Focused radiation on the met lymph node

I visited Dr. William Oh at Mt Sinai on Monday. My PET/CT oncologic scan showed a right obturator (groin) lymph node lighting up. A met.

So Dr Oh proposes focused radiation on the met lymph node that will include hormone deprecation for about six months total.

About four years ago I had a prostatectomy and salvage radiation to the prostate bed. My PSA is now 2.17. Doubling time about 15 months.

Has anyone had radiation on a lymph node?

I appreciate all comments, tips and warnings,

Luke

49 Replies

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  • When Dr Oh was at DFCC I was his patient, I have often considered going back to him in NYC. I believe Dr Oh to be one of the very best in expert management of APC, I would do exactly as he says.

    Best wishes ,\

    Dan

  • Dan59,

    Where is DCFF?

    Rich

  • Dan59,

    My bad, I mean DFCC.

    Rich

    PS: I had my first ever Lupron injection today.

  • Dana Farber Cancer Center in Boston MA

  • I have not had radiation of a lymph node, however if I were you, I'd strongly consider it.

    There is a good chance that it won't help. If you have a metastasis in the lymph node, you could have other metastases elsewhere that will keep growing. However, I think it is common for prostate cancer to spread first to the lymph nodes and, assuming your most recent scans show no other metastases at this time, there is at least a decent chance that this is the only one, in which case the radiation might, conceivably, cure you. This may be your last shot at a complete cure.

    If your doctor were an untrustworthy person whom you suspected of just trying to get money from you with useless treatment, I'd be suspicious. But it appears you've got a reputable doctor who can be trusted.

    Best of luck.

    Alan

  • Lukedohner,

    The six month ADT, is that, before the radiation or begining with radiation treatment?

    Rich

  • I need to meet with Dr Stock at Mt Sinai to work out a radiation treatment plan. I believe it will be 3 months ADT then the radiation, then three more months radiation.

  • I recently had proton beam radiation to prostate gland and several lymph nodes. This was done 4 1/2 years after diagnosis of PSA 29, Gleason 10, and numerous lymph node mets. 44 proton treatments to prostate and 25 plus 5 boosts to lymph nodes. PSA had been on an 18 month climb after many drugs (Zytiga, High Dose Ketoconazole, Xtandi) stopped working. PSA now declining with no real side effects.

    Risk to other organs minimized due to use of proton beam radiation and SpaceOAR. IMRT keeps going after hitting targeted lymph node.

    Best wishes with your decision.

  • Vandy69,

    Where did you get your proton beam radiation, name of hosipital?

    Rich

  • Good Morning Big Rich,

    I was treated at Hampton University Proton Therapy Institute (HUPTI), by Medical Director, Dr. Christopher Sinesi. They were recommended by Dr. Snuffy Myers even though I live in Atlanta. We lived in a leased apartment for 3 months!

  • Vandy69,

    Where is Hampton University? Why, 3 months; in otherwords, how many treatments to treat lymph nodes? In addition, did you trear the prostate and prostate bed?

    Rich

  • Hampton, VA. 44 treatments to prostate gland (not removed) and 25 treatments and 5 boosts to lymph nodes. Treatment began 12/19 and finished 3/3.

  • Vandy69,

    How many Grays Gy to Lymph nodes only?

    Did you begin ADT before or at beginning of radiation treatment?

    Rich

  • I have been on continuous ADT since diagnosed in August 2012 with mets in lymph nodes. Could not have either surgery or conventional radiation due to the many nodes with cancer. Snuffy recommended proton radiation after a C-11 Acetate PET/CT scan and since PSA had been rising for 18 months. I also take Lynparza. Do not know exact radiation doseage.

    Call me on 404-312-4065.

  • I had 75 grays in 50 fractions to all pelvic lymph nodes after MRI found two suspicious iliac nodes after PSA recurrence post SRT. It's wasnt certain to be curative and in fact PSA recurred again after stopping 13 months of ADT before and after imrt. I'll know today where the new mets are located and what to do next. Radiation of mets after failed primary treatment is controversial . The TOAD clinical trial concluded that ADT is better at extending life.

    Bob

  • My story is similar to Break60's. Had SBRT to a single lymph node that was 4cm on the iliac chain. Good for several years. Rising PSA showed we didn't get it all. Redid. Also had Provenge and switched from Zytiga to Xtandi. Been PSA undetectable for 3 years.

  • David20451

    How much radiation to lymph node. Grays,Gy? You say Redid. How much radiation the second time? Why did you not radiate all pelvic lymph nodes?

    Rich

  • 700cGY 5 doses the first time. The second time was 500cGY 5 doses. There only appeared to be one lymph node on the iliac chain affected. 4.4cm x 4.4cm. Second scan a year later had the node at 3.3cm x 3.3cm.

