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Rapid Reccurance and Short Doubling Time after RARP
Prostate Cancer | Last Active: Dec 20, 2024 | Replies (26)Comment receiving replies
Doc, thank you for that account of journey. I'm very happy for your outcome! I note with interest that you didn't do salvage radiation. Reading about so many peoples journey, it appears that "SOC" is just that, a standard applied to all, regardless of an individuals details. That is to say, all RARP patients who experience BCR and no MET is identified, will get salvage radiation with ADT, regardless if thier cancer is G9 or G7. I like that you treated your advanced disease with an aggressive path. Since we know the G9's are likely to become castration resistant and chemotherapy resistant, it makes since to hit the cancer with everything you've got before this happens. It gives me discussion material when I meet with my team in a couple of weeks. Thank you.
Replies to "Doc, thank you for that account of journey. I'm very happy for your outcome! I note..."
Doc, based on your response I did some followup. What you described as treatment for your mHSPC was the use of hormone therapy (Lupron), an androgen receptor pathway inhibitor (darolutamide), and chemotherapy (docetaxel). This treatment was approved as of 2023 and is refered to "triplet" therapy and would now be considered the SOC.
What is a bit of a conumdrum are the guys with Grade 5 disease with short time to BCR, short PSADT's, and other predictors of matastasis, yet the PSMA PET scan shows no MET's. The fact that no MET's are identified could be false negatives from the scan (PSMA negative PC) or it could be the MET's are too small to detect, yet all stakeholders know there is micromatastisis, if not outright matastisis going on. The SOC here is going to be salvage radiation with possibly an androgen receptor pathway inhibitor, and NO chemotherapy.
This is where it seems appropriate to assume this individual is not just having BCR, but in fact has mHSPC. In this case I suspect the patient is going to have to work hard to add the third leg of chemotherapy to the protocol as it is not the SOC.
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My mistake; I omitted my pelvic radiation. After my triple therapy, while still on Lupron, I received 37 radiation treatments to my pelvis, including boost to my prostate bed and the location of the one positive node. My MO at Hopkins said to have maximal beneficial effect the radiation needed to be started 8-12 post chemo.