Please Read - Hormone Therapy Will Work Against the PaC

If Gleason score is high 8, 9, 10, the prostate cancer may have metastasized and hormone deprivation therapy (e.g. lupron) may not work and actually increase chances for neuroendocrine carcinoma which is aggressive and terminal cancer.

https://journals.lww.com/oncology-times/pages/articleviewer.aspx?year=2015&issue=02250&article=00003&type=Fulltext

Anything bad for cancer cells is bad for good cells and ... and vice versa ... anything good for good cells is good for cancer cells ... except maybe a few exceptions

NewHere123, we are very sorry for your loss. Too many men pass away far too soon from this insidious disease. Just last fall another good friend John16 fell after just about two years of treatment in his early 50's due to advanced G10 and extensive mets at diagnosis. Many men so diagnosed don't fair well as at that point the disease just is not curable. .

As we know, most men that receive ADT do not go on to develop the neuroendocrine strain and are well served by it. I am in that category. Some men have the strain when they are first diagnosed so not all is caused by a response to ADT. It is known that the strain is generally not curable and very tough to manage for a significant time. Thankfully it is found in less than 2% of those diagnosed with PCA.

That ADT is a well proven standard of care that has proven effectiveness as a front-line systemic treatment is important in the treatment consideration. That other strains of cancer may develop is well known and not limited to PCa. If that is as high as some of these papers suggest it still remains that 80% treated do not go on to develop the more threatening strain. Thus. I interpret your message as being cautionary, but I don't take it as a message that ADT should not be used.

Again we wish you well and are here to do whatever we can do to assist you at this difficult time.

NewHere123, thank you for the link you posted...it is a good primer for...as the title says.."The Treatment Challenges of Neuroendocrine Prostate Cancer."

It doesn't really sound like the first two respondents in this thread actually read the article...despite your request to "Please Read.” I think the article highlights important facts about ADT that not everyone realizes. To me, the important point is NOT to say "full steam ahead with ADT no matter what," paraphrasing those first replies, but that everyone's individual case is more nuanced, and should be handled more nuanced care than "one size fits all."

Firstly, there is absolutely no suggestion in the article, and no suggestion elsewhere, that ADT causes NET (I'll use this common abbreviation, NET, for neuroendocrine tumor). Rather, it highlights that for those very small percentage of cases diagnosed with NET that ADT likely will make the cancer worse.

Further, while the diagnosis of NET is reportedly only about 2% of cases, the actual incidence of PC cases with NET is most certainly higher because another biopsy while in the metastatic state...not commonly done. I know there’s some folks here who limit their knowledge to the “reported incidence” rates, but this is yet another instance where we know better.

Additionally, the report employs impactful statistics to highlight the very serious nature of NET cases: 2% of the reported diagnoses, but present in at least 25% of PC deaths...and again for reasons state above (another biopsy in metastatic state) it is likely much higher than 25%. No data behind this, but my gut says the vast majority of PC deaths are NET-related. Dr Willet Whitmore talked (decades ago) about the PC that can be cured but probably doesn't need to be cured (common), and also about the Starkly contrasting PC that needs to be cured and cannot be (rare)...in this second case, he was certainly talking largely about NET (although decades ago, much, much less was known about NET...it was just considered the small number of "bad" cases of PC).

The article’s key takeaway, in my view, is for those who are trending towards metastatic castration-resistant PC to be diligent with their oncologist about possibly testing (biopsy) for NET because continued of ADT may do more harm than good...and the article suggests appropriate chemo regimen to transition to.

Good article...but ya gotta read it!

Post Edited (Blackjack) : 5/30/2019 12:13:10 PM (GMT-6)

BlackJack, well summarized on the article. For my husband, was the NET cells mixed in a small part to the PC - and why was the NET not caught post surgery pathology that determined his Gleason score upgraded to 9 from 7's and 8's? The PET and nearest lymph nodes were clear, but the seminole vesicles and bladder neck had some cancer that the urologist thought he had removed to "clean" tissue.

NewHere123
Really sorry about your loss. Thanks for sharing this link and on second thought now this info is really very relavent in many ways. I ignored reading it on the first go - as in so many cases ADT is the first line of treatment and also second and third option for so many more.
Your husband Is resting in peace - he doesn’t have to do this battle no more.

Hello Newhere. I wanted to offer my sincerest condolences on the passing of your husband. Your story speaks to me on many levels. My hubby was dx at 44 (now 46) and receives care at CCF. We are also located far west side of Cleveland. You can look at my previous posts for full details about Mike’s cancer progression. He started off more typical metastatic prostate cancer (poorly differentiated) with high PSA and extensive lymph node and bone met involvement. He has been maintaining very well with Lupron and daily casodex until recently. I am and have always been worried about neuroendocrine involvement (neuroendocrine markers were present in original biopsy but not unusual in small amounts). Now a doubled PSA but low level which is alarming to me with increased ALK Phos and enlarged necrotic lymph node in the neck; however, his scans looked good. More questions for the MO this week.
If you are on FB there is a special group of amazing women who have lost their husbands to this horrific disease. Many of them have been in similar situations with high risk PCa and/or neuroendocrine/small cell. Please search for Prostate Cancer Widows. Prayers for you as you continue on and know that you are not alone and your knowledge has helped others.

Bird8 thank you very much, I like this article. I have had genetic testing so am aware of where I fit at the moment but my sample was from the surgery, and I have not had ADT yet. The samples that they examine in the paper are post ADT. So I am not really sure what exactly it means for me, but it is something to discuss with the doctors. Thanks again and best wishes to you and your husband.