Bad news again (still)

Posted by briang1958 @briang1958, May 17 11:56am

Perhaps you read my story, perhaps not.
Gleason 8, spread to bladder neck 55 years old.
Prostatectomy with bladder lesion cut out.
Recurrence after a year, 39 External Beam with ADT for 6 months
Was undetectable for 8 years with no ADT.
last year PSA .15, and .30 had the PETScan found cancer in a lymph node, VA said your stage 4 and all we got is ADT. ADT and I did not get along previously.
Called Mayo, Great Doc recommended Photon SBRT (single shot), I tolerated that very well.
Now 6 months later PSA .38
I wonder what's next?
Someone said now that I am 66 as opposed to 55, I don't have as much testosterone, and it shouldn't be as bad.
I don't think I have ever had my testosterone level tested before, but they did yesterday. 407 where reference range is 221-870.

This thing that has invaded my body is really fucking me up

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

kujhawk1978 | @kujhawk1978 | May 20 8:50am

Well, the VA may not be the answer given their response of mono-therapy which today is not consistent with the NCCN or AUA guidelines
https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459
https://www.auanet.org/guidelines-and-quality/guidelines/oncology-guidelines/prostate-cancer
As others have mentioned, if ADT is not something you want to consider, there are choices.

The PATCH Trial
EMBARK Trial though yes, ADT
Metastases Directed Therapy - this may delay the need for ADT - https://ascopubs.org/doi/10.1200/JCO.23.01274

The guidelines might lean towards doublet, though not triplet therapy.

There is also the choice of doing nothing as it could be some time (years...?) before action is required given your clinical history, the 8 years after SRT + ADT...

Kevin

briang1958 | @briang1958 | Jun 3 3:30pm

***Update***
Going back down to Mayo for another set of PET Scan and MRIs end of July.
He is pretty sure he got the cancer in the iliac lymph node on the recent SBRT so we're going to have another look.
♪ This is the song that never ends ..... ♪
Not done fighting

kujhawk1978 | @kujhawk1978 | Jun 4 9:32am

Well, what's next, that depends.

As to the VA, run, if their answer is monotherapy, ADT, that is Stoneage treatment given today's NCCN and AUA guidelines and data from clinical trials.

As you can tell from the responses, you have options.

The PATCH trial is certainly an intriguing one - https://www.urotoday.com/conference-highlights/asco-2025/asco-2025-prostate-cancer/161000-asco-2025-dedicated-resources-for-veteran-clinical-trial-participation-the-prostate-cancer-analysis-for-therapy-choice-patch-program.html?utm_source=newsletter_14270&utm_medium=email&utm_campaign=uroalerts-prostate-cancer-weekly
Depending on financial toxicity associated with repeat imaging, you could image again, say between .5 - 1.0, then decide:
MDT only, may delay the onset of ADT
MDT with short term ADT, say six months Orgovyx
MDT with short term ADT + ARI
ARI only, think EMBARK Trial

Another possibility -https://www.urotoday.com/conference-highlights/asco-2025/asco-2025-prostate-cancer/161008-asco-2025-bullseye-discussion-radioligand-therapies-unplugged-is-it-time-to-break-up-with-androgen-deprivation-therapy.html?utm_source=newsletter_14270&utm_medium=email&utm_campaign=uroalerts-prostate-cancer-weekly

Kevin