ADT and rising PSA

@mjp0512

Do you collect Inonotus obliquus in the forest from living or dead trees?

@denis76 - Living. Quite a few stands of Birch not far away.

@mjp0512

Have you tried drinking this mushroom's vodka tincture?

@denis76 - No, I'll keep my booze single malt.

@denis76 mentioned "I've heard that if you treat cancer aggressively, it becomes aggressive itself."

Just the opposite, at least according to the latest thinking on metastatic prostate cancer. They used to treat it gently and incrementally: trying one treatment until it failed, then escalating to the next (somewhat stronger) one, etc.

These days, the leading-edge thinking is shock-and-awe: hit metastatic prostate cancer aggressively, up front, as many ways as you can, all at once. That's the philosophy underlying doublet and triplet therapy, MDT and PDRT, etc. Researchers at top cancer-treatment facilities like our host Mayo in the U.S., Princess Margaret and Sunnybrook in Toronto, etc., have been at the forefront of that movement, and so far, recent major phrase III trials have supported them.

@denis76
Must be the first time I have heard that. There have been Quite a few cases in this Mayo forum where people have gone aggressive as could be on their prostate cancer, and it helped.

People get triplet therapy to try to stop the cancer in its tracks and it works for a lot of people. It doesn’t work for everybody, Some prostate cancer cases can’t be stopped, not because people were too aggressive. It’s because their cancer is too aggressive..

I know someone that actually got triplet therapy when he didn’t have it recommended, but he wanted to be aggressive so that he didn’t have to worry about the future.

Normally, however, people get aggressive therapy because they have an aggressive case.

As I've mentioned before, my treatment was unusually aggressive, even by leading-edge standards, because it also included surgical debulking of the metastasis in addition to the regular MDT, PDRT, and doublet therapy.

There is some research showing that surgical intervention for large metastases with oligometastatic PCa reduces recurrence risk even further, but it's not standard of care yet, especially if the metastasis is somewhere tricky like the spine: the risks are just too high (as the old surgeon joke goes "The operation was a success, and the patient died").

I got that intervention because I was at risk of permanent paralysis or death if they *didn't* operate immediate. Fortunately, there was a top spinal specialist on call that night, he drove in from home at zero dark thirty with no notice and no opportunity to plan, and not only was the 10+-hour operation a success, but I did wake up again. 🙂 So ex-post, knowing that I didn't die on the operating table, it was a good choice for me for cancer-control as well as mobility, but there was no way to know that ex-ante.

All my cancer treatments:

October 2021
- surgical debulking of the metastasis on my spine
- 20 gy of post-op radiation to my spine (MDT)
- ADT (first Firmagon, then Orgovyx) -- ongoing to present
- ARSI (Erleada) -- ongoing to present

May 2022
- 60 gy of radiation to my prostate (PDRT)

As of May 2026, I'm still NED, so in my case, the aggressive approach seems to have paid off, but as @jeffmarc mentioned, everyone's cancer is different.

@mjp0512 Man, what a shit show. So that spinal lesion definitely was cancer from the get go and was not spot radiated with SBRT…
But even your prostate, which WAS radiated is still active? That is a real new one me, for sure. You may have no choice other than docetaxel at this point, as others have pointed out.
Pulling for you, man!🤞🤞

@heavyphil - Thanks Phil. Yea...I'm not looking forward to the GUO visit on 6/2. Pretty sure chemo's on the way unless something popped in the genetics I don't know about yet.

@mjp0512

And after the biopsy, did they give you docitaxel?