Should I be on chemo as well?

[IKNY]

Gleason 9 (4+5)

I’ve undergone

08/29/2023: RP & bi-lateral lymphandectomy of the pelvis, pre op PSA 6.8

11/07/2023: Lupron & Bicalutimide(1month), PSA 1.13

12/07/2023 Abiraterone added to Lupron therapy PSA .70

01/26/2024 PSA <0.10 - (undetected)

06/27/2024-07/24/2024 RT to prostate fossa and a couple of lymph nodes.

Node furthest from the pelvis was the left para-aortic.

My concern is, radiation wasn’t to the entire pelvis, maybe that was due to the bilateral lymphandectomy coupled with the fact that it was already up to the para-aortic node?

So far, I’ve been PSA undetected for over 1 year.

Should I be discussing chemo to try to knock the cancer entirely out at this point?

Currently on Lupron and Nubeqa

Thanks

============

PSA history:

01/17/2025 PSA <0.10

12/20/2024 PSA <0.10

11/07/2024 PSA <0.10

10/18/2024 PSA <0.10

08/08/2024 PSA <0.10

06/28/2024 PSA <0.10

(Abbreviated)

01/26/2024 PSA <0.10

12/01/2023 PSA 0.70

10/16/2023 PSA 1.13

07/11/2023 PSA 6.8 (preoperative)

05/16/2023 PSA 4.4

10/25/2021 PSA 2.1

=================

[Tall_Allen]

If you didn't have whole pelvic radiation including the para-aortic lymph nodes there is little chance that it is possible to "knock the cancer entirely out." Chemo has no benefit if the cancer is not actively growing.

[IKNY in reply to Tall_Allen]

Thanks, the para aortic node was targeted, just not whole pelvis.

I’ll inquire why that wasn’t considered.

I was very sick with the liver/Abiraterone at the time radiation was being considered/performed.

Frankly, I was expecting to croak from liver failure.

So, I guess that’s that.

[IKNY in reply to Tall_Allen]

Correction, just got my note back from the RadOnc…

I did recieve full pelvic radiation as well as to the paraaortic Lymph Node!

[Tall_Allen in reply to IKNY]

Great! So after 3 years of ADT (and 2 yrs of abi or equivalent) you will see if it was curative. Good luck!

[IKNY in reply to Tall_Allen]

Thanks!

[rfgh20 in reply to Tall_Allen]

With STAMPEDE data in hand, 2 MO's and urologist all felt 2 years ADT still enough. They said data hasn't shown the 3rd year was beneficial. I reluctantly went with their recommendation. This is an example of why it's called "practicing medicine". Rarely universal agreement. Appreciate you sharing your knowledge. My 1st urologist was only recommending radiation with no hormone therapy. Your recommendation got me looking at STAMPEDE and getting more effective treatment.

[Tall_Allen in reply to rfgh20]

"They said data hasn't shown the 3rd year was beneficial. " That's certainly true because the purpose of the trial was to prove that 3 years of ADT+ 2 years of abi was superior to 3 years of ADT alone. It wasn't a trial to optimize the duration of ADT.

I think they started with 3 years of ADT because they looked at the DART 01/03 GICOR Trial that found that 28 months of ADT was superior to 4 months in high risk patients with localized PCa. They reasoned that patients with pelvic lymph node (PLN) metastatic PCa would probably need more.

However, hormone treatment has been intensified (with abi+apa and SBRT boost) and shortened (to 6 months) in the AASUR trial in localized PCa. The PREDICT-RT trial investigates Decipher genomic scores to determine intensity and duration of hormone treatment with apalutamide. DASL-HiCAP tests darolutamide. The STAMPEDE trial was begun before PSMA PET/CTs became prevalent.

It seems reasonable to have ADT shortened if PLNs are only visible on PET scans and not on conventional imaging, or if HDR-BT or SBRT boosting or "FLAME-type" boosting (extra radiation to sites of cancer) is done.

[rfgh20 in reply to Tall_Allen]

Thanks for sharing your knowledge .

[IKNY]

Thank you Tall Allen, I greatly appreciate the information and support.

All the best

IK