I found out I was BRCA2 positive about five years ago. I’ve had prostate cancer for 16 years and I’ve had surgery and radiation and multiple different drugs And four reoccurrences. I had to have a metastasis on my spine zapped a couple of years ago Even though I had been on ADT and an ARPI, But Zytiga didn’t work well for me. It does work well for many other people I know Who have stayed undetectable for many years on it.

Getting off ADT when you have BRCA2 is a real gamble. I’ve been on it for eight years now. I became castrate resistant 2 1/2 years after I started it, but I’m six years past that. I’ve been undetectable for the last 26 months, but that’s because I take Orgovyx and Nubeqa. Nubeqa Has been incredibly helpful. I was on Zytiga For 2 1/2 years and was only undetectable for one month in all that time.

Just to show how aggressive BRCA2 is. When I was on Zytiga, I tried taking only three pills instead of four to see if it would help with the brain fog. After 19 days, my PSA went up from .2 to 1. A 500% increase in 19 days. That’s BRCA2 for you.

You really should get yourself on both ADT and an ARPI drug. A lot of doctors like to start with Zytiga, That could keep your PSA down and your cancer from spreading for a long time. Nubeqa Has almost no side effects and doesn’t pass the blood brain barrier so it doesn’t cause brain fog like all of the other ARPI drugs.

The normal treatment path for a a metastasis is SBRT radiation to zap it. The thing is, we cannot tell you if the metastasis you have can be zapped with that, or if they are too close to areas that could be damaged. You could look into photon radiation, which has a narrower beam and might be able to get to all of your metastasis.

None of your SUV numbers are very high. They would be considered moderately elevated. It could be that just getting on ADT and an ARPI could shrink them down to negligibly noticeable. This is something you really needed to discuss with a doctor.

Whatever you decide, you should be back on the drugs. With BRCA2 you are really taking a chance.

Getting only on ADT will increase your chance of becoming castrate resistant significantly. Recent studies have shown that adding an ARPI greatly extend extends the amount of time it takes to become castrate resistant with ADT. Make sure you discuss this with your doctor.