Seminal Vesicle Invasion & PR22/MIDS/SPORT Trials ADT & ART

Hello all, Thanks for reading. My father is 63 close to 64. He was diagnosed with prostate cancer (acinar adenocarcinoma) late last year 2022. We were told based on the biopsy report that this is an aggressive prostate cancer. He had CT scan and Bone Scan done but no MRI or PSAM PET scan. After saw both his Urologist and Radiologist/Oncologist, he decided and had robotic radical prostatectomy and PELVIC LYMPHADECTOMY procedures done on April 10,2023. His final diagnosis from the RP surgery:
********
A) Prostate and Seminal Vesicles, Radical Prostatectomy:
- Adenocarcinoma of prostate;
- Gleason score 7/10 (pri-4, sec-3);
- ISUP grade group: 3;
- Extraprostatic extension is seen (multifocal);
- Resection margin is focally/minimally involved at right base of prostate;
- Seminal vesicles are involved (bilateral);
- pT3BN0 (see comment)
B) Periprostatic Fat:
- Unremarkable adipose tissue;
- Negative for malignancy
C) Left and Right Pelvic Lymph Nodes:
- Three Lymph Nodes, negative for metastatic malignancy (0/3).

Comment:
Adenocarcinoma is seen involving both sides of the prostate gland, including the base of the gland with relative sparing of the lower most of part of the apex, for total involvement of at least 30% or more of the surface area of the prostate. The predominant gleason pattern is 4, which constitutes > 90% pf the tumor amd the rest os pattern 3 as well as pattern5. Multifocal extraprostatic extension is seen in multiple blocks (mostly right and left posterolateral and right and left base, as well as focal anterolateral aspects). Focal involvement of cauterized margin is seen at right bladder neck/right base of the prostate.

TUMOR
Histologic Type Acinar adenocarcinoma
Histologic Grade
Grade Grade group 3 (Gleason Score 4 + 3 = 7)
Minor Tertiary Pattern 5 (less than 5%) Present
Percentage of Pattern 4 Present Greater than 90%

Intraductal Carcinoma (IDC) Present
IDC Incorporated into Grade Yes
Cribriform Glands Present
Treatment Effect No known presurgical therapy

TUMOR QUANTITATION
Estimated Percentage of Prostate Involved by Tumor 31 - 40%

Extraprostatic Extension (EPE) Present, nofocal
Location of Extraprostatic Extension Right bladder neck
Right anterio
Right posterolateral (neurovascular bundle)
Left bladder neck
Left postero-lateral (neurovascular bundle)

Urinary Bladder Neck Invasion Not identified
Seminal Vesicle Invasion Present, bilateral
Lymphovascular Invasion Present

MARGINS
Margin Status Invasive carcinoma present at margin
Linear Length of Margin(s) Involved by Carcinoma Less than 3 mm (limited)
Margin(s) Involved by Invasive Carcinoma Right bladder neck

REGIONAL LYMPH NODES
Regional Lymph Node Status All regional lymph nodes negative for
Number of Lymph Nodes Examined 3

Primary Tumor (pT) pT3b
PN Category PN0
*****************
*****************

On May 4, 2023, a month after his robotic Radical Prostatectomy, his Urologist (who did the surgery) told him some cancer escaped to seminal vesicle. He will need hormone therapy and radiotherapy to treat the remaining prostate cancer cells. On June 8, 2023, my father saw an Oncologist (same one he saw before his RP surgery). She said the consensus from the Tumor board is to move forward to have 24 months hormone therapy (SPORT Trial - starts with bicalutamide tablets, then injections (Trelstar). Other treatment is radiation (5 days a week for 20 days) to the prostate bed and lymph node pelvis. She also mentioned there are clinical trials available in Princess Margaret Hospital in Toronto Canada which require PET scan but needs PSA level to reach 0.1 to get the test. These two clinical trials are called 1) PR22 - adds new drug called Theralutemin to hormone + radiation; 2) MIDS - uses PSMA PET scan to intensify PET scan (does not target healthy cells). We decided to get more information about these two clinical trials before we make a decision. Right now we are waiting for an appointment. It has been almost two weeks now but we are still waiting.

It has been a little over 3 months after his RP surgery. My father seems doing fine except with the side effects such as: urinary incontinence; occasionally headache, minor constipation, pelvic area discomfort and wake up 2-3 times during the night. He does the Kegel exercise and exercise (walking & jogging) every day. He requires 1-2 pads every day.

His first PSA result is 0.047 on June 2 two months after RP. His second and last PSA went up to 0.067 on July 6. We are really worry our father because of the cancer is aggressive (with T3B) and also if the cancer spreads as the PSA seems rising up. The next PSA test is scheduled on July 27th. We would like him to have PSAM PET scan test to ensure if the cancer cells have not spread, however, he is not qualified as his PSA is low and may not be detected.

I wonder if someone has any information about the following clinic trials and/or if you know someone has/had experienced with the similar prostate cancer situation (i.e. T3B with seminal vesicle invasion) as my father ... very much appreciated.
- SPORT
- PR22
- MIDS