A Quandry between two medical recommendations for mPCa to lung only

Was just reading about someone else who had two lung lesions, went on ADT and Zytiga And after a year, the lung lesions could no longer be seen.

They decided to hold off the chemo until later.

Chemo with carboplatin might just knock out everything right away. Carboplatin is not normally used unless it’s an advanced case, but I have not heard of everything. You don’t mention where you are going for treatment now, Maybe there is information that says it is beneficial in your case.

It appears you’re saying you are going to a medical oncologist. To get an oncologist that specializes in prostate cancer, you want a Genito urinary oncologist. If you can’t find one, then you should go to a center of excellence that has them. You want more than one medical oncologist making your decisions. You can ask things here and we can help you get more informed so you can be proactive about your treatment when you talk to doctors.

Thanks for your reply. Our local MO is at a fairly large system and he is a genitourinary oncologist who was at Columbia before coming to Michigan. We saw a noted urologist at a center of excellence where we had a PET and lung biopsy. We could seek yet another 2nd opinion, but have also been told that too many consults creates inaction. These nodules were first discovered Jan 30 and due to medical team being so crazy busy, a doc vacations, and getting to the center of excellence, its now 3 mos later. What do you do when your two experts don’t agree? I have a lot of questions and the appts are 20-30 minutes if they are on time. We feel ready to start treatment, but uncertain which approach. And of course, it all needs pre authorization…. Ugh - getting frustrated and we have yet to start. I suppose we could see about a video consult with UMich but it sure they do that. Rambling here, but thank you, @jeffmarc.

I wish I can help in any way but I am novice here so I just want to say that "low mutation burden" maybe indicates that triple therapy is enough ? That and the fact that local MO never heard of quad therapy ? As far as I understand metastases from prostate are actually prostate tissue regardless of where they are present. Who were doctors who recommended quad ? Were they from center for PC or general oncologists ?

I am writing all of this also to bump this thread up so it is more visible .

Your husband had very long and nice remission period, that could maybe point to the fact that his cancer is not very aggressive and might respond very fast to any treatment < 3

Sending you healing vibes and keeping fingers crossed that you find clear answer to your dilemma very soon.

@surftohealth88 Thank you for your reply and your kindness which comes through your words. It’s a major center team recommending the aggressive treatment as they suspect something unusual by the low psa and the visceral (lung) metastasis. And yes, the long ‘remission’ or years not doing more than distantly watching were a blessing as we launched our children. We are just figuring out retirement now, and not alone in a diversion from that promise. I think we have settled to go with our oncologist and do the heavy chemo as the first response. There is a lot in the literature about sequencing therapies, and while much is known about, much still represents ‘million dollar questions’. Given the ‘high volume’ because it’s the lungs, even with the slowness so far and low mutational burden, we are likely to settle with the chemo first attack followed by Abiraterone and the big center team has said while not the most ideal, they support that. My hub has felt fine, but admittedly has lost weight unexpectedly along with stamina due to postponing a hip replacement. The full quad onslaught seems like it could be really challenging. I wish most of all, they could do more testing to tell what is the makeup of theses cancer cells. I thought the liquid biopsies would give us some of that footprint, but the results have not center discussed. There are 4 mutations but not the obvious brca or atm and more obvious mutations seen with prostate cancer. Berliner testing was also negative for the obvious. So,…alas…as many navigating this journey there is the body of unknown that has more to say. We have to choose what we are unsure of and …trust…..I guess.

Be aware that Pluvicto Doesn’t work well with some genetic problems. RB1, PTen, TP53 are Pluvicto resistant and will probably not get good results.

Yes, so much is unknown with this cancer in general and so many sub-types :(, it is mind-boggling.

I am glad that you were able to make decision and perhaps protocol can be adjusted if needed ? Maybe they can lower the dose if necessary and perhaps adjust according to your husband's weight. They are as you said big center and they maybe did not have exactly the same case but at least saw thousands of patients with different stages and also with different side effects and will know how to react if anything proves to be too much for your husband.

I understand wholeheartedly your comment about retirement, we can not retire at this point and maybe not even ever, and having a cancer on top of everything puts than extra heavy burden on the whole picture.

I really wish I could help more and give any valid advice :(.

Please let us know how is your husband doing and I am wishing you both smooth and easy path through chemo with complete and forever disappearance of lung metastases < 3.

Update: decided to go with ADT (Firmagon shots) and double chemo (doxetaxel+carboplatin), followed by Abiraterone after 6 cycles of chemo. There are multiple studies differing results on sequencing, but we will likely never know - that proverbial, “What if I did, or didn’t do X first?” If it is well tolerated, perhaps we can add the Abiraterone in later cycles, as the center of excellence doc recommended all 4 at once. There are also some studies that say when ‘advanced’, do chemo first.

Its been hard to grasp ‘aggressive’ or mutated when there is no data to say so - liquid biopsies are low mutational burden, genomics show no big known ones like brca, etc, Gleason 7, most recent PSA 0.34 and Mets lung only with no symptoms. So, it’s been hard to get in the ‘aggressive wagon’ that the recommended treatment is intended for. And not having had any hormone treatment, surely he is not yet castrate resistant.

So, even though we have moved forward, it will be hard not to wonder about our choice - so be it. Perhaps, if we get a choline PET next time, we will see something different that is guiding the suspicions of this cancer that was lurking for 17 yrs, now being ‘aggressive’ since it has settled in the lungs.

First chemo is onboard and we are hoping the next week is manageable. Will keep posting under this thread with updates. Many thanks for this group.

Wishing you best of luck and yes, keep us posted about the progress. I am sure that those 3 spots will be eradicated in no time !
Doctors are probably concerned of lung location since lungs have so many capillaries and spread is possible if not stopped in timely manner, so they decided to send the Army, Navy and Air Force to clean that up with possible special units deployed later. Perhaps those spots will disappear very early in treatment and they will adjust protocol accordingly.
I find your husband's case intriguing and interesting for other reasons too. You mentioned that he had bad case of COVID (cytokine storm )? I think you mentioned that in previous post and to be honest the fact that COVID virus attaches to prostate tissue and causes inflammation (prostatitis) should not be dismissed as possible trigger. Maybe he had dormant metastases that were poked by that "storm" :(. My husband had pretty stable PSA over the past 10 years going up and down 2 points and than he had COVID September 2024 and his next PSA January went to 7.6 which lead to biopsy and finding aggressive elements out of the blue. BUT, what scientist would listen to "wife tales" .
I will be thinking of you and sending healing vibes < 3 I hope he will be able to eat and keep his weight stable .

Update: Day 7 post Chemo #1/6. Doxetaxel + Carboplatin.
He feels pretty good today and has been able to stay active, which we are told is key - slow walks, short bike rides, and some wood splitting! His worn out hip joint appreciated the steroid in the cocktail on day 2, even though it was a temporary reprieve. Yesterday was first day without deep long naps, yet sleep at night turned less deep. Appetite has been good, although he needed encouragement the first 5 days. I recommend the book, ‘Cancer Fighting Kitchen’ highly - good info on how to nourish for side effects. We don’t know what to expect but it seems the side effects and impact will be cumulative. We will see - so far, the plan is kicking it to the curb asap!

Yeayyy : ))) !
Those are wonderful news indeed - I can imagine how happy you felt today seeing your husband pretty active and even splitting wood :).

It is very encouraging that he tolerates the treatment well and that his appetite is good. I am so glad to hear that you liked the book and that it was helpful 🙂 , I think that it is very nicely put together and all recipes look very yummy.

Keep us posted 🙂 and I am wishing your husband week 2 as tolerable as the first one !