Hormone Sensitive, Advance Prostate Cancer - Agressive Treatments

Posted by BertFromEarth @bertfromearth, 16 hours ago

I am 69 and live in Portland, OR. I was diagnosed with a PSA of 25 in 2019 at age 63 and had surgery in early 2020. The surgeon found other affected tissue outside the prostate. That began my journey of treatments. I started with lymph node targeted radiation and 8 months of Elegard. I took a break from that and over the next several months my PSA approached 4.0. We did a PET scan and located another lymph node to zap. We did that and I started 6 months of Orgovix. It has been about a year since ending that and my PSA has been doubling about every 3 months and I'm at about 12 now. I have had 2 PET scans with different agents recently and they are not finding anything significant to treat with radiation. My current doctor wants me to go 6-9 months on Elegard plus a Gen 2 inhibitor. I am very much interested in finding the cancer so it can be treated instead of just putting it to sleep for a while. I am still hormone sensitive.

I have been doing a lot of research and watching presentations mainly on PCRI.org Some of the doctors are recommending more aggressive approaches. Because of that, I decided to go to Mayo Clinic in Rochester and met with Dr Eugene Kwon's team. They are focused on cure or remission. I am returning in a few weeks to do a PET scan with a Choline tracer, a pelvic MRI and extensive blood tests. Then I'll meet with Dr Kwon and talk about a path forward.
If we cannot see a tumor with those tests, it may mean I have micro-metastatic cancer. Just a lot of very small groupings spread around. The other possibility is having a type of cell that does not show up on PET.... very rare.
In that case, the suggested treatment may be Elegard, Zytiga (Gen1&2), and Docetaxel (Chemo) all together (Triple Tharapy) The chemo is six treatments one every 3 weeks. Then I would remain on the Gen1+2 for a couple of years. He has had some luck with this approach in cure or remission.
I am wondering if there a men out there that have tried or considered a more aggressive approach with Dr Kwon (Mayo) or others. If so, what were your treatments, results, and experiences?
Thanks in advance,
Bert

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northoftheborder | @northoftheborder | 12 hours ago

I have oligometastatic castrate-sensitive prostate cancer, and am receiving latest standard of care (SBRT radiation to both the spinal metastasis and prostate, ADT, and one of the -lutamides). Additionally, I had emergency debulking surgery to the spinal metastasis, which isn't normal standard of care, but was necessary to halt the spinal compression and save my mobility — although that wasn't directly part of the cancer care, several recent studies have suggested that decreasing the tumour burden that way improves the odds of deep, prolonged remission, so it may have been an accidental benefit. 🤷

Whatever the reason, I started treatment in 2021, and my PSA is still undetectable on the ultrasensitive test almost 4 years later, with no sign of progression in scans or other blood work.

I hope that info is helpful. Chemo (Docetaxal) isn't usual standard of care for oligometastatic, castrate-sensitive PCa (they radiate the individual metastases instead), but that and/or Pluvicto may come into play if the cancer becomes polymetastatic or castrate-resistant.

Best of luck settling on your own treatment programme!