psma directed salvage therapy or no additional therapy for recurrence?
Hello,
I am new to this group. My husband is recovering from prostatectomy 2 weeks ago. His cancer had some very unfavorable features: t3b, seminal vesicle invasion both sides, extensive extraprostatic extension, Gleason 4+5 including in the positive margins, ductal and cribiform cells…So the next step is waiting for the first follow-up psa in 6 weeks. He is 74 years old and previously incredibly fit except some genetically acquired heart issues currently well managed. We are very concerned that they will be recommending radiation and adt in the future as I am aware he is unlikely to have been cured. I am fearful about the risks of side effects of radiation to bowel and bladder especially as he takes anticoagulants. And adt is rough on the heart. Right now I feel like he could still have some good years left after he recovers from the surgery. But this could be toast after all of that. Is there any type of targeted psma radiation being used that just chases the hot spots to limit the radiation exposure to the rest of the prostate bed? And if one chose to skip further treatment, what does the quality of life look like as the cancer progresses? He is definitely biased toward quality of life versus length of life in his decisions. Anyone who has chosen no further treatment, or just the bare minimum of targeted treatment for recurrence, I am interested in your input.
I am sorry to learn where you are on this journey and diagnosis . While there are no easy answers please understand there are many treatments. Yes some will have negative impacts others may not . What impacts your husband may experience are unknown as they are often patient dependent. In short you do not know in advance how he will react.
I have been where you and your husband are currently. In 2013 I was diagnosed with an aggressive Gleason 9 for what was believed to be a contained cancer. After surgery - the team was convinced they got it all. Sadly in 2018 it came back and I under went 8 weeks of radiation and hormone therapy. The ideal of radiation scared the heck out of me. At that point I decided to do a video record my 8 week journey with radiation. Pleas understan that many hospitals here in CT refer patients to my video. I invite you to visit www.TheProstateCancerCoach.com and view the video journal. I trust it will offer some helpful insights to both of you.
So far I am 5 years after my radiation and have had no reactions to the treatment. My post op PSA had remained at 0.02 until a few months ago when it jumped to 0.38 . Due to the rise I will be going in for a highly targeted scan in 2 weeks to see where the cancer is located. If it is discovered in isolated clusters it most likely can be targeted with radiation or proton etc . If it has spread to many parts of my body then there are other treatment options.
My approach to all of this has been to treat the cancer today and to live for today vs presuming there may be some type of negative future developments due to treatment. Personally I think it is a good idea to treat the cancer vs not doing so and dying before my time.
This is all about personal choice and just know ....whatever decision you all make .... it is the best decision for both of you given what you know NOW. Dennis(ProstateCancer.net TEAM)Thanks for your response. Sorry to hear that your psa is back up. Wishing you the best going forward. In 5 weeks he will have that first psa test and we will have a better idea of where it stands…
Hi
. Your concerns are certainly understandable and it is great that you are seeking information and advocating on behalf of your husband. There is a radioligand called Pluvicto that can be used in conjunction with the PSMA PET to specifically target recurrent/metastatic prostate cancer (see: https://prostatecancer.net/treatment/psma-targeted-pet-imaging). Your husband's doctor should be able to provide additional information on whether this would be an option should it prove necessary. Also, there is a relatively new androgen deprivation therapy in pill form called relugolix (Orgovyx). What is particularly notable for your husband's case is that this drug was found to be much less likely to cause heart issues than Lupron in clinical trials. This article from the National Cancer Institute goes into further detail: https://www.cancer.gov/news-events/cancer-currents-blog/2021/fda-relugolix-prostate-cancer-androgen-deprivation-therapy. Hopefully none of this is needed, but I hope this information is helpful. There really have been great advances in treating recurrent prostate cancer and more on the horizon. Wishing you and your husband the best and please feel free, if you like, to keep us posted on how things are going and to ask additional questions. Richard (ProstateCancer.net Team)
