The Gleason 9 and 10 Crew - Welcome and how ya doin'? (Part 4, continued thread)

reply to Sr Sailor regarding variable responses to 177Lu-PSMA-
some correlations exist-
Some extreme responders also carry BRCA mutations, which cause defect in repair of double strand breaks, which the radiation causes to happen in cancer cells

over many administrations of the drug in Europe and Australia, patients with only lymph node metastases seem to fair better; median PSA decline of 92% vs 72% in patients with nodal mets plus only 1 or 2 bone mets; longer time to progression, better survival.

there was a trial of this drug that predated VISION here in the states; used a "cost-recovery" mechanism where subjects could be in a trial if they paid $10K per injection for the drug; shut down now due to lack of relevance because of VISION, but one subject showed mixed response after two injections: very substantial increase in bone and organ met volumes with 97% decrease in lymph met volumes

reference for lymph node study
https://doi.org/10.18632/oncotarget.26789

rf

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Dx Mar 2016 w G10 M1a @ 62yo, PSA 29
For 3 yrs: Lupron, PROSTVAC/chemo (PSA nadir 0.5)
Provenge, BAT, Zytiga, Xtandi, cabazitaxel
4/10/19 start VISION trial (177Lu-PSMA for mCRPC), PSA 65
2nd dose PSA 17
p 3rd dose PSA 5

Fairwind,
Hope you get a good response.

Good luck!

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Part I
2015 (Age 54) PSA: 20.8
Bx: All cores G7 (4+3)
RALP & Adjuvant RT
Pathology: G8 (4+4)+5
PSA nadir: 0.1, steady increase until 2019: 64

Part II
2019, March: Lupron/Xtandi, PSA: 0.036

Hi Grandpa Marv - I am sure the last 4 months have been tough, starts out with a concern and the next thing you know, you are up to your knees in learning about PCa and what all the abbreviations and numbers mean..

My guess is the doctors are not going to be pushing surgery given your age and the fact that your high risk cancer is probably outside the prostate but you never know. The MRI should provide some insight of what is next. Might consider a PET scan at some point to get more info on where the PCa is or isn’t. The second opinion at JH is a real good idea and should provide some additional guidance. Probably some good resources in DC as well.

It might be a good idea to start your own thread (New Topic) so everyone sees it and can help as needed.

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7/2018-66yo, PSA 4.1->5.1
8/2018-MRI, PI-RADS 5
8/2018-MRI Biopsy, 4+3
9/2018-CT/Bone clear
11/6/18-RALP @ St. Johns
11/2018-Post-Op Path G7 (4+3) 5% Tert Gr 5, pT3a pN0 Grade 3
Pos. Marg (SM+), EPE, <3mm, L=0.1mm?
11/2018-Decipher 0.47, Ave. Risk
1/2019-Epstein-G9(4+5) Gr5
“Difficult to distinguish EPE vs intraprostatic incision, 3mm” Extent:pT2x
2/2019-PSA<0.10
4/2019-6/2019 ART
5/2019-PSA<0.10

Yeah, the G9/10 thread has been going on for a long time and veers in many directions so many do not even look at it often. I only do it once in a while and happened to see your post.

The low PSA situation happens from what I have read. No one knows why, the PCa just does not generate the PSA in some people.

I would agree that EBRT of some variety + high dose brachytherapy + ADT (the triple play) will be suggested but additional scans will help with that decision.

