A newer phase in my Systemic treatment now with metastasis in bone
To all in this forum and particularly the old members that have help me along the years in understanding facts on PCa issues based to their experiences, or suggestions to my case.
It has been 18 months since I dropped a post in the forum (July 2022). I felt that I have failed those that were used in receiving my prompt comments or eager in reading about developments in my PCa history. After all, we are in the same boat Navigating through the Darkness.
However, I had a busy 18 months in private doings as well as in regards to the decline of my PCa situation. Fortunately to me, I believe that I managed again to get a grip on the bandit.
It all started when the NHS changed the doctor assisting me in the fight, back in August 2022. The new one postponed my consultation twice, and I only met him in April 2023.
Meanwhile, my PSA increased from 2.03 ng/ml (July ’22) to 3.34 (Jan ’23) to 4.61 in April ’23.
The sharp increase worried me very much as it surpassed the threshold of PSA =2.5 set by my previous uro-oncologist in 2012, as the marker to end the vacation period (off-drugs) in my intermittent hormonal therapy, obliging a restart of full ADT.
This new doctor (Ukrainian national) approaches were all out of pace and sort of antiquated. He opposed my wish in doing scans to verify the sudden doubling of the PSA which, in my opinion, could help in deciding the protocol of the treatment, regarding the choice of the drugs.
A friend of mine and member of this forum, come to my rescue and help me in having consultation and exams done in Singapore. The results drastically changed the procedure of my continued treatment.
The scans (18F-PET FDG and 3T-MRI) identified recurrence at the urethra which prompted me in conducting a 68Ga PSMA PET (Oct ’23) that confirmed the localized recurrence at prostate bed in addition to a bone metastasis in the pubic bone.
According to a NHS radiotherapist I can do spot radiation SBRT (oligometastatic treatment) but radiating the three “volumes” at the urethra can cause stricture which is not recommended as I am CKD stage-3.
My case history is in study at the NHS’s weekly Multidisciplinary Meeting reviewed by seven doctors from different disciplines.
Meanwhile the NHS assigned a medical oncologist to assist my case who have decided in a protocol of three blockades made with a LHRH agonist (Triptorelin 6-shot, started in October), plus a 5-ARI (Dutasteride, started in June), plus an antiandrogen (Apalutamide, to be started in January).
My PSA continued the increase reaching the level of 11.64 ng/ml (Sept ’23). From there it started to decline now at 0.21 (Dec ’23).
The PSA accompanied the decrease of the testosterone from 456 ng/dL (Sept ’23) to <2 ng/dL (Dec ’23). Such signifies that my cancerous cells dependent much on the circulating testosterone. Can I keep the bandit on the canvas again as I did it in 2010?
Well, my next appointment is scheduled for January 24th, in which day I will be informed about the SBRT decision from the Multidisciplinary Meeting. Most probably they will recommend spot radiation but I would prefer to radiate only the metastasis at the pubic bone. I want to keep my quality of life.
Please note that I have no private insurance to choose what I most like. I am dependent on the Portuguese national health services (NHS) where it takes ages to have things done.
For those interested in reading the details of my history please refer to previous threads listed under my acronym VascodaGama.
Best wishes for a happy holiday season and a healthy new year to the members of this forum and their families.
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