David's Story

T3b NO Mib Gleason 4+5 carcinoma of the prostate with presenting PSA of 5.3 Treatment 1. Androgen Deprivation since 2021 2. Early chemotherapy 3. hormone tablets since 2022 4. Radiotherapy to the prostate completed 2022 Clinical Review & Examination First presented with lower urinary tract symptoms and found to have high grade local ladvanced disease. Although the initial bone scan was unremarkable, I was found to have small volume bone metastasis on whole body MRE. I therefore had low burden metastatic disease at presentation. Since then, have been treated with triple therapy, ADT + chemotherapy + hormone tablets and radiotherapy to the prostate. No family history of prostate cancer. Treated with ADT and hormone tablets and the addition of chemotherapy in six fractions on a three weekly basis. Radiotherapy in 22 factions. Bone health agent once a week in order to reduce the risk of osteoporosis and fractures in years to come. Some oncologists recommend DEXA scanning to monitor bone health and only introduce the bone health agent if there is a problem on the DEXA scan. My practice use treatment as a matter of routine in order to prevent a deterioration in bone health. On the possibility of radiotherapy to bone mets. Not recommended by Oconoligist at present. Rather, the possibility of SBRT to one or two bone mets to be considered if and when there is evidence of disease progression on imaging. Normally, one would rely on PSA monitoring to monitor the cancer. Given that I had such a low presenting PSA, it was considered useful to perform some imaging as well. One option to do an annual diffusion-weighted whole body MRI scan even if PSA remained well-controlled. Other options that might be worth considering would be to monitor his alkaline phosphatase and his LDH level (as well as the PSA), although these are probably of limited value.