RALP, SRT, Triplet next?

[SCreader]

From my recent PSMA Pet scan: 02/2025: PSA 0.7 hyperactivity along 7th lateral rib max suv 24, multiple hilar thoracic LNs max suv 18, multiple lung parenchymal nodules max suv 2.1.

I'm looking for thoughts on Triplet treatment (Regulix/Orgovyx, Docetaxel, Darolutamide/Nubeqa) after RP in '22 and SRT w/6 mo Regulix in '23. Chemo would be 6x w/3 weeks in between. I've just started Regulix ADT, not being on it since SRT. Haven't had antiandrogen or chemo in the past.

[Tall_Allen]

Your lung nodules have no higher uptake than background. Consider EMBARK or PRESTO protocol:

prostatecancer.news/2023/05...

prostatecancer.news/2022/09...

[Tall_Allen in reply to Tall_Allen]

Sorry, my mistake. The rib met if seen on conventional imaging precludes those trials. Consider this triplet:

prostatecancer.news/2022/10...

[SCreader in reply to Tall_Allen]

TA, I'd appreciate your take on ARASENS pharmacytimes.com/view/daro...

It sounds encouraging to those with aggressive mCSPC.

[Tall_Allen in reply to SCreader]

ARASENS was only among newly diagnosed patients with metastases on conventional imaging.

[SCreader]

I'd like to hear from anyone with mCSPC that has experience with triplet therapy, especially with use of Darolutamide/Nubeqa.

[ron_bucher]

At age 66 docetaxel helped give me 4+ years of undetectable PSA with only 9 months of Lupron. My side effects were not bad. But I would rely on a top notch medical oncologist who has had hundreds of prostate cancer patients for potential treatment effectiveness in your situation.

[street-air in reply to ron_bucher]

thats a heartening bio/history you got there. We should all be so lucky.

[ron_bucher in reply to street-air]

I decided at the beginning to do everything possible as soon as possible to keep the upper hand on the beast.

[MateoBeach in reply to ron_bucher]

Glad you are still here posting, Ron. 👍🏼

[RoseDoc]

Have you had a biopsy of the lung nodules? You don't really know if they are metastatic lesions.

I would consult with your oncologist, however, it does seem as though you would be a candidate for triplet therapy.

Good luck!

[SCreader in reply to RoseDoc]

Good point RD. I was given that option, but since it wouldn't affect the treatment plan, I declined. At their SUV, they may very well not be metastatic lesions. Thanks for you comments.

[RoseDoc in reply to SCreader]

It may affect the intermediate/long term plan if these are metastatic lesions. Also be good to know if they are a primary lung lesion. A follow up CT is required at around 6 months