  • David20451

    After the second radiation treatment, how long before you saw it reapper on the scan?

    Rich

  • David20451

    What is the difference of SBRT and IMRT?

    Rich

  • SBRT is a highly focused beam. Different manufacturers have different names for their product; Cyber knife, Rapid Arc (Which I had). Never showed up again. We deduced that it was smashed to smithereens the second go round.

  • David20451

    Thank you very much for your replys.

    Rich

  • Yah! Smash it!

  • David20451

    Is 700cGY= to 70GY. Did your doctor ever suggest surgery to remove the pelvic node?

    Rich

  • He did. I saw a highly regarded urological surgeon. The lymph node was wrapped around a loop in the bowel. No way He'd do surgery.

  • David20451

    I have 3 pelvic lymph nodes, between 1.7 and 1.9 centimeters. I am going to see if Lupron and Casodex can destroy them after 6 months. If not, radiation or surgery. I am in information gathering mode.

    Rich

  • On the other hand, .... another opinion on this general topic.

    "Unwarranted conclusions about treatment of oligometastatic prostate cancer"

    prostatecancerinfolink.net/...

  • Ctarleton,

    Thank you for the link, it was an interesting read.

    Rich

  • Interesting article. In my case it seems better to have the lymph node radiated.

  • Yes! I had R. T on a non-operable prostate, bladder ,2 pelvic lymph nodes,and mainly to shrink P. C. Tumors blocking urethra preventing urination completely .It was palliative care in hopes to improve quality of life ,mainly to take off bi-lateral neauphostemy tubes out of my kidneys.Dr. said 50/50 chance..R.T. & ADT worked...Thank God! That R. T. Was 2 yrs. ago for me..Currently no signs of P.C., minus PSA. I have lost 10% bone density..but I'll take it..compared to were I was( near death) I'm happy to be in this status .My focus now wil be to attempt regaining stamina endurance and hopefully some of the strength lost due to all the treatments..So yes, i had R T. to two lymph nodes and now no signs.The combo of R T & adt worked for me to this point and I pray that it will work for you also.

  • LULU700,

    What ADT drugs and dosage are you taking now?

    Rich

  • Well , "Big Rich" .. 1st shot firmagon, at the same time I started test drug Tak-700 and continue that until failure ,dosage is 600mg per day. next Eleguard,then lupron for 11/2 yrs until finally Orchiectomy 9-1-17..and it is a finality..no balls ,no going back..either way I was already castrated with chemicas...I feel that the surgery was a good decision for me .. no more shots for life.In my case I'm told this will come back statistically in 4 yrs but Dr said hopefully with a My anti cancer Lifestyle this type of no signs whatsoever of P. C. In my system we could extend it. 5-6-7 or who knows..Everything will take resovle and resilience on our part to stay ahead of our condition.This is a test of will power ,a test of faith. There are no guarantees for any of us. Personally I've been with a naturalpathic oncologist from the onset ,As well as conventional treatments of which I believe all the diet and nutrients help to improve treatment effects and their after effects..I was close to death.Im not rich and natural treatments can be costly , but I figured what's my life worth?My beautiful wife ,newlywed on my diagnosis insist that I do everything possible to stay here with her. Her love is the real healing force in my life ..If you have love you can have hope..Don't be passive in your recovery ...Good luck brother!

  • LULU700.

    What is your anti-cancer lifestyle? What type of diet do you use? What supplements and dosage do you use?

    A member of the Reluctant Brotherhood,

    Rich

  • No sugar.For sure no fruit juices, no white potatoes or bananas.There are many well known reasons beside "C", not eat sugar..Its hard core at first if like me you have enjoyed bread and deserts maybe a little too much.No animal proteins or dairy?.An alkaline diet..Garlic ,onions,Cruceferous organic veggies.Apples , eat the seeds,chard,broccoli kambucha,edamame or tofu good for hot flashes..Manuka honey,hibiscus & macha tea..After 1 yr of this and showing no signs of P..C.. My naturalpathic onocologist of which there are only 100 of in the US.,says that I can once a week eat grass feed organic meat ,game,or wild caught deep water fish because he knows how much I love fish especially..So once in a while anything is o k..We are all human..

  • I eat grass fed beef once every other week. Years ago, I used to eat 112 0z of beef a week. Now I eat 12 0z every other week. I eat fish once a week, deep ocean caught. I don't believe that the seeds of the apple are good for you; they contain trace amounts of arsenic.

