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New treatment question

mtop
Posts: 25
Joined: Jan 2017

I am looking for insite from anyone who might be on a similar course of treatment that I'am schulded to start on Dec 9th. Currently on Lupron every three months. Doctor wants to start me on Abiraterone and Predrisone and also Prolia.

History and reason for new treatment:

1/2016 - Prostate removed, Gleason score 9 (5+4). High Risk. Had 7 weeks of radiation treatments in 2016 and was on Lupron for three years. While on Lupron PSA was 0.014.

2019- Took a vacation from the Lupron for almost a year. Contiuned having PSA tests while off Lupron. 

2020 - PSA test showed a rise to .9  so back on Lupron. Three months later PSA 1.0. Had a PET scan early November. Scan showed that cancer has gone to bones. Two places, spine L-10 and small spot top of head. Maybe I should not have taken the vacation from the Lupron???? But wanted a break for side effects. Now I'am sure to have even more. Anyway  any body have any inside or advice? 

Thanks.

Momschooling
Posts: 6
Joined: Nov 2020

My husband has been on the Zytiga/and prednisone (not the prolia) with Lupron for almost a year, and hasn't felt that Zytiga brings side effects any worse than the Lupron already does. He actually stopped Zytiga for a month to see if that was what was making him feel terrible in the summer, but it turned out not to be the case, the Lupron is the culprit. Good luck!

mtop
Posts: 25
Joined: Jan 2017

Thank you for the information.

Clevelandguy
Posts: 647
Joined: Jun 2015

Hi Mtop,

If it was me I would get to a Oncologist and see if the spots can be treated with radiation in conjunction with testosterone lowering drugs. 
Possibly some chemo drugs in the future?  I am not a doctor but giving you my non medical opinion as to what I would do if it was me.

Dave 3+4

Hemlock's picture
Hemlock
Posts: 2
Joined: Aug 2019

I have been on leuproreline Acid (Lupron, for hormonal castration), and Zoledronic Acid (Zometa, for metastatic to bone), and Abiraterone Acetate (because of failure of Leuproreline Acid). All from about 14 months, down to 4 months. My latest PSA was 50. I suspect I will be going back into chemo. Progression seems to be stubborn. I dont see any miracle solution coming. Just know, you are not alone.

Guber4
Posts: 8
Joined: Feb 2017

I would get another opinion on the scan

what type of scan was it?

mtop
Posts: 25
Joined: Jan 2017

A FDG-PET scan 2nd one I've had since being diagnosed with prostate cancer in 2016. First before prostate was removed and the second in November once PSA started to rise. Test done at the NRMC San Diego.  Coild you give me the reason that you feel that I should  get second opinion on the scan?

Thanks 

Old Salt
Posts: 775
Joined: Aug 2014

can't hurt, but I see no strong reason for it.

I would suggest to get another PSA test to see if the rise continues. Two data points aren't enough to prove that you are castrate resistant.

I do support the idea (Clevelandguy) to ask about spot irradiation.

mtop
Posts: 25
Joined: Jan 2017

Was seen by my Urology Oncologist on 12/8 and a Radiation Oncologist 12/15. They have requested for me to get another different type of PET scan and a pelvic MRI. Have PSA tests every 3 months, PSA has gone up slightly in the last 9 months. Before I went on my year vacation from Lupron PSA was 0.014. This months PSA was 0.347. Still a low PSA but continues to go up each time I'm tested. Started the new treatment plan listed above last week. Time will tell if it will keep the PSA rise in check .

Clevelandguy
Posts: 647
Joined: Jun 2015

Hi,

From what you reported earlier your last Psa went from 1 to your latest of .347.  If thats the case it's a good thing.  Just have to keep an eye on it with the doctors and see what they want to do.  Have a great Holiday season and back to the battle in 2021.

Dave 3+4

VascodaGama's picture
VascodaGama
Posts: 3297
Joined: Nov 2010

MTOP,

I understand the reasons that lead the doctors in requesting different exams. The FDG PET scan is not the best in detecting PCa as this exam will depend on cell's absorption of glucose (most cancers do) which is not the case in all types of prostate cancer. Our bandit prefers androgens to sugar. FDG is great to detect PCa in bone.
PSMA PET or 18F-Choline PET, or F-18 Fluciclovine (Axumin) PET have proven to be better in detecting PCa with the former (PSMA) being the best because it aims the prostatic specific membrane antigen (PSMA) produced by prostatic cells. PET exam results are more trustful if one tries to avoid false negatives by letting the PSA increase to levels above 1.5 ng/ml (1.5 to 2.0).

The next PET exam will drive you to the best treatment if that becomes required. Even after RP and RT, you may still aim cure if the bandit is found in appropriate location to be tackled with added radiation (or dissecting). Surely ADT is always available to keep the bandit under certain control.

I think you did well in stopping Lupron after 3 years on the run. The bandit do not like permanent castration (Lupron affairs) and at some point would start producing its own androgens for its survival. Intermittent approaches in ADT seem to be preferable as it prolongs the period of cancer's dependency, extending its status of dormancy. Typically the intermittent period (On and Off drugs) is regulated in PSA thresholds that can reach levels of PSA=5 to restart On-drugs and remission levels (PSA<0.05) to start the Off-drugs period. These thresholds depend on the details of each case.

Let's be positive and respect the restrictions imposed on the Covid-19 affairs.

Have a good Christmas.

VGama 

mtop
Posts: 25
Joined: Jan 2017

Thanks to all for your insite and advice. Everyone give a very Merry Christmas and hopefully a better New Year.

Myop

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