Still castrate sensitive after 6 1/2 years

"On the molecular level, PCa is almost always initially driven by excessive signaling through the androgen receptor (AR) pathway (reviewed in {3}). Consequently, men with metastatic PCa will be offered androgen deprivation therapy (ADT) as the primary treatment. After a median of around 18–24 months, the disease tends to become resistant to hormonal manipulation and progresses towards so-called metastatic castration-resistant prostate cancer (mCRPC). " Source. [Emphasis mine]

I don't think the average time to castration resistance will be of much help -- as the following recent study shows, much depends on the genetics of your particular cancer (see also the Reference section in the above paper). And you are already far beyond the above-cited mean. My uro has a couple of patients who have been on ADT for many years for locally advanced PCa who have no distant metastases. On the other hand, some patients do not respond well at all to HT (perhaps I am in that group, see below).

Clinical and genomic insights into circulating tumor DNA-based alterations across the spectrum of metastatic hormone-sensitive and castrate-resistant prostate cancer (2020, Full Text)

A seminal Decipher study showed that met risk cuts across all G scores, from 6 to 8. The breakdown for low, intermediate, and high met risk for your cohort, pT3a/pT4, was 7% low, 16% intermediate, and 76% high. However, I do not think your G score enters the picture any longer, since you knew from your RP that your were node positive. (G score reflects how the cancer genes affect prostate-tissue architecture.) I think the focus of your research should be on the genetic factors that determine the time one's cancer will remain sensitive to HT. But that assumes one has that genetic information.

The optional GRID report that accompanies the Decipher test result has a score for theoretical ADT response based on your cancer's RNA, i.e., the time, short-to-long, before your PCa becomes castration resistant. GRID data, unlike the Decipher score, has not been clinically validated and is technically "for research purposes only" and not for treatment decision. Nonetheless, my Decipher score (0 to 100 scale) was low risk for mets; however my score for ADT response was a dismal 1. When I pointed this out to my uro, he said that, despite the generally quoted fact that about 10% of men will show no response at all to HT, in all his years practicing, he has never had a patient that did not show some response, at least initially.

But, other than the personal knowledge you'll gain from your research, the proof is, as they say, in the pudding, and first-line HT will work for you until it doesn't

Keep smiling,

Djin

GoBucks said...
Do you mean castrate sensitive?

The thread title is confusing. He's asking about when he'll become castration resistant, rather than meaning he is currently resistant. "Castration resistance" would have been clearer.

Djin

Thanks Djin!!

The study was interesting, but I tell you what, that second sentence really jumps out at you, or at least me.

That second sentence jumped out at me too.
I was under the impression that from time of BCR, if you do NOTHING, on average one can expect 5 years to bone mets and 8 years of survival after that. Yet that second sentence seems to imply 7 years survival if you do SOMETHING
What am i missing?

Thanks Djin my brother! I do have some very long lived relatives. My G-Mother died at 103, my GG-mother died in a car wreck at 94. Both my mother and G-Aunt died with breast cancer but they were in their 80s. My mom actually died of a broken heart as dad had died seven months prior, 61+ years together.

Prato, I too was under that impression also, confused I am, believe I do whom?

Mattam, I too had seen those stats, and chose to ignore as it made me depressed. But now, I'm aware and have had time to adjust and I know I can't do a darn thing about it

But all in all, I'd love to get hold of a dataset which included gleason scores, doubling time at DX, doubling time after TX, dates of a boatload of factors,IOWS everything.
The problem with medical stats is I fear they are put together mostly by physicians and their staff. I want raw data, my mathematics and statistical background will sort it out. I would seek out questions from forums like this

Yes, clear vision