    Rich

  • Apple seeds recommended by Rick Simpson the 1st guy to claim curing cancer with cañaby oil. You probably know more than I about nitrition and I try most anything that interest me. I also have done the R. S. Oil 60 gms in 90 days 4 times .I do it for P. C. And it also helps me with all of the side effects that most of us have including mood swings and the general duldromes of fighting this P. C. Mule and kicking it down the road with a smile on my face and the munchies..Also I've done Majic mushrooms , ayahuasca, hopa and zaringa2 other Amazing Amazonian drugs that have all helped me with my fears of death & suffering and eleviated some of that morose black cloud I've felt over my head since that wonderful day of diagnosis.

  • There are many on this site that are much more knowledable than I in this P. C. Reluctant brotherhood..I'm telling you what I have done under my nat. Drs advice..I've done IV C& b vitamins ,DMSO,artemisia,from the onset.Been on these nutrients also for 2yrs.." The list". Appox $600 per month entotal,excluding the Iv's that are costly and none of this is covered by my insurance.///// pure encapsulations zinc-30 1 per day w/ food,"""lycopene20mg twice per day with food, "Thorne research" Meriva 500 -sf 2 caps twice daily",EcoNugenics" Hono pure= supports cellular health, 2 with food twice daily, I like this next one.." QOL labs" ImmunoKinoko 750. Ahcc=immune support 2 twice daily away from food, Rx Vitamins Liqui-D-3 2 drops sublingual daily , K-2 any organic 100 mcg per day...at night before bed"Vital nutrients" melatonin 20 mg,and prescribed by my Nat. Dr.. is Naltrexeone 4.5mg at bedtime. On my own accord I take cayenne caps 40,000 hu or more with meals,and "Sun Chlorella"with meals, and "Klaire labs". Vital -10. Probiotic , not nessasery if you eat a lot of organic sourkrauat or fermented things like cambucha..If you are interested in the natural I d suggest to get advice from an accredited Nat. Ono,, This routine is for me although many of these are widely supported by Nat. Med affianados,your needs could differ. At least i believe these things to be beneficial .So doing something instead of doing nothing empowers me .Even if it's the placebo effect, I'll take it

  • Ezekiel bread, quinoa,lentils and there is pasta made with those two.Organic raw nuts & seeds,, fresh organic turmeric ,ginger,, almond butter ,avacados,oil & organic coconut oil. I also like spiralina,seaweed.Specifically for "C" a Chinese sour melon & sour sop. wheat grass..Yum yum. Not really but I ate these last 3 thru R. T. .My wife is Persian and makes everything organic and delicious just another way that I'm blessed with her love. That's my food routine .Ive been cheating since good news 2 wks ago but now I'll adhere better. Always room for some improvement !!!Good luck to you!

  • LULU700

    "quinoa,lentils and there is pasta made with those two." What is the name of the pasta, and where can I buy it, for I would like to eat it.

    Rich

  • Whole Foods,Costco ,Trader Joe's,in Az all have pastas made from quinoa and lentils.I do lycopene and I' ll ask about zaflemend.Thanks!

  • LULU700

    Do you eat potatoes, boiled or baked?

    Rich

  • Only sweet ,red,yellow but not too much.

  • LUlu700

    You may want to discuss with your doctor adding Lycopene and Zflamend to your supplement protocol. I take both.

    Rich

  • >I have lost 10% bone density...

    You might ask your doctor(s) about the possibilities for taking some amount of either Zometa (zoledronic acid) or Xgeva (denosumab). Advanced Prostate Cancer patients and also female Breast Cancer patients who are on long term hormone treatments or who have bone "mets" are often given one or the other of these agents. Commercial versions of them are also prescribed for post-menopausal women, in lesser dosages, to help prevent osteoporosis and bone fractures as they age. (As seen on TV and in many print magazines.)

    Charles

  • Thank you very much for this info..I will ask my Doctors ?And return with their answer.Ono told me 10% is in the normal range. Doesn't sound that good to me.. Yes ,my fear is what I'm told I have to look forward to = osteoporosis and heart disease.So far I'm told strength training and excessive are the best attributes to fighting those predictions..I appreciate your advice...Thank you!

  • Sounds like you have a good Dr. ..I did the same therapy as suggested for you and it has worked for me so far .Ive been clear for 1 yr now..But as we all know, we can not ever say I'm clear...Maybe after 10 yrs ,but for us this is a life of awareness and continued effort... best wishes!

  • I did regular R. T. Not proton which I think should be even more effective hopefully..You can do it with success!

  • Seeing as this thread got into the suppliants issue, here is another link:

    healthunlocked.com/advanced...

  • I am going to see Dr Stock at Mt Sinai on the 6th of June to review a ADT and radiation plan of action on my met lymph node. I will most likely follow the plan.

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