ARPI use after radiation treatment may be an issue

wow..that sounds a bit ominous...so perhaps a PET scan at the 2 yr mark even if your PSA is below the .2 threshold of possible trouble brewing ?
any thoughts on this, Jeff ?

Ha ha , just what I needed to hear 😆. I do not know how than EMBARK showed outstanding reduction of metastatic disease in high risk patients over 6 years of study ? Did they just measure PSA and did not do any PSMA scans to check for metastatic disease ??? 🤯

OK - where is that lady with Marijuana protocol LOL ??? Honestly every new study shows the opposite of the previous one , just ridiculous.

@xahnegrey40
This just highlights the fact that one of the studies showed that even though people had undetectable PSA’s, they still could have metastasis popping up. Here’s a couple more articles that discuss it.
https://www.sciencedirect.com/science/article/abs/pii/S1078143924007075
https://pubmed.ncbi.nlm.nih.gov/17171704/

Thanks for sharing that. Two questions:

1. They compare % of participants with radiographic progression (rPD) but no PSA rise. To what extent is that accounted for by the fact that the study group (on ADT+Enzalutamide) had less much less rPD than the control group (just ADT) in the first place?

2. They refer to "any PSA rise from baseline/nadir by treatment" without disaggregating how low the nadir was or which test (PSA or uPSA). They probably didn't have a choice, since it was a retrospective review.

Still, the conclusion makes sense: it doesn't say "don't use an ARPI" (since there are huge overall survival benefits); instead, it recommends not relying 100% on PSA monitoring, but to do periodic imaging as well (which seems uncontroversial).

@northoftheborder
Thanks North - I was even afraid to read the study since my nerves are frayed today because tomorrow we have MO consult. Without reading it I was trying to comfort myself with a thought that perhaps bottom line message was - do scans no matter PSA level. *sigh Thanks for summarizing it ! 🙏

@surftohealth88 I haven't read in detail yet (just the summary), but I suspect the cancers that get by ADT+ARPI would be the very nastiest of them, so it makes sense you'd see a bigger ratio of nasty cancers.

It's like if the water bombers put out all the smaller forest fires, you're left with a bigger percentage of large fires.

But again, I'm not an expert, and just exploring possibilities. Restrospective studies of other studies' data are useful for showing where researchers should look next, but in themselves, they're relatively unreliable: more about asking questions than providing answers.

@northoftheborder yes...if you read enough of PC studies, it can make you a bit crazy..and while I have no doubt there have been instances of PC metasis even with normal PSA, I imagine they are somewhat unusual.

I have done quite alot of PC research in the past yr obviously..most of us do..for ex, Wm Hurt, the actor, passed away from prostate cancer which he had for many yrs and treated with a somewhat holistic approach by Dr. Kenneth Matsumura’s "Side Effect-Free" (SEF) chemotherapy..Matsumura's methods were proven to be mostly a sham and without proper research protocol..and he was subsequently disbarred ( medical license revoked) ...Hurt died in 2022...altho it was reported he ahd been diagnosed as early as 2013..so my take is MOST men are mostly succesfully treated IF they follow sound medical protocols, make lifestyle changes and maybe a bit lucky too..certainly there are some who are not ( lucky) and their disease is able to circumvent even the most robust pc protocols available today..

@xahnegrey40 After reading all these posts - and Jeff’s totally depressing news - it seems that the best answer comes from a Sloan researcher who chronicled 7 types of cancer ( brain, breast, prostate, lung, etc) on a PBS special over 20 years ago.
After ALL 7 patients died during the study - using cutting edge treatments of the day - he concluded:
“Some patients will die no matter what we do, some will die because of what we do. But some patients will die no matter what.” And so it goes…
Phil

Last night during the ancan.org Meeting, Len Who wrote the article commented on the fact that Darolutamide Results were almost the same as placebo results, Much better than the other two drugs

well I actually think us prostate cancer guys are gonna do pretty well..as compared to other cancers..I think we should do as much as we can to stay fit, take the meds prescribed ( mostly) and let the chips fall..doing nothing with cancer is not a good idea...

look at Jimmy Buffett, he prob had a 1-2 yr window in which he could have been successfully treated but was touring and having fun that he put it on the back burner..prob was told by a few "oh thats prob nothing, lets fly down to Barbados and Martiniique for a couple of weeks dude !"

I think we are gonna be ok !