Treatment Recommendation for father with advanced PCA to regional lymph nodes

[MissMel2024]

Hi All,

I was hoping for some feedback on the treatment schedule advised for my father. All the details for his diagnosis are in my bio.

We met with the radio oncologist last week and he suggested the following

1. Start cosudex tablets now for 28 days and then stop

2. Start Zoladex injection within the next 2 weeks, then once every 3 months for the next 2 years.

3. Referral to Medical Oncologist to discuss adding second generation hormonal therapy.

Radiotherapy will not begin until September/October - 20 treatments EBRT daily for 4 weeks. He has suggested he will hit the prostate and all the nodes up the pelvis and into the lower abdomen with a little beyond that as well.

We will be meeting with him again and the MO shortly.

My questions are:

1. Is this a gold standard treatment? Is there anything else we can ask for?

2. Is one second generation drug tolerated better than another and also more effective for this stage of treatment?

3. I have read a lot about triplet therapy, but unsure whether this is something that would suit in my dad's case. I will ask MO about this when we meet, but if anyone has any advice here it would be appreciated.

4. My father has suffered with very high blood pressure most of his life. He takes a multitude of drugs for his condition. Are there any drug combinations which work best for boosting life expectancy and quality of life that won't interfere with his blood pressure?

Thank you so much in advance

[Justfor_]

There was a clinical trial in Australia where they used one or two Lu-177 PSMA infusions ahead the primary (RP?) treatment. It may still be recruiting as it started a couple of years ago. It is the "new kid in town". What you have been offered is the "business as usual".

[Tall_Allen]

1. The gold standard would be to add extra radiation with brachytherapy to the prostate in addition to the external beam radiation and the hormone therapy.

2. There was a trial (STAMPEDE) that showed superior results with 2 years of abiraterone+ 3 years of ADT. A trial now (PREDICT-RT) uses 2 years of apalutamide+ ADT. Another trial (DASL-HiCaP) uses 2 years of darolutamide+ADT. Take your pick.

3. Triplet should only be used with bone or visceral metastases.

4. Abiraterone can sometimes raise BP if not enough prednisone is taken with it. He probably has a home BP sleeve which he should self-monitor with.

[GP24]

" My father has suffered with very high blood pressure most of his life. He takes a multitude of drugs for his condition. Are there any drug combinations which work best for boosting life expectancy and quality of life that won't interfere with his blood pressure?"

ADT can increase blood pressure. You have to make the RO and the MO aware of this problem. I would recommend Xtandi monotherapy instead of triplet therapy.

[GAdrummer]

Only about 10% of men with advanced PC remain nodes only. Wishing you good luck with your treatments. Don't get discouraged, this is a roller coaster ride full of good times and bad. Work on the bucket list to create memories to cherish. And be sure to take some "your" time to keep up your energy and spirit.