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Advanced Prostate Cancer
Center of Excellence
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Georg Potthast
Feb 16, 2018
"Too much disease for retreatment" should be specified. The PSA=3.7 suggest there are a few lymph node metastases only which could be removed with LND.
Charles Maack
Feb 16, 2018
Noting: "Too much disease for retreatment, prostatectomy, or cryotherapy. Without proven metastatic disease of castrate resistance, what choices are there outside of standard HT for a patient in good health without significant SE from previous therapies?” begging an answer to the question, what IS available? Since moving to more advanced ADT with Zytiga/abiraterone or Xtandi/enzalutamide is not available without known metastasis, then Erleada/apalutamide, recently approved by the FDA for men with non-metastatic, castration-resistant prostate cancer who are at high risk for the development of metastasis, would appear in order to accompany an LHRH agonist with likely a series of chemotherapy also considered. Like others, would like to know the professional, physician, recommendation.
Richard Peksens
Feb 16, 2018
Possible combination cryotherapy debulking of recurrent prostate primary followed by anti-androgen therapy with apalutamide/LHRH-agonist
Charles Maack
Feb 19, 2018
With this patient having already experienced EBRT/HDR/HT that has encompassed the entire prostate gland and its periphery, it is unlikely the invasiveness of Cryo to what little is left in that periphery would serve any purpose. The 12 of 12 biopsy tissue samples is evidence the cancer has migrated well beyond the confines of the prostate and its periphery. Thus, it appears the only path left is continued manipulation with latest ADT medications available to shut off all access of testosterone and dihydrotestosterone to continued presence of prostate cancer cells to hopefully slow their growth/proliferation and bring them under control/management for as long as possible. Always difficult to manage at this stage of development.
Charles Maack
Feb 19, 2018
Good to know that Zytiga/abiraterone has now been approved by the FDA for early metastasis should this patient's diagnostics actually indicate the presence of metastasis. Another but different from Erleada/apalutamide medication now available if needed without resorting to chemo if chemo not yet considered necessary. However, it would appear with this very advanced disease that chemo is a reasonable additional option to accompany one or the other or both of these options. Recognizing the cost of Zytiga, and expecting Erleada to be similar in cost, it will be unlikely health insurers will want to pay for both to be prescribed simultaneously though it would be nice to be blocking production of testosterone from the three sources of testicular, adrenal gland, and that prostate cancer cells can manufacture within themselves, along with more total blockade of the multitude of androgen receptors found on all cancer cells for about as total blockade as one could currently hope for.
May 04, 2024
Pending Moderator approval.
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Georg Potthast
Feb 16, 2018
Charles Maack
Feb 16, 2018
Richard Peksens
Feb 16, 2018
Charles Maack
Feb 19, 2018
Charles Maack
Feb 19, 2018
May 04, 2024
Pending Moderator approval.