Gleason 8 - No ADT

[Nonno]

Updated my profile. I have never been undetectable, now 0.58. Two years post surgery and one year since IMRT. Anyone else similar?

I have had low grade bladder cancer, removed, and almost finished intervesical therapy.

I have appointment with M.O. on Thursday.

Any ideas or comments?

[raoulmaher]

Hi sounds like for prostate cancer with a low PSA like that that your fine currently - but your Doctor will no doubt know more !

[Nonno in reply to raoulmaher]

Thanks for encouraging words. Appointment tomorrow with M.O.

[vintage42]

With perineural invasion and bladder cancer, I think the cancer is systemic and you would benefit from triplet therapy -- ADT, an ARPI, and chemo Taxotere.

[Nonno in reply to vintage42]

Thank you, but the bladder cancer is not caused by prostate cancer. I will post after my meeting with M.O.

[vintage42 in reply to Nonno]

I believe that perineural invasion is a path out of the prostate for the cancer, which it may have already taken on diagnosis.

You showed perineural invasion on diagnosis in Mar 2023, which means cancer cells had spread into the tissue surrounding nerves. Similar to you, I showed perineural invasion on diagnosis in 2021, had treatment (radiation vs your RP), and then no ADT.

By 2023 I had biochemical recurrence and mets to nodes, and only then started doublet therapy (ADT + ARPI). I believe that early systemic treatment would have delayed or prevented my mets.

[Explorer08 in reply to vintage42]

Yes, PNI is a pathway for cancer cells for sure. That was my issue with BCR showing up years later.

[Nonno in reply to vintage42]

Thanks for your reply. Did you have psma pet scan? If so, did mets show up on scan?

[vintage42 in reply to Nonno]

Yes, when rising PSA showed BCR, I had a scan that showed cancer remaining in the prostate and spread to an abdominal node.

[Nonno in reply to vintage42]

I am assuming my MO tomorrow will order a new PSMA PET scan. My one last year showed nothing, with PSA at 0.32, now it's 0.58.

[beachguy43]

Similar here. After IMRT PSA never dropped lower than 1.0 before starting back up. Been fighting it for 19 years. Push it back for a while but it always seems to find a work around and pops back. Have had low grade bladder cancer with two resections. The bladder cancer also seems to always find a work around. Just finished Pluvicto with good results but I am sure it will just be temporary. Also on Nubeqa and Lupron. PSA undetectable for the moment but been there before after other protocols.

[Nonno in reply to beachguy43]

Thanks for your reply. My appointment with M.O. is tomorrow.At least you have made it 19 years. I'm almost 75, so 19 years would be wonderful.

[NanoMRI]

As you have again asked for "Any ideas or comments". I too had salvage RT after my RP; my cancer had spread beyond both treatment fields. I did not want ADT either so found my way to imaging in Europe that successfully identified multiple pelvic lymph node mets at 0.13. That imaging is not available here in the US.

In a few weeks I have FDG with MDA Houston - main focus is metastatic melanoma but also a comparative glance for any possible lingering prostate cancer. My PSMAs have been clear for prostate cancer so have awareness question as to whether my PCa is PSMA avid.

I also have liquid blood biopsy testing. Hope this helps. All the best!

[Nonno in reply to NanoMRI]

Thanks again for your reply. I may reach out to you again as I will probably be back to Europe in the fall.

I have appointment with MO tomorrow in Houston. Will update after. Sorry that you also have two cancers to deal with, and wish you the best.

[j-o-h-n in reply to NanoMRI]

Ask doc's about treating metastatic melanoma with Keytruda..... My lung was metastatic due to a treated Melanoma on my neck. Keytruda WORKED....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Nonno in reply to j-o-h-n]

Thanks for the info

[IKNY in reply to NanoMRI]

What’s the name of the imaging in Europe that identifies these smaller quantities of cells ?

Thanks

IK

[NanoMRI in reply to IKNY]

Ferrotran nanoparticle MRI. splmed.com. Had mine 7 years ago - seems to be ongoing trial drama. This began as Combidex in US in 1990's - conspiracy thinkers could find a story here. In my anecdotal case, five cancerous pelvic lymph nodes found at 0.13 - when many would say nut'in to worry about; maybe even 'undetectable' because <0.2. All the best to all of us!

[IKNY in reply to NanoMRI]

Thanks, greatly appreciated!

[VictoryPC]

Keep an eye on it and everything else, educate yourself and don't let em scare you.

[Nonno in reply to VictoryPC]

Thanks, I try to constantly keep up education with both csncers