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Time to Castrate Resistance: Anyone remained castrate sensitive 5+ yrs
Prostate Cancer | Last Active: Oct 29 10:14am | Replies (25)Comment receiving replies
I can't answer that, others on the forum may based on their experience.
Think statistics and the Bell Curve. Some on ADT will get the "standard" time on ADT before adaptation and resistance. What that time is, not sure. Others will get one or more standard deviations to the right, longer, others to the left, less.
Problem is, the medical community doesn't know, they have no definitive answer of if this, then that. It's like asking (or your medical team saying!) how long can I expect to live...
There are as others have said, many treatment choices. The SECURE Trial is one example - https://www.urotoday.com/conference-highlights/asco-2024/asco-2024-prostate-cancer/152557-asco-2024-secure-a-dose-escalation-expansion-study-to-assess-the-anti-tumor-efficacy-of-67cu-sar-bispsma-in-patients-with-metastatic-castrate-resistant-prostate-cancer.html?utm_source=newsletter_13080&utm_medium=email&utm_campaign=advancements-in-psma-based-treatments-in-metastatic-castrate-resistant-prostate-cancer
There are the PRINCE and UCSF trials - https://www.urotoday.com/conference-highlights/snmmi-2024/152776-snmmi-2024-combination-treatment-of-prostate-cancer-using-pembrolizumab-with-psma-based-radioligands.html?utm_source=newsletter_13080&utm_medium=email&utm_campaign=advancements-in-psma-based-treatments-in-metastatic-castrate-resistant-prostate-cancer
and this - PSMA-targeted radionuclide therapy - https://www.urotoday.com/conference-highlights/suo-2023/suo-2023-prostate-cancer/148290-suo-2023-psma-radioligands-current-and-future.html?utm_source=newsletter_13080&utm_medium=email&utm_campaign=advancements-in-psma-based-treatments-in-metastatic-castrate-resistant-prostate-cancer
Are they cures, no... Can they extend life with a degree of quality, possibly...
If you have not already, ask your medical team to have Genomic testing done.
If not already, access to cutting edge treatments and thinking may necessitate consultation and care at major NCCN Centers of Excellence.
Attached is my clinical history. I have chosen the intermittent route for several reasons. One was the concern of resistance. When deciding to come off treatment in April, my oncologist was arguing for six more moths on Orgovyx, while I was arguing to come off it. He didn't have the conclusive data about the benefit - extending PFS, OS...I didn't have the data about becoming resistant...so, we agreed to come off and actively monitor, labs and consults every three months, criteria to go back on. My first labs are today, I am expecting no surprises but...
You can read through the NCCN Guidelines, the PCRI and PCF both have excellent guides as well as videos. You can also search for Dr. Kwon's videos, they are useful in informing any decision you take with your medical team.
As others have said, you are not out of options but you have homework to do so that you can discuss the way ahead.
Kevin
Replies to "I can't answer that, others on the forum may based on their experience. Think statistics and..."
Thank you Kevin,
I have had Genomic testing 2x and there were no genetic markers found. I am de novo metastatic stage 4. I was diagnosed on my Birthday 7/27/2022. The Cancer spread to the bone only (spin, pelvis, ribs). I was started on Casodex first and radiation (10 cycles to the spin) and 5 additional cycles to the ribs. After 30 days I was put on Eligard shots every 3 months) along with Nubeqa. I immediately started chemotherapy and completed 10 cycles (Docetaxel 3 weeks apart). I have very few side effects from the chemo other than extreme fatigue. Radiation was absolutely the worst and very difficult to endure. To date, I remain castrate sensitive with my PSA < 0.100. My oncologist says I have beaten the odds up to this point. So, I am castrate sensitive 2 years now and I will be checked again in 3 months. My treatment plan was patterned after the ARSENS study. But what I am learning is that no matter what, every man responds differently to treatment.
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I know the statistics. What I am asking is for peoples personal experience with regard to time to castrate resistance. For example, there are other threads where people have asked if anyone has lived longer than 10 years with metastatic prostate cancer. And thank God, several people responded and others reading were encouraged. I'm looking for others to chime in with there personal journeys with regard to the length of time they remained castrate sensitive. For example, I am at the 2 year mark. But I was treated based on triplet therapy based on the ARSENS trial. To date, time castrate resistance has not been reached with that study. Because the men in that study that received 6 cycles of chemo, ADT, and Darolutamide are still alive and many still castrate sensitive. I'm asking if there are other out there that are still castrate resistant after several years 5, 10 etc.