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7/2018-66yo, PSA 4.1->5.1
8/2018-MRI, PI-RADS 5
8/2018-MRI Biopsy, 4+3
9/2018-CT/Bone clear
11/6/18-RALP @ St. Johns
11/2018-Post-Op Path G7 (4+3) 5% Tert Gr 5, pT3a pN0 Grade 3
Pos. Marg (SM+), EPE, <3mm, L=0.1mm?
11/2018-Decipher 0.47, Ave. Risk
1/2019-Epstein-G9(4+5) Gr5
“Difficult to distinguish EPE vs intraprostatic incision, 3mm” Extent:pT2x
2/2019-PSA<0.10
4/2019-6/2019 ART
5/2019-PSA<0.10

Fairwind-
I am very glad you are in the treatment arm. We are three weeks apart for injection dates; I get #4 next week. keep us posted and great luck to you-


grandpamarv- everything in your posts suggests you are getting good treatment; best luck to you, friend, it sounds like cure is possible for you; be well-

rf

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Dx Mar 2016 w G10 M1a @ 62yo, PSA 29
For 3 yrs: Lupron, PROSTVAC/chemo (PSA nadir 0.5)
Provenge, BAT, Zytiga, Xtandi, cabazitaxel
4/10/19 start VISION trial (177Lu-PSMA for mCRPC), PSA 65
2nd dose PSA 17
p 3rd dose PSA 5

Diagnosed with Stage 4 prostrate cancer March 2019. Extensive bone metastasis and multiple lymph nodes involved. Gleason score of 9 (5+4). Age 73. Getting ADT shot every 3 months and taking generic Zytiga and prednisone. On diagnosis PSA was 14. Went for my first 3 month checkup to Urologist and got another shot. My PSA is now 21 from 14. Had to go for another CT and bone scan. Have not gotten results back yet. Concerning that my PSA did not go down after generic Zytiga for 3 months. Anyone with similar experience?

Hi,

I was doing fine up to this morning when I saw my PSA and testosterone lab results. I guess you can see my situation and my treatments in my signature but here it is again. I'm 47 years old, two years ago DX with G9, mostly %100 with perineural invasion, MRI, PET Scan, CT Scan, GA68PSMA PET Negative Mar-May 2017, Completed IGRT 46Gy, Brachytheraphy 110Gy, Chemotherapy, HT Lupron for 2 years. My PSA was <.1 during the whole treatment. My oncologist was saying <.1 is undetectable but after reading comments here that actually should be <.01. So I'm kind of confused there. That might be Kaiser standard. My testosterone was low teen during HT until today's result. I am at PSA 0.2 and T 625. Those are huge percentage increase in 3 months. I'm not worried much about testosterone level. But PSA has increased between %100 to infinity mathematically speaking. My PSA could have been 0 or near zero 3 months ago. Testosterone level increase is unusual too, 60 times more than previous test. No wonder I have been feeling great after completing HT, going to gym 5 times a week and getting back into shape and a huge increase sexual activities.
I'm just very concerned about the PSA increase rate. Are this rates normal? if there's a normal for a cancer patient.

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D.O.B March, 1972
DX Feb, 2017
MRI, PET Scan, CT Scan, GA68PSMA PET Negative Mar-May 2017
5 (5+4), 7 (4+5) mostly %100 PERINEURAL INVASION
PSA
39.4 02/17
37.1 02/17
28.0 02/17
0.5 07/17
0.2 09/17
04/17 Started Lupron
07/17- 08/17 IGRT 46Gy
09/17 Brachytheraphy 110Gy
04/19 Finished Lupron
PSA <0.1 during treatment T in low teen
06/10 PSA <0.1 T=12
09/16 PSA=.2, T=625

My PSA went up from <.1 to .2 in three months but it's at 6 months past ADT.

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D.O.B March, 1972
DX Feb, 2017
MRI, PET Scan, CT Scan, GA68PSMA PET Negative Mar-May 2017
5 (5+4), 7 (4+5) mostly %100 PERINEURAL INVASION
PSA
39.4 02/17
37.1 02/17
28.0 02/17
0.5 07/17
0.2 09/17
04/17 Started Lupron
07/17- 08/17 IGRT 46Gy
09/17 Brachytheraphy 110Gy
04/19 Finished Lupron
PSA <0.1 during treatment T in low teen
06/10 PSA <0.1 T=12
09/16 PSA=.2, T=625