12 years post radical prostatectomy, now positive for mets

I'm sorry to hear this but wish you both much better news going forward in the fight!

If you husband hasn't already had germline testing, I would ask about it (although I'm sure the specialists will bring it up). Some of the newer systemic treatments are targeted for men who have inherited specific DNA mutations. It requires only a saliva or blood sample (I was told that blood is marginally better in that they can test for a few more gene mutations with it--in mitochondrial DNA, I believe).

Djin

Doxa,
The doctors may have already told you that this type of PCa met is rare, as evidenced by my literature searches. I could only find case studies involving one or a few men. Was your husband's scan a PSMA scan? If so, and no mets were seen at other locations, that would make it exceedingly rare. In any case, the literature seems to be sparse. I don't know if the size of his nodule would be categorized as early detection but one paper described a man with a "massive" nodule (though I didn't see that the actual size was noted) whose biopsy showed a Gleason of (5+4). By the time this group saw him his PSA was 586 while on ADT for two years. They simply added Abiraterone to bring his PSA down to 1.22, where it remained as of 2022. This excerpt is from the same paper for the treatment of other patients:

"The optimal management for the isolated peritoneal dissemination of prostate cancer has not been established yet. The majority of patients received docetaxel based chemotherapy. Their overall survival time ranged from 3 weeks to 33 months . Only three patients with isolated peritoneal carcinomatosis were treated with abiraterone acetate. Two of them showed a rapid response as in our case. The other one showed a radiological response for more than 4 years."

It would seem that previous patients treated with ADT + Docetaxel didn't fare that well, while adding a "second generation anti-androgen" drug like Abiraterone, not surprisingly, really improves the outlook. I suppose one of the androgen receptor blockers from this group of drugs such Enzalutamide might work just as work well too.

I think there's good reason to believe that your husband would respond well to treatment for this rare situation.
I've included a link to the paper.
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc9320699/

Hello,

My husband has psma avid confirmed cancer mets to three subcentimeter retroperitoneal lymph nodes. We chose surgery initially knowing we would have radiation as a fall back given his high risk status. There is no evidence of mets anywhere else. He is being treated with Casodex (three weeks only to start things up and prevent flare) and Lupron/Zytiga/Pred for at least 24 months. He has just started Salvage IMRT IGRT with an extension to cover the retroperitoneal lymph nodes. Since this is "guided" by imaging every time, the radiation oncologist has already seen a huge response to the lymph nodes from the ADT alone. He is being treated at Yale (Smilow Cancer Center) and we had a second opinion from Memorial Sloan Kettering. His salvage IMRT is 70 gys in 39 treatments.
Since your husband has already had radiation, I would think that hormone therapy with an agonist and an antagonist (Such as a Lupron/Abiriterone/Prednisone combination would work since he sounds like he is oligometastatic and micrometastatic, so systemic. Then, for the nodule in the retroperitoneal area, I would get a radiation oncologist's opinion if that can be zapped with SBRT radiation. We were counseled by Yale and MSKCC that my husband is still considered low burden, and that Chemo would be more optimal for high burden disease, so we are saving that for when the time comes. We are praying for a long remission. Good luck with everything!

Stephanie

Hi Sr Sailor, the little nodule (15mm x 15 mm in size) in his lower abd area was biopsied and came back positive for metastatic adenocarcinoma with prostate origin. Spoken to a few specialists already and they were very surprised at the location of mets and the fact that's positive for prostate ca. We've been told that it's a very rare location for mets. Gulp!
Husband is wondering if the cancer nodule is in the same location as one of the portal entries when he had the davinci procedure done? Of course he has no proof, just a thought...

Crappy Update re: metastatic peritoneal nodule. After numerous consultations and opinions ranging from active surveillance to radiation therapy, husband opted to undergo one week radiation treatment in mid-March to eradicate the cancerous nodule. Radiation therapy did work for that one spot but the newest results now show more lesions - “small hypermetabolic lesions to spine, ribs and iliac bone, and several areas of metastatic nodularity along peritoneal cavity lining”. PSA increased from 3.81 in April, to 4.59 Now we get to start another round of consultations.
Any guidance would be greatly appreciated!
Thank you

Doxa, after being diagnosed with mets to my spine and rib’s, I began taking lupron and Zytiga. After that failed about one year later, I was placed on xtandi and lupron. That worked well and my psa went down to zero and at this time I take lupron only. The Mets were diagnosed eleven years ago. Wishing great results for your husband.
Michael