So, I am de novo stage 4 with mets to 6 spots in different bones and have my last (6th) chemo scheduled in 3 weeks. PSA has dropped from 28.2 to just over 1 as of last week. Once 6th chemo is done, will have new scans done about 4 - 6 weeks later and meet with MO as to what's next.
I know situations such as mine are treated systemically; no surgery or radiation to prostate. My question is why not. If there are future mets, aren't they likely to come from the prostate itself, rather than from an existing met? If so, wouldn't reducing the burden of disease (via radiation) or removing the source (via surgery) be a positive? I understand there are risks involved with radiation and/or surgery. This is more of a theoretical question, at this point.
Thanks
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rsgdmd
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"If there are future mets, aren't they likely to come from the prostate itself, rather than from an existing met?" No. And you put your finger on the reason. Spread from the prostate is only important at the very beginning. In fact, if there are more mets than 3 on a bone scan, treating the prostate (called "debulking") doesn't slow progression at all. Then met-to-met spread takes over. You also have many more metastases than just the ones you can see on scans.
Thanks, that's what I thought. Will be re-trying abiraterone, starting at 1/2 dose, after chemo is done and if still a problem, switch to daralutemide. I'm a good candidate for Keytruda with MMRd and MSIh and high TMB. Now, the question is might radiation therapy help make the tumor more "hot" for immunotherapy to possibly work better?
My understanding. Micro-metastasis are shed to the vascular and lymphatic systems from any existing metastatic lesion or tumor. Once in their “network highway”, they look for a place to colonize and grow.
I radiated my prostate very recently 4.5 years after my initial diagnosis as multi metastatic in my bones with more than 15 mets.
The RO ordered PSMA PET scan and CT with contrast and the SUV max value of my prostate was 14.
My therapy was and still is Degarelix injections only. I also had early docytaxel chemotherapy treatment 6 cycles.
95% of my prostate was full of cancer before radiation.
I had no visible mets on any scan.
My PSA was 1.5 and we decided to SBRT my prostate with MRI Linac 5 fractions 38 Gy.
After the 4th fraction my PSA dropped to 1.2.
I made this decision as I wanted to avoid local spread of my prostate cancer to my rectum etc. As my PSA was slowly rising from 0.2 to 1.25 in the last year and so. Therefore indicating CRPC.
I wanted to avoid the escalation of my treatment to chemotherapy, or Enzalutamide.
Chemotherapy is not good for you and Xtandi can breed out in 15% of people neuroendocrine cancer.
I also wanted to avoid side effects of the chemo and/or Enzalutamide and to save them for later.
I don't have side effects from the radiation and hope that everything will stay this way.
My biggest concern now is that I am osteoporotic now and I have to see soon the endocrinologist.
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