Treatment options for locally advanced prostate cancer?

Tom 30 months ago I was diagnosed as G 9, CR, advanced PC I had 6 months of ADT and Erleada then robo RP then 6 more months of these meds. I have been off of all meds for 17 months. My PSA has been .02, T has been single digits but it recently has been going up, but it is still very low. The surgery was not bad, the meds had their effect on mood, weight, hot flashes sleep etc but all things considered livable. My doctor advises that I might be event free for about 10 more months and when my PSA rises then will make a recommendation ( possibly ADT and Erleada and chemo treatment). The treatment has been fine but I am glad that I am retired and not have to deal with this damn cancer while still working. Good luck to you! Life is worth this difficulty.

In September 2022, I received a diagnosis of PCa with a Gleason score of 8, accompanied by local metastasis to several lymph nodes, seminal vesicles, and the bladder neck. My Uro Onco surgeon who initially was in favour of RP, decided against it after receiving my biopsy and MRI results. Treatment commenced immediately with Zoladex injections of 10.8mg once every three months, alongside daily intake of 1000mg of Abiraterone on an empty stomach. Subsequently, in January-February 2023, I underwent 20 sessions of Tomotherapy. Currently, I remain on a regimen of Zoladex and Abiraterone, with a recent adjustment to my Abiraterone dosage to 250mg post-breakfast, as per my doctor's recommendation. My PSA levels are currently stable, ranging between 0.02 to 0.03.
Considering your situation, it's likely that you will continue with ADT and then proceed with radiation therapy. Following completion of radiation treatment, your doctor may discuss the possibility of chemotherapy as part of your ongoing management.
Wishing you all the best.

Research Proton Therapy (Loma Linda in California, UFHPTI in Jacksonville, FL, etc.). UFHPTI will send you a free Proton Info packet via Fedex at no charge. You can get the therapy at any Proton facility your insurance pays for. There are almost two dozen Proton therapy facilities across the US now after Loma Linda started this here over 20 years ago. Unfortunately, with prostate cancer, you have to do your own due diligence as there are many therapies recommended. I was actually more concerned with side effects and am halfway through my proton therapy at UFHPTI. Good luck.

I m doing ok with stage 4 , Gleason 9-10, two pelvic lymph nodes affected after RT and taking ADT- Arbiterone/ prednisone for a year now. PSA IS < .01. No surgery or chemo required yet. I m 75. They told me they d use RT again if Pet scan. Shows something. Too old for surgery.

I too am on Arbiterone /prednisone treatment, just curious does the prednisone cause you shortness of breath, as for me that's a big yes since starting prednisone at beginning of treatment. best to you

Had removal surgery @Northwestern Medicine Chicago suburb Apr 2019, 39 radiation sessions, 2 yrs aberaterone. Gleason 9, decipher score .96. PSA was 12.5. One lymph node affected.
PSA was undetectable by July 2019 and has stayed that way ever since. T back up to 415 as of Feb 2023. I’m now 78 and feel very fortunate.
Best of luck to all!

No sir, no shortness of breathe as my dose is only 5mg.(very small dose). FYI- my sister who is on prednisone after her chemo treatments for Lymphoma- she takes 100mg of Prednisone for 5 days there after and has no shortness of breath....if anything I may have shortness of breath from Low T. which Arbiterone causes....crepy skin, loss of muscle tone....told them they are trying to make me look like a Prune.

thank you for replying, was on the prednisone for the chemo treatment, continued while taking Arbiterone. I tell myself that if all I have is shortness of breath quit my complaining. I take 2 5mg. a day, Dr offered to drop to 5 but I don't want the sides from the Arbiterone. Also, my Testosterone is less then 3. Best to all.

taking 2.5mg prednisone.....dropping it to 5, is not a drop its an increase. Your prednisone dose is so low, I find it hard that it causes shortness of breath. My one pill of 250mg Arbiterone causes me no side effects except to make my skin old and crepy....LOL Also makes a small penis too....

I had PSA persistence (0.93 6 weeks post op) after surgery probably because I was diagnosed before PSMA/PET scan was widely available. Pre-op I was assessed as cT2c which turned out to be optimistic when my surgery slides were examined. My Gleason score was 8 which was verified by my PSA doubling time during the BCR after surgery. Unlike you I did not have any of the gene mutations associated with PCa.

My PSMA PET scan showed mild uptake by 2-3 lymph nodes but no distant mets and no evidence of disease in the prostate bed. So as soon as I had the PET scan I started Orgovyx which froze the cancer spread where it was with a PSA level of 0.2 when started. I went through planning for salvage RT and had 38 fractions of IG/IMRT with Radian True Beam. The treatment fields included the prostate bed, the broader pelvic region and a booster dose to the nodes that showed contrast uptake during the PSMA/PET scan.

My MO added abiraterone/prednisone to the Orgovyx soon after completing the RT. This protocol was based on the arm of the STAMPEDE trial in which men with high risk disease features and primary radiation treatment with BCR were given either just basic ADT (Lupron, etc) for 3 years or Lupron + abi/prednisone for 2 years. The results showed at 9 years a substantial benefit in terms of % of each arm that experienced another BCR. Search on STAMPEDE and abiraterone and you'll find the latest results which were reported last year. It includes Kaplan Meier curves which clearly show the various survival benefits.

If you go somewhere like Mayo Rochester you may be able to receive triplet therapy (Chemo + abi + LHRH-based ADT) given the aggressiveness of your disease.

The thing that's unique in your case is the BRCA1 mutation. You should be eligible for treatment with a PARP inhibitor that targets that particular mutation.

Best of luck to you and try to stay positive!