What is next? BCR after 14 months

[dkingsley]

RP in 3/20, 9/44 postive lymph nodes post surgery PSA 1.7

PSMA done 5/20 one lymph node in Paraaortic showed up

Radiation to whole pelvic bed with a boost to Paraaortic lymph node

ADT 3 years, Appalutamide for 2 years (last ADT shot March of 2023)

14 months undetectable after stopped ADT

9/24 PSA went up to .1

mid October/24 up to .2

12/17 up to .3

Saw MO today is going to schedule PSMA scan mentioned PTEN tumor mutation for the first time.

Is it too early to do a scan? What is next line of treatment?? MO still refers to PcA as a treatable chronic disease? Can we still count on that!?

[Tall_Allen]

Your PSADT is rapid enough that the PSMA PET may show something.

For PTEN loss, capavasertib+docetaxel may be beneficial:

sciencedirect.com/science/a...

Capavasertib is FDA-approved for breast cancer, so it can be prescribed off-label.

A biosimilar drug, ipatasertib, had mixed results in a trial to men who are castration-resistant with PTEN-loss:

thelancet.com/journals/lanc...

However, it was quite toxic:

clinical-genitourinary-canc...

Capivasertib may be less toxic.

[dkingsley in reply to Tall_Allen]

Tall_Allen, Thank you so much for your insight and information. Can’t tell you how much I appreciate your response. His MO mentioned this drug today. But talked as if it would be further down the road. I guess we wait to see what the PSMA shows and plot a course of action from there. I’ll update once we get that far. Thanks again,

Dkingsley

[Xavier10 in reply to dkingsley]

curious what test they took that told them you had a PTEN mutation. That seems to a signficant one for prostate cancer; somehow it fools the body into thinking the cancer is ok. which i guess is typical for cancer.

[dkingsley in reply to Xavier10]

I think they found it when they tested (examined) the tumor.