It's back and the genetic thing.

For those who do have one of the BRCA gene mutations, one of the PARP inhibitors can be offered later down the line once other treatments have failed. For example, Olaparib is suitable for men with BRCA1 or 2 who have become castrate-resistant, have mets and have already had abiraterone or enzalutimide.

My treatment history is in my recently updated profile but a recap is diagnosis in December 2015 (Gleason 7 - [4+3]). Treated with Bicalutamide and EBRT at Clatterbridge early 2016. All good until late 2019 when PSA rose to 3 ng (after a succession of small increases). Bone and CT scans clear but a PET scan revealed 3 mets in the lymph nodes in the abdominal area. 2 years Bicalutamide and 9 sessions of SABR radio therapy.

Fast forward to January this year. Blood test carried out in December showed PSA up to 2.7 ng (a series of steady increases since stopping the Bicalutamide in early 2022). I await the results of bone and CT scans.

Now for the genetic bit. The nurse who gave me the bad news mentioned that my new oncologist (I think the previous one has retired) has looked at the family history and was talking about genetic testing. I'm not clear if this is to guide treatment or research - either way I'll comply if they want me to do it.

The history is as follows:

Dad - died of Pca aged 57 in 1971

Older brother died of Pca age 80 in June last year

Me

Younger brother just diagnosed with Pca age 71

I've always thought the disease was largely genetic but, I gather, I might be wrong. Anyway - round 3 with this cursed thing awaits.

DH was diagnosed with prostate cancer 9 years ago. He had brachytherapy and psa was 0.01 for many years. His father had prostate cancer, however it was slow growing and he died age 93 not prostate related. DH’s mother had ovarian cancer age 80. She had treatment, it returned when she was 89 the symptoms of which she died of. We didn’t really think of genetics as neither of these are unusual in old age. Then DH’s daughter was diagnosed with breast cancer in her early 30’s. It was caught early and she’s fine, they tested her for the brca gene. She is positive for the brca2 gene. We thought it must be from dh. So he was tested too and was also positive. We have recently found out dh’s prostate cancer is now in his lymph nodes. The prostate is still clear though, which is probably unusual. The next line of treatment at this stage would usually be chemo. but apparently chemo doesn’t work on gene mutations. So dh isn’t being offered it. So he’s on lifelong HT and enzalutamide, he can have olaparib once these drugs stop working. But hopefully HT will keep psa down for many years. 

Pete, I will be interested to see how you progress with further treatment. I had two lots of SABR treatment to two separate lymph nodes following on from salvage RT five years earlier. 

I changed to the private sector through our insurance company due to possible restrictions on the NHS.

Thanks Chris