Seeking your thoughts on PSA of .1 on Orgovyx and Nubeqa

In a similar situation as your husband except when discovered, my cancer had already metastasized past the point of surgery being a viable option. Full Dx is in my profile for reference, but it suffices to say that the Orgovyx/Nubeqa doublet is my primary treatment. We did zap the prostate with IMRT but my RO specifically told me that this was an additional treatment and that the drugs would be the primary. One thing I don't see brought up often is somatic testing of the malignancy itself. My GUO doc was very adamant about the importance of the genetic makeup of the cancer for future targeted treatments when ADT/ARSI stumbles. Best wishes.

good to know. I responded to ucla, because my doctors have great urgency while hers does not.

I was told by a nurse in training that once it's in the bones, it affects I forgot what. Even my radiologist said once it's in the bone, it's a death sentence.

@lacraig1
There is no factual basis for that comment that once it’s in the bones it’s a death Sentence.

One was wrapped around the bone in my spine (L4) and I’ve been undetectable for 25 months since I had that metastasis zapped with three sessions of SBRT.

I couldn’t tell you how many people I know that have had their bone metastasis zapped and are still around years later. One guy who had multiple sessions and more than 12 bone mets and is still around a couple years later with no issues.

Dr. Scholz, who is one of the leaders of the PCRI conferences, has Based a lot of his practice on treating people who have metastasis with SBRT and saying they will go on to live normal lives. He prefers to wait until they show up in a pet scan and then zap them.

@jeffmarc His last PSA was .1. The doc thinks next time it will be < .1.

Thank you so much everyone for your responses, greatly appreciated. Radiation might be possible sometime but the RO we went to said he wouldn’t be comfortable radiating a bunch of little nodes in the abdomen that are close to vital organs located there. He said the side effects might not be worth it down the road. (My husband is 64.) That’s why the chemo option was put on the table. After all of your informative input I think I will consult another radiologist. We are treated by UCLA but the RO we saw is not a UCLA doc because we live three hours away from UCLA in Westwood. I did ask our UCLA oncologist about radioligand options and he seemed supportive of that option if it becomes necessary. I am also thinking maybe we could have radiation of mets sometime in the future if the hormones shrink things down to just a few avid mets. As the situation is now, there are a bunch of little mets that apparently would be difficult to “zap”. On an interesting note, all the docs we have seen described the situation as oligometastatic.

@mjp0512 We had two tests right after the biopsy. The nurse said one was to look for “family” influences ( I guess like BRCA etc.) and the other was to look at the characteristics of the tumor itself. Or something like that. I was pretty overwhelmed at the time.

@jeffmarc wow, I'll keep this in mind. My radiologist essentially said that when the bones get it, you're done.

@lacraig1 My understanding is that in the bones might suggest a different treatment path but it is totally treatable as is the lymph node situation.

I’m surprised an RO would say that in 2025.

@ucla2025
That was an hereditary genetic test, followed by a somatic genetic test. If either one shows a genetic anomaly, then maybe something different can be done in treatment. Good to hear you had both done. I didn’t have my hereditary test done until 11 years after I got prostate cancer. My treatment may have been different if they knew I had BRCA2.

The somatic test which is done on tissue or blood can be repeated if others tumors appear. Changes can occur in genetic issues with tissues. The hereditary test never changes.

I’ve heard many times that they cannot do SBRT radiation on certain metastasis that are in areas that could damage other tissue that is important. You might look into having proton radiation done on those spots, It is much more targeted. It might be able to zap them.

Dr. Carl Rossi at UCSD has been doing Proton radiation treatments since 1994 when they built a building for the machine in San Diego. The first patient was the person that invented it, He lived to over 100. Rossi has done Proton radiation on over 13,000 prostate cancer patients. You probably can find somebody closer, and San Diego is a long drive, But I figured I’d tell you about it.