ChatGPT - Any experiences with that?

Hi !

I’m a member in another forum for prostate cancer and there are some there that posts information where they have used ChatGPT. At first I thought it must be difficult to use it and some of the answers people posted left me with many question marks.

Anyhow, fast forwarding I decided to try it myself as it’s a app you install on your Phone and / or your Tablet (I didn’t even know it was a regular app…).

After testing it and learn how to formulate your questions or the things you’re wondering about I must say that ChatGPT can really surprise you with very informative answers and you actually don’t need to be a scientist to evaluate its answers.

So with that said i tried to do a summary of my treatment pathway and added some questions in the end and I actually was impressed of how it presented its facts and findings.

So, for does interested here is my ’question’ in ChatGPT and then its answer.

QUESTION:

Diagnosed in May 2021 as T1C with a Gleason of 3+4 (40 % of Gleason 4).In January 2022 i had 2 fractions of HDR Brachytherapy which failed. In December 2022 I had a PSMA Pet Scan that showed a T3BN1M0 and in January 2023 i had a new biopsy that showed recurrence with a estimated Gleason 4+5 (65 % of Gleason 4).

In November 2023 I did a new PSMA Pet Scan that still showed T3BN1M0 and also a NaF Pet that showed M0 (no bone mets). My PSMA activity was high in prostate and in affected lymph nodes.

In December 2023 I started treatment with LU-177 and was finished in the end of February 2024. All my SPECT Scans showed activity only in the prostate and in the affected lymph nodes and no other places in the body.

My radiation activity decreased for each cycle of LU177 and decreased approx 75 % in prostate and in the affected lymph nodes the activity almost vanished after the LU-177 treatment.

1 week after my first cycle of LU-177 I had a big Rise in my PSA level (65 % increase of PSA) with a rapid decline after 4 weeks well below the initial PSA I had before I started LU-177

In the beginning of January 2024 I started Orgovyx.

In the beginning of March 2024 i started 20 fractions of hypofractionated VMAT RapidArc IMRT together with WPRT. After I finished this radiation I started adjuvant Abiraterone.

Three months after treatment my PSA was < 0.1 nmol/l and six months after treatment my PSA is still < 0.1 nmol/l

What do the different treatment modalities treat? Should I consider any other treatment modality? Is the treatment with a curative intent? Is it an option to think that I stay on Orgovyx for 3 years and Abiraterone for 2 years?

ANSWER:

Your treatment regimen for recurrent, locally advanced prostate cancer has been comprehensive and effective, as indicated by your undetectable PSA level (< 0.1 nmol/L) sustained at three and six months post-treatment. Here’s a breakdown of the different treatment modalities, the curative potential of your approach, and guidance on the duration of Orgovyx and Abiraterone.

1. Purpose of Each Treatment Modality

• Lutetium-177 (Lu-177): Lu-177 is a targeted radioligand therapy that binds to PSMA-positive cells, delivering radiation directly to prostate cancer cells in the prostate and affected lymph nodes. Its systemic nature allows it to target both visible and microscopic disease, which is especially beneficial in aggressive and recurrent cancer. In your case, the reduction of PSMA activity by 75% in the prostate and near-complete reduction in the lymph nodes reflects Lu-177’s effectiveness in significantly lowering the active cancer burden.

• Orgovyx: Orgovyx is a GnRH antagonist that quickly lowers testosterone levels, depriving prostate cancer cells of the hormone they depend on for growth. This systemic androgen deprivation therapy (ADT) acts on both local and circulating cancer cells, enhancing other treatments by slowing disease progression.

• VMAT RapidArc IMRT with Whole Pelvic Radiation Therapy (WPRT): The 20 fractions of hypofractionated VMAT RapidArc IMRT deliver a focused, high-dose radiation to the prostate and surrounding regions, while WPRT extends radiation to the pelvic lymph nodes. This combined approach targets both the primary tumor and any regional lymph node involvement, essential for managing T3bN1 cases and reducing the risk of regional recurrence.

• Abiraterone: Abiraterone adds a secondary layer of androgen suppression by blocking androgen synthesis in the adrenal glands and within the tumor itself. When combined with Orgovyx, it achieves a more complete blockade of testosterone production, crucial for managing high-risk, recurrent prostate cancer.

2. Curative Intent of This Treatment Approach

• Curative Potential of Multimodal Therapy: The combination of Lu-177, ADT (Orgovyx and Abiraterone), and targeted radiation (VMAT RapidArc with WPRT) is a strategy often pursued with curative intent in cases of locally advanced, high-risk prostate cancer without distant metastasis (M0). By addressing the disease from multiple angles—locally, regionally, and systemically—this approach maximizes the chance of eradicating all cancer cells.

• Sustained Undetectable PSA as a Positive Indicator: Your PSA remaining undetectable at both three and six months is a strong indicator of successful disease control. If this trend continues, it significantly increases the likelihood of achieving long-term remission and potentially a cure.

3. Consideration of Additional Treatment Modalities

• No Additional Treatments Needed Currently: Your current regimen is comprehensive and has yielded excellent results. There’s no indication at this stage for additional treatments, as your scans and PSA trends suggest that the current therapy is effectively controlling the disease.

• Regular Monitoring for Early Detection: Continued PSA monitoring (every three to six months) and periodic imaging, such as PSMA PET scans, will be essential for early detection of any potential recurrence. If your PSA remains undetectable over a longer period, this would support the curative potential of your treatment.

4. Duration of Orgovyx and Abiraterone

• Orgovyx for 3 Years: Continuing Orgovyx for three years aligns well with standard practices for high-risk prostate cancer. Evidence supports the use of long-term ADT (2-3 years) for locally advanced cases, as it can improve survival outcomes by suppressing androgen-sensitive disease during the highest risk period for recurrence.

• Abiraterone for 2 Years: A two-year course of Abiraterone provides intensive androgen blockade during the most critical period post-treatment. This duration effectively complements the three-year Orgovyx plan, maximizing androgen suppression while minimizing the risk of long-term side effects from prolonged use.

• Adjustment Based on Response and Tolerance: If you tolerate both Orgovyx and Abiraterone well, this timeline is appropriate. However, at the two-year mark, your oncologist may reassess the need for continued Abiraterone based on your PSA trends, overall response, and risk assessment.

Summary and Outlook

Your treatment plan is well-designed with curative intent, and your sustained undetectable PSA level strongly supports that the treatment is working as intended. Continuing Orgovyx for three years and Abiraterone for two years is a sound approach based on current evidence for managing high-risk prostate cancer. This plan allows for comprehensive disease control while minimizing unnecessary long-term treatment exposure, positioning you well for a durable remission and possibly a cure if the PSA remains undetectable over time.

So for you interested in trying to evaluate what your treatment and your medical team is doing with you and your prostate cancer ChatGPT can give you rather good information. Then of course remember to take the information as NOT a ’absolute truth’ of course.

Best wishes - Ulf