Chuck had PCa G 7(4+3)...had a RP which failed...BCR at 8 months...Had SRT which failed..BCR at 11 months...PSA DT of 11 months....went on IADT when PSA reached 2 and responded well with one year on and 18 months off..the trigger point being a PSA of 2. Not being satisfied with controlling the beast...like many of us...wanted to go for the kill and went to The Mayo Clinic and had the Choline 11 Pet Scan which identified 4 Hot Lymph Nodes. But 2 of the lymph nodes could not be safely surgically removed so the plan was 4 months of ADT and then 37 doses of radiation. Remember, Chuck had previous SRT so the plan was to radiate all the lymph nodes but limit the doses to the pelvic nodes that had previously radiation.
Chuck reached a PSA nadir of <.1 but the PSA started rising after 15 months. Side effects of the radiation were Monoclonal Gammopathy and Normocytic Anemia. But here is the kicker...his previous G 7(4+3) with a DT of 11 months was now a G 9(4+5) with a DT of 30 days..seems all the radiation did was select for the most aggressive cancer cells which survived and multiplied...maybe, the idea that the enemy of my enemy (radiation) is my friend is flawed . Chuck went on to fail Zytiga, Xtandi, Xofigo and chemo within 13 months...his body lights up like a Christmas tree on Pet Scans with a PSA of 6300. Chuck is now in hospice on a morphine drip. The moral of the story..live with PCa and keep it on a short leash as long as possible.