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ARPI use after radiation treatment may be an issue
Prostate Cancer | Last Active: 6 hours ago | Replies (41)Comment receiving replies
My experience:
Last year was diagnosed with prostate cancer metastatic to two lymph nodes. Had IMRT radiation to prostate, lymph nodes and surrounding area with SBRT booster to a Gleason 8 prostate with intraductal and squamous differentiation. Also present were ECE and perineural invasion.
ADT with Orgovyx was started immediately, and ARPI with Nubeqa was added a month later. PSA and Testosterone were undetectable at 3, 6, 9 and 12 month checkups.
At 12 months FDG PET/CT scan was done because of the squamous differentiation. This showed a mid uptake (SUV 3.8) with a lesion measuring 26 x 17 mm.
A follow-up PSMA PET/CT scan showed mild uptake in the same area.
A bone biopsy was done last week and was positive for adenocarcinoma consistent with prostate origin with negative PSA staining. SBRT is scheduled for that lesion.
Replies to "My experience: Last year was diagnosed with prostate cancer metastatic to two lymph nodes. Had IMRT..."
@pcscott
Actually, your case with squamous differentiation it’s not the same as what we’re discussing here. That particular problem can lead Metastasis without PSA rise. It’s also resistant to standard treatments. That makes it difficult to find if it gets worse. The intraductal Also makes it a lot more aggressive.
Must admit I’ve never heard of a case with this problem before. I attend nine online, advanced prostate cancer meetings every month and Attend a lot of talks about prostate cancer and this has just never come up, It is so rare.
Sounds like this is something where they need to do regular SBRT scans, So they can zap metastasis as they come up. The PSA is really irrelevant.
I wish you luck on finding the latest problem and treating it.
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@pcscott I'm so sorry to hear that, and it's very much in line with what the study @jeffmarc shared ended up recommending: that it's still important to do imaging, even when PSA is low or undetectable on ADT + an ARPI. I'm glad they caught it.
If you don't mind my asking, was your PSA undetectable on the ultrasensitive test (e.g. < 0.01) or the regular PSA test (e.g. < 0.1)? I'm asking only because I have not yet been able to find an example of the former in the papers I've read, while I have found (a few) examples of the latter.