Dxed with mCRPC and a G-9 in 2007. Still on ADT only, anyone similar??

My subject pretty much says it all except for the fact that I also underwent Provenge during 09/13--10/13 with no effect other than a slowly elevating PSA. It has risen from a 4.7 on 04/09/2013 to a 67.8 on 24/10/2014, other than that I have only been treated with ADT, Lupron, for 90 months now. I'm looking for anyone with a similar case history to compare notes with. . . Q

Thanks SL,
The past 7.5 years have really flown by, and now, all of a sudden I've been noticing that I don't have many contemporaries that haven't had their prostate removed on the board. This rising PSA without mets is a strange beast I suppose. The two bony mets that I had at Dx were rapidly shrunken by the ADT . . . Q

Dan,

I don't think anything has gotten lost. Quincy is the OP. He put a lot of his information in the title of the thread and that is what he was referring to in the original post.

Quincy,
not similar, but a bit in this direction. DX Jan 2009, aPSA:25, GS:5+4, cT3a, Nx M1b (spine + pelvic bones).
I went for iADT+RT in 2009. Cholin Pet done 2012, during the1st iADT off phase shows no tracer uptake, dissapointing. Restart ADT 2012, PSA down <0.01ng/ml. PSMA-PET/MRI scan done yesterday during the 2nd iADT holiday period (@PSA: 2.3, T:600) shows a single tracer uptake in the pelvic bones. That gave me the opportunity for a local approach, combined with my 3rd round of iADT – still hormone sensitive nearly 6 years after DX with Gleason 9.

“if you are going thru hell keep going”

Allen,
the GA68-PSMA-PET/CT or PET/MRI is widely available in Germany and has a better sensitivity than a Cholin-PET. In the recurrent setting after primary therapy failure the detection rate is nearly 90% if the PSA is >2ng/ml! A multiparametric MRI combined with PSMA-PET has some advantages in low PSA patients, down to 0.5ng/ml.

For me the PET scanings shows a suspect area within the prostate and a single bone lesion or tracer uptake (OS Pubis). Because of my primary therapy (HDR-Brachy + EBRT) the local recurrent lesion is questionable. After some discussions with the radiologist we decided to take some additional sequences of the pelvic area. I entered the noise machine a second time…

Advantage of the PSMA-PET scan is, that if it shows disseminated systemic tracer uptake, you can start a LU177-PSMA, high-dose radionuclide therapy. This is a total different approach than Alpharadin or Samarium, which targets bone remodeling. The PSMA-Tracer bound LU177 heavy beta emitter binds directly to the cancer cells expressing the PSMA membrane receptor. Works for lymph nodes, bone- or any other soft tissue lesion! A friend of mine, early kastration resistance, does this a few weeks ago. PSA drops from 23 to 8 within 3 weeks. Next week he will get his 2nd injection (4 in total).

For me this is not the way to go, because the lesions are not disseminated in the body. I will try to get a local RT (Cyberknife ?) to the bone lesion if it does not overlap with the primary RT volume and to biopsy the suspicious area in the prostate to get a clear pathologic result – Slavage HiFu if it is recurrent cancer.

To make it very clear: this is not the standard procedure for PCA in Germany! You have to organize it for yourself, and if you do not have an insurance which covers some off guideline approaches, then it may generate some costs! But medical procedures in Germany are far less expensive than in the US.

Allen, I am a big fan of your “Drug Repurposing for Advanced PC” blog!