Upcoming SBRT: Any advice to help me prepare?

It is my understanding that ADT
stops the clock as it were for
progression. It also sensitizes the prostate tissue to radiotherapy
by ‘67’% I read that the 2nd gen ADT Nubeca (dorsolimab) sp? further sensitizes to 100%. However the approval of that 2nd drug may require meeting certain
criteria PSA>20?, etc.

Yes, ADT does stop the Metastasis from growing And can also shrink them. It doesn’t work forever, however. Most people on it for a long time become castrate resistant and have to move on to other drugs or other treatments.

Dr. Scholz also commented that 1st and 2nd generation ADTs work better than either alone. That was to related to mets not tissue sensitization to primary whole gland radiotherapy.

Did he possibly say ADT and the second generation ARSIs (ending in "-lutamide", like Apalutamide or Enzalutamide)? Those definitely work better together, as many studies have demonstrated.

They're all hormone therapy, but they work differently: ADT like Lupron or Orgovyx blocks testosterone production, while ARSI blocks testosterone reception by the cancer cells, so you're attacking it at both ends.

North, If someone becomes castrate resistant, the ARSI would no long work, right?
Is the next step a PARP inhibitor - Or is that just for BRCA mutations?
Phil

If someone becomes castrate resistant to ADT, then the ARSI’S do work. Once they become resistant to the ASRI It’s possible that they could switch to the other type of ARSI (Abbie to a ludamite, Or the other way around). Unfortunately, this doesn’t work well in most cases.

The PARP Inhibitor only works well with people with BRCA. They think that maybe people with ATM might get some benefit, But it’s not as helpful as those with the BRCA.

Once you have failed ADT and ARSI Then using SBRT to zap metastasis Can work if there aren’t too many. At that point you will need to go to chemotherapy or Pluvicto.

They are working on a drug that can be used once those two Treatments fail, But it is still in early development.

What they told me is that even after a critical mass of the cancer cells evolved castrate resistance, there will still be many that are castrate-sensitive, and they will continue to respond to ADT and ARSI.

If I recall correctly, in the TITAN study, even subjects who did eventually evolve castrate resistance still had slower progression and longer overall survival while taking the ARSI.

Thanks North!

Hi @pilotdave, when starting out with a prostate cancer diagnosis, the terms and short forms can be a steep learning curve. For that reason, the guys here compiled this list of commonly used acronyms that you might find useful.

- Prostate cancer-related abbreviations: What acronym would you add?https://connect.mayoclinic.org/discussion/prostate-cancer-related-abbreviations-what-acronym-would-you-add/

How did the biopsy go? Have you had a chance to talk about treatment options with your cancer team yet?