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The paradox of testosterone and ADT
Prostate Cancer | Last Active: Apr 10 10:22am | Replies (82)Comment receiving replies
Pondering this same concept: that perhaps the cancer is NOT hormone dependent prior to treatment. I believe Theron lies the importance of testing and pathology. Isn’t hormone dependence determined ahead of time?
Our situation is PET lighting up in nodules appearing in lungs only 17 years post RARP and not further treatment. PSA is an outlier at 0.36. Nadir was o.o1 post surgery. We are awaiting confirmation that three 1.1 cm nodules in the R lobes are Pca metastasis with this odd PSA. And I wonder, if not much psa is being expressed from these tumors, just how hormone dependent are they, if at all? I truly hope the chemohistopathology and liquid biopsy will tell us about those hormone receptors before ADT is begun. Isn’t it protocol to make this determination prior to ADT? And of course we need to know if there is any possibility of small cell lung cancer or if it’s a neuroendocrine prostate cancer. These are the questions I am hoping are answered from our trip to see the Wizards at Mayo. In fact we just returned home.
Replies to "Pondering this same concept: that perhaps the cancer is NOT hormone dependent prior to treatment. I..."
It’s interesting that you mention lung metastases. @jeffmarc recently posted observations from one of his PCa groups and lung metastases show up very frequently in the lungs, even with low -ish PSA readings and scant evidence on PSMA. Another older PET agent is usually employed in these cases, but your husband’s showed so no need for another scan (IMO!)
Phil
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I think all prostate cancer is usually hormone-sensitive ab initio. What happens is that once you suppress the hormone-sensitive cells, the very rare mutated cells that don't depend on testosterone eventually become dominant. Various treatments can slow that process down for people with metastatic PCa, perhaps to the point that it doesn't happen before you die naturally of old age. ARSI like the -lutamides are especially effective at delaying castrate-resistance when combined with ADT.