone loss, cardiovascular risks, hot flashes, loss of libido.
ARPI: Fatigue, hypertension, falls, and cognitive issues.
Chemotherapy: Nausea, low blood counts, neuropathy, and increased infection risk.
The choice of triplet therapy is individualized, taking into account the patient’s overall health, extent of cancer, and preferences.
Both of my oncologists are seeing a lot of patients' success with radiating tumors that appear on PSMA scans. That is the approach I am currently using, without ADT. My first tumor appeared earlier this year on PSMA scan at PSA = 0.45, but the radiologist missed flagging it. At PSA = 1.05 there was still only one visible tumor and I had SBRT. My PSA is now nearly undetectable and still decreasing.
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To the brains of this forum ,a question about PET/CT PSMA result
History of my cancer becoming castrate resistant
My PCa history
Next step. Some advise please
Question, each month with rising PSA, when do I do a pet scan 
