FYI, PEACE-1 recommendation validated by second opinion I received yesterday at MD Anderson, Jacksonville, FL

[Skipper238]

First, here is a current summary of my condition:

* Age 65 * DX in late November, 2021

* Low PSA (4.68), High Gleason (9 - 10): 12 samples taken during biopsy and all 12 had either a 9 or 10 Gleason score.

* Lymph nodes above and below the diaphragm "lit up" during PET SCAN in early December 2021. Undetermined whether they are due to Metastatic spread, lymphoma or other.

* ADT treatment underway, with Casodex started 12-7-2021 and first Eligard shot (6 month dosage) 12-14-2021. For the sake of clarity, my current MO has NOT recommended AGAINST the PEACE-1 recommendations. We just haven't had the conversation, yet. We need to figure out the lymph node tumor source first, I suppose.

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Hello and Merry Christmas to all!

I wanted to provide an update on my meeting with a Medical Oncologist at MD Anderson, Jacksonville, FL. One reason I wanted to provide this feedback, is that Tall_Allen suggested I discuss the PEACE-1 recommendations (prostatecancer.news/2021/05... during my meeting, which I did. I am new at this, so I don't know how widely known, understood and accepted the PEACE-1 study currently is among MO's, but as you'll see in my summary, this MO was 100% onboard with it.

MD Anderson Second Opinion -- MEETING SUMMARY:

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1. The MO felt it might be worthwhile to determine whether my enlarged lymph nodes were truly enlarged due to metastatic prostate spread or if they were due to lymphoma or possibly benign enlargements (although that seems unlikely to me, under the circumstances). He said that waiting 60 days to see if the ADT treatment shrinks the lymph tumors is an option, but he suggested that he present my case in to their tumor board to determine whether there was a prefered course of action (biopsy, etc.) That sounded good to me, so that’s the plan. I’ll have the tumor board’s recommendation on January 10, 2022.

2. I was able to determine that the course of treatment recommendation from the PEACE-1 trial would be the preferred treatment path, assuming I don’t have lymphoma instead of metastatic prostate spread. The doctor said that if that if I had metastatic cancer in my lymph nodes, the PEACE-1 treatment recommendations would be a "no brainer" approach to follow. (Note: The reason that he thinks it might be lymphoma is because I did have a low-grade fever for a month prior to my biopsy and did have some minor night sweats during that time. Also, my PSA was lower than typical for metastatic spread to the lymph nodes. My PSA was 4.68 and both Oncologists I have met with -- MDA and Southeast Georgia Health System in Brunswick, GA -- said it should have been closer to at least 30. But, from the research I have done, it seems that a very small percentage of people can have this occur, so I think I am simply in that small percentage. We’ll see what the tumor board recommends as the best course to make that determination.

QUESTION: What is the deal with continuing Casodex after 30 days have passed from the Eligard shot? It it recommended to stop taking Casodex after the flare has passed, or does it depend? Thanks.

[noahware]

The link to TA's article does not seem to be working.

For those not familiar with PEACE-1 recommendations, it amounts to early use of ADT + Abi + chemo (all three at once early on, rather than just one or two while "saving" the other for use sequentially or upon progression).

Not sure why to bother with Casodex after a month, but possibly a holdover from the old "triple androgen blockade" days, when some MOs added Proscar, too. (It was well before Abi was around, but Dr. Bob Liebowitz was also a big proponent of early chemo, and I think PEACE has vindicated that view!)

[Skipper238 in reply to noahware]

Here's the full link to the Peace-1 article. My bad!. Thanks for letting me know. prostatecancer.news/2021/05...

[Hidden]

Or they could be benign or represent inflammation. Though the fact that they are enlarged tends to corroborate metastasis. Scans are pretty good but the ones i have had always seem to say something different. And I think SOC is to corroborate with traditional imaging (CT scan, MRI)

[maley2711 in reply to Hidden]

Am I correct in this......PSMA PET can have a large number of false positives? Is that the case with the other SOC scans, or do they perform better regarding false positives?

[Hidden in reply to maley2711]

Large number of false positives? No, I don’t think PSMA has a large number of false positive but they do occur hence the need for corroboration. Degenerative bone formations, inflammation, benign lesions, etc. can cause ambiguous readings. i think his low PSA is an issue here that makes these scans suspect. but he does appear to have an enlarged node. Of course a biopsy can answer the question if its thought wise. All these tools and none are perfect. All these tools and still PSA is our primary guide. Refinement of the cfDNA and ctDNA tests will be helpful also so as not to require an invasive biopsy. Obviously if they are taking it to board review there is some measure of uncertainty