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Expert Opinion / Cases · October 01, 2021

52 y/o With High Volume Lung, Mediastinal, Bone, and Pelvic Nodes Metastatic Prostate Cancer With Primary Tumor of 9.5cm With Germ Line BARD1 and Somatic BRAFV463 Mutation

Christos Galanopoulos

 

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  • Juan Artigas

    Recent studies have shown an survival advantage when abiraterone plus docetaxel is used in the novo metastatic hormone sensitive PC. Adding docetaxel may be something to consider and discuss with the patient.


  • Eman Ahmed

    I do opt for addition of SBRT to the primary tumor to the present treatment as long as there is marvellous response with disappearance of all mets and only small residual at primary site


  • Charles Maack

    Add SBRT to primary tumor to present treatment. Question why Orgovix replaced Firmagon given that it is an oral medication and may not be covered by many insurers unless covered by Medicare Plan D. Also, not certain it is any more effective than Firmagon. Given that ADT has been effective to date, metastasis found to have disappeared, and lab results as desired, continue ADT, but target the tumor to hopefully clear this patient's PCa activity


  • Christos Galanopoulos

    Orgavix changed from formalin due to physical symptoms/reaction at site of injection- patient states his overall performance status improved and side effects lessoned following the switch.


  • Charles Maack

    Christos: Did patient have to pay for the Orgovyx (relugolix) ?


  • Christos Galanopoulos

    Insurance covered with copay of $35


  • Christos Galanopoulos

    And all labs stayed good- PSA dropped to 0.04 and T level still <10 x 3 months of use


  • Christos Galanopoulos

    Would anyone get PSMA PET since initially high volume metastasis converted to low volume


  • Charles Maack

    I am trying to make sure reinsurance coverage for this oral medication in order to advise patients if considering. Dear Christos: Thus, was this patient covered by, and was it, Medicare Part D? The importance to patients is, of course, since this is otherwise an extremely expensive medication. As to PSMA PET: if you mean as a 68 Ga-labeled, PSMA-targeted radiotracer, Ga 68 PSMA-11 used with PET/CT and PET/MRI with what is known as the patient's current status, it would appear unnecessary at this time.


  • Christos Galanopoulos

    He has private employer supplied insurance- If planning Lu-177 then he will need a PSMA PET


  • Charles Maack

    For Christos: Thank you for submitting this case for discussion and for your responses to my remarks. I have been a mentor online to men diagnosed and to their caregivers for over two decades. If interested, type Charles (Chuck) Maack in the internet search box and result will direct you to my website. I was hoping Dr. Sartor might comment here, so we shall see.


  • Charles Maack

    I notice no one has yet commented regarding the presence of Germ Line BARD1 and Somatic BRAFV463 Mutation. Here, as well, based on the patients current status, it appears they are not having any effect on the patient's significant improvement with current ADT medications so, if anything, keeping aware and if things begin to go haywire, look further into this presence to determine if playing any role in the change of status.


  • Oct 27, 2021

    Pending Moderator approval.
    Delete

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