BCR after 14 mos of undetectable PSA

[dkingsley]

My husband was diagnosed in 2020 with Gleason 9 Grade 5 PSA 5.3

He had a RP in 2020, 9 /44 positive lymph nodes

PSA was 1.7 after surgery. PSMA scan done at SMK found one lymph node in para arotic

fall of 2020 had Radiation to whole bed with boost to lymph node.

ADT for three years, Apalutamide for 2 years

14 months undetectable. First PSA rise 10/24 .1, 11/24 .2

12/24 .3 1/29 PSA went to .7 so PSADt is less than 6 weeks

PSMA done 1/29/25 did not show anything yet

What should be our next steps? What are our options?

Do we wait to do a second scan?

Do we go back on ADT and an Anti androgen? (which one?)

Try Docetaxel?

concerns: MO mentioned his tumor testing showed Pten mutation (loss)

[103532]

It is very worrying, and my husband’s case is similar to your husband’s. Since your husband completed his initial systemic treatment, some cells may be active but too small for the scanning. I would ask the oncologist if he should immediately go back on the ADT with a possible different second generation AR drug like Xtandi if he doesn’t want to stay with the Apalutamide again. If you don’t want to go back on the systemic just yet, you could repeat the PSMA PET after a bit of time and see where the net is and radiate it. There are so many choices. I am not sure if there is enough volume for chemo but I would definitely ask. Others will respond who are more knowledgeable than me, but I think he is likely still hormone sensitive, and you can maintain this like a chronic disease for years. That is our plan. Please let us know how you proceed. Best wishes!

Stephanie

[dkingsley in reply to 103532]

Thank you Stephanie! We were promised a “chronic disease “ path too! I am hoping that is still where we are at! He is doing bloodwork again today and then we are seeing the MO and then following up with one at MSK at the end of the month. Best of luck with your journey!

[103532]

My husband’ is being treated at Yale but we head to MSK for second opinions, and they concurred with Yale so far.

[Tall_Allen]

There are a couple of protocols used in the EMBARK and PRESTO trials that seem ideal:

prostatecancer.news/2023/05...

prostatecancer.news/2022/09...

[dkingsley in reply to Tall_Allen]

Thanks Tall Allen! Appreciate your response and information!