Information on Intraductal PC

[Bcgkelly]

My PSA is starting to creep up. Now 0.05 up from 0.035 3 months ago. This is concerning and while I’m not seeing the consultant until tomorrow if the increase is confirmed will probably be heading to further treatment. I’m looking for information on Intraductal Cancer. I know it’s generally associated with aggressive cancer but does it change the normal treatment plan. Is it different to ductal? My PSA pre operation did increase from 3 to 4.05 over a year but was told it should have been higher given that the cancer was locally advanced.

[Tall_Allen]

Ductal is different from intraductal (IDC-P)

In the following study (albeit small and retrospective), abiraterone got a more rapid PSA response than docetaxel.

ncbi.nlm.nih.gov/pmc/articl...

[Bcgkelly in reply to Tall_Allen]

Thanks for the reply and I read the report but I can’t say I really understood it. It it true to say that Intraductal generally responds to standard treatment. I had my RP six months ago so I would be moving on to radium and hormone treatment when my PSA reaches a certain level? I have read that the remission time with IDC-P is short with hormone treatment eventually failing, radium not working in some cases and am I right in thinking that the report you have brought to my attention is the treatment at that stage? I am just trying to understand what’s going on so that I can ensure I am receiving the right treatment and know all options open to me.

[Tall_Allen in reply to Bcgkelly]

In general, earlier treatment - while you are still hormone sensitive - is better. My understanding is that IDC-P responds to the same therapies, just not as well.

[Bcgkelly in reply to Tall_Allen]

Thank you

[AlanMeyer Moderator]

I am not knowledgeable about the biology of Intraductal cancer but have read that it is aggressive and dangerous. I would ask the consultant about the possibility of getting salvage radiation. If he agrees that this is a possibility, I suggest telling him that you know that this type of cancer is both very unusual (less than 3% of patients have it according to an article I just saw on Pubmed) and very aggressive, so you want to see the most learned and skilled radiation oncologist that can be found for you, and you want to see him soon. If the consultant can start you on androgen deprivation therapy right away that's a good thing because it should halt the growth of the cancer while you're waiting to get radiation treatment.

One good thing about your report is that your PSA is still very, very low. That means that the amount of cancer in your body is probably still quite low and may still be localized to the region of surrounding the prostate bed that is easily reachable by radiation.

Best of luck.

Alan

[Bcgkelly in reply to AlanMeyer]

Thank you

[Borisbadenough]

Question: Does your Urologist state that there is an absolute zero [eg. PSA=0.000] measurement of PSA using the same lab ?

My Urologist explained that my post op PSA of 0.02 means that PSA is "undetectable". The difference between 0.05 and 0.035 is 0.015...is that SIGNIFICANT? Should it be used to determine initiation of further treatment?

[Bcgkelly in reply to Borisbadenough]

He said that I need to repeat the PSA test in one month and if it’s 0.05 or higher it’s a Re-occurrence requiring radiation treatment. Suggesting s PSMA-PET, scan in Germany first. I live in Ireland. He considered 0.05 or higher is a re-occurrence, others consider above 0.1 or 0.2.

[Borisbadenough in reply to Bcgkelly]

Thank You for the information...marty

[MelbourneDavid]

It might be worth asking if there is a trial of an advanced anti androgen that might include you. It looks like these (abiraterone or enzalutamide) might more effective for intraductal prostate cancer than chemotherapy and might be good to start early.

Repeating the PSA is important because its a pretty marginal increase in terms of the test's sensitivity. Sadly you seem to have a fairly aggressive cancer, as the Gleason 8 shows, and the low PSA for having already spread to lymph nodes makes it harder to monitor or understand. I hope the PSMA-PET is not too expensive.

[Bcgkelly in reply to MelbourneDavid]

It’s €1900 plus travel & hotel costs and insurance won’t cover it unfortunately. I have no choice but to get it done. I will ask about the anti androgen drugs. Can’t say I really understand them. I thought they were only used towards the end.

[MelbourneDavid in reply to Bcgkelly]

Ouch. That's expensive. They do it for overseas visitors for about $1000 here in Australia. Any plans to visit the Great Barrier Reef ?

[Bcgkelly in reply to MelbourneDavid]

No unfortunately and I believe it’s fabulous. I don’t think the flights that far would be a great idea as I had complications following surgery that led to DVT & PE. It is going to be expensive and my sisters have said I’m not going alone. I only hope it pinpoints where it is. There’s no guarantee given my PSA is so low.

[pwallace]

hi bcgkelly! (hi tall allen! i'm pwallace from the other pc forum! you helped me so much when my husband was first diagnosed.) anyway, bcgkelly, my husband was also diagnosed w/intraductal carincoma & he's doing well now, but if his psa rises in the future the first thing we'll do is go see emmanuel antonarakis at johns hopkins, or at least consult with him over the phone. out of all the docs i reached out to when my husband was first diagnosed (A LOT), he was the one who seemed to know the most about IDC. he told me that intraductal carcinoma is a distinct entity all on its own & requires a particular diagnostic & therapeutic consideration. he has a great amount of experience w/it. any chance you could reach out to him? or fly there? one thing i remember- he said my husband should do tumor DNA sequencing using the foundation medicine platform. he said it was v important for treatment. have you done any dna testing? please reach out if there's any other info/research you need. i've done a lot. best of luck!

[Bcgkelly in reply to pwallace]

Thank you for your reply but I live in Ireland and I don’t see how it would be practical to be treated by someone so far away. I am being referred for genetic testing to who is considered the best in Ireland and have questioned and been told that I do not need to go outside the country for treatment. Can you tell me if your husband’s PSA levels have correctly reflected the level of cancer because I note that you refer to his rises in PSA? Also any additional information you can give me would be appreciated. Experience that might be relevant or websites that might be useful. Bill

[pwallace]

he hasn't had a rise in PSA since his surgery, thankfully. but his numbers were always low (pre-surgery) which i think is common w/intraductal carcinoma (at least as far as i know). as for living in ireland, i'm wondering if you could still consult with doctors here in the states, especially if they have more expertise? you might be able to do a conference call or the like. just thinking out loud. but honestly it sounds like you're doing all the right things w/genetic testing & not waiting on treatment etc. best of luck to you!