Three big challenges in metastatic prostate cancer | Dr Alicia Morgans

Today we have Dr Alicia Morgans, GU Medical Oncologist and Director of Survivorship at Dana Farber Cancer Institute, in the GU Cast studio for a chat. We wanted to ask Alicia to look forward and identify three big challenges we will face in metastatic prostate cancer over the next 5-10 years. What did we come up with??!! Tune in to find out!!
Also available as an audio podcast in all the usual places.

[@FrancoisPicanza]

I appreciate the open minded discussion rather than blind fixation on a standard of care mantra. We are all different so there is no one size fits all.

[@gu_cast]

Thanks Francois! Declan and Renu

[@Bob-lk8fu]

Thank you! Outstanding episode. Super relevant to me. Diagnosed at 52 with Gleason 9, oligometastatic (lymph nodes plus one bone met) disease. Did triplet therapy plus radiation to prostate, pelvic LNs and bone met. I’m about 2 years into it and fighting the quality of life issues with long term ADT.

[@gu_cast]

Sorry to hear that Bob. So tough but hope you are doing great. You might enjoy listening to our two previous podcasts with Tim Baker. He was diagnosed with metastatic prostate cancer aged 49 and has some amazing insights into ADT and managing side-effects. Sending you our best wishes. Declan and Renu

[@joeax61]

Had a RP in April, 4 lymph nodes removed as well. Path Report GG4, Gleason score 8, pT3aN1. Three month PSA coming up soon. I realize the risk is pretty high for metastasis, if I need radiation can i do it without ADT? Thank you, Joe

[@gu_cast]

Sorry to hear about your diagnosis Joe and hope that you are on the mend. Let's hope that first PSA is good news. If radiotherapy were to be recommended, then there are definitely two schools of thought on adding ADT for a period. Conventional wisdom is that it helps, but most of that is based on men having radiotherapy to the prostate itself, not following surgery. We hope that you have a good team advising you. Good luck with the PSA! Declan and Renu

[@MatthewMcGillen]

I had brachytherapy and 16 external beam radiation sessions as well as 4 mos of ADT in Oct. 2022. I was so miserable after six months that I begged my urologist to let me start TRT. It's been a year and my testosterone has gone from 32 to 720 and my QOL is night and day. I did have a single tumor in a single lymph node found with a PSMA Pet scan after my PSA rose from 1.5 to 3.9. I had 17 lymph nodes removed on April 17, 2024 and in addition to the tumor, they found four with microscopic Pca. I will get another PSA test in four weeks to see if the residual PSA has washed away, and then I assume start active surveillance to see if the PSA once again rises. I've told my cancer team that I would prefer 8-10 great years (I am a world class master's athlete) than 15-20 so-so years, where I am constantly fighting various side effects. I am 70. Love your podcasts here in the states. Seems you guys are ahead of the curve in some ways.

[@gu_cast]

Wow Matthew that's quite the story! Hopefully your most recent surgery will help avoid the need for more ADT.Your words on the misery of ADT really chime with us. And going on testosterone replacement is something we should do more of as we talked about in this episode. Your story very compelling. You might enjoy listening to our podcasts with Tim Baker who has written a great book about his experience with ADT having been diagnosed with metastatic prostate cancer in his 40's. The book is called "Patting the Shark" and his most recent GU Cast is here kzbin.info/www/bejne/mXOvZZyfqNCmgs0si=5vau1N-D2xpq7e2_

[@anwarpadhani]

Thank you..

[@gu_cast]

You're welcome Anwar!