Treatment for Prostate Cancer Metastasized to Bones

As I mentioned earlier in the thread, after watching his videos, it seems a little more nuanced:

- for oligometastatic (just a couple of spots), he recommends "zapping" the metastases (radiation); that was in a separate interview in his YouTube channel
- for more widespread metastases, he recommends the triple therapy right from the start

Again, just a layperson, but the plan seems to be to avoid the really harsh therapy for oligometastatic if you can treat each metastasis separately, but if you can't, then try the triple treatment right from the start instead of one thing at a time.

I think that's a little harsh, and unnecessarily discouraging for people with newly-diagnosed bone-metastatic prostate cancer. It really depends on the number of metastases, and even then, there's huge benefit from introducing androgen-reception inhibitors like Apalutamide. I'm at 26 months now, with PSA still undetectable (< 0.01) — tested today — and no progression. I had the metastasis in my spine radiated, as well as the primary tumour in my prostate.

The TITAN study for metastatic, castrate-sensitive prostate cancer (using ADT and Apalutamide) did not even reach median overall survival at 52.2 months. Median overall survival with ADT and placebo was still almost 40 months.

Source: https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.6_suppl.11

Thanks for sharing this.
That's definitely a encouraging clinical trial, assuming the results are comparable, which I am unqualified to assess. If I understand correctly, from whatever the starting point was, the mean overall survival rate was 40 months for the standard of care treatment, and increased by over 20% to 52.2 months with the treatment plan undergoing the clinical trial. Yeah!
Also, great news that at 26 mos from this diagnosis you have no (noticeable) progression. That sounds great to me.
Note: I'm not sure if the other study starting point was newly diagnosed bone-metastatic prostate cancer either. I tried to note that in my comments, but I don't know if it came across. Since I am not a researcher in this field, I am really unqualified to make any independent assessment of these articles. When I summarize something, I'm just restating what [I think] I am reading.
With regard to the link you posted, I only got access to the abstract there. Perhaps the article itself is behind a paywall?
In any case, I have no idea what the actual situation is, but I certainly like 52 months better than a lower number for overall survival :-). Thanks for posting this. Since this was a phase 3 trial over 2 years ago and it went well, can I assume this is now a publicly available treatment option?!

How long does it usually take for Orgovyx and Erleada (together) to have an effect on psa score?
Is it days, weeks, months?

May be SoC varies from one doctor to another, depending on their experience. As one doctor on a different disease put it, if the only tool you have is a hammer, then everything is a nail.
Doctor Schulz puts it another way. It would take many years for the benefits of one treatment to be proved. Even then, there may be no 'formal' or official statistical study for many years. Given the treatment, scanning etc have been moving so fast, it may be well advised not to dwell too much on all these studies.
For example, PSMA PET scan finds the bad cells much earlier than ever before. It is possible to eliminate them before it becomes a problem.
Beyond that, we are not testing a radioactive drug that both finds the bad cells and kills it at the same time.
So the chances or probabably of eliminating the cancer is much higher.
Does that help?
Dont mind me. I am just another layman trying to make some sense of the the whole thing.

When I watched Eugene Kwan's video, it sounded like the Triple Therapy was the 'cure'...That you do the therapy for 18 weeks, and then you're off the Eligard and Apalutamide...
He's at the Mayo Clinic. You'd think other doctors would all be doing the same ...
My bone metasis is widespread...PSA levels now after 8 months of Hormone therapy are .2, so they tell me that's low...
I asked about a PET scan, and they told me they'd do a bone scan in a year...
I don't understand why all Doctors aren't doing the same standard treatment that apparently works...
Do I have to go to the Mayo Clinic to get treatment? I'm in Canada...so not as easy to go down there for treatment...
Is there a cure for Stage 4 prostate cancer, or do the treatments just give you a few extra months...
Frustrating...

I think that the recognized Standard of care is presently more accepted and less effective than Dr Keon’s triple therapy. If the cancer is visible in multiple areas and if the patient is healthy enough then I think that the triple therapy is best

Unscientific experience:
PSA dropped to undetectable after about 6 wks on Orgovyx.
Best wishes.

According to my hospital charts (which I can access online), my PSA was 67.90 on 13 October 2021 right before I started on Firmagon and Erleada. It fell to 11.60 by 4 November, a couple of weeks after starting on ADT and Erleada, then was detectable (< 0.01) at the next check on 4 February 2022, where it has stayed (last check was yesterday).

YMMV

Yes, with widespread metastases, Dr Kwon's triple approach would apply (from my layperson's understanding of his videos).

At my cancer centre (in a different Canadian province), I've been closely consulted and offered information and choices for every stage of my treatment. I know it's hard when you're already sick and low on energy, but I suggest moving heaven and earth to get into your cancer centre in Calgary — a team approach is always better than one (possibly-opinionated) urologist. You could even cold call the cancer centre to find out what referrals you need.

I'd hate for you to spend your retirement savings getting treatment in the US. What you want is available free here in Canada, probably even in your own city — my friend with lymphoma in my city was offered every available treatment, up to and including some brand-new genetic stuff and CAR-T (oncology's last, desperate Hail-Mary pass).

You deserve at least a good explanation of why your urologist is not offering you the option of chemo together with your ADT and radiation (they might have a good reason, but they don't seem to be communicating it to you if they do).

Best of luck, and remember that you're your own best advocate. DM me if you want to discuss further.