Second Recurrence now at PSA .5 - Advanced Prostate...

Advanced Prostate Cancer
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Second Recurrence now at PSA .5

Moespy
Moespy

RP in 2011, first recurrence and subsequent IMRT in mid 2015. Second recurrence (PSA .2) August 2017. I have not had any medication (hormones, chemo) in the 7 years I have been fighting. Learned this morning my PSA is now at .5 so I assume will be having the PSMA pet scan done at Hopkins Baltimore to try and find out where the PCA has gone. I assume I will then go to Zytiga, Prednisone and Lupron. I am choosing Zytiga because I think it is as effective and has fewer side effects than Docetaxel. Seeing my doc on the 19th and would appreciate any thoughts on this plan I have for my next step. Thank you!

15 Replies
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Could you please clarify - you had SBRT for a recurrence after primary surgery. That is a very unusual salvage radiation - it is usually IMRT to the prostate bed ± pelvic lymph nodes. Or did you have selected bone mets zapped with SBRT?

Moespy
Moespy
in reply to Tall_Allen

38 sessions of IMRT to the prostate bed ± pelvic lymph nodes.

Moespy
Moespy
in reply to Tall_Allen

Post now edited. Thanks

Tall_Allen
Tall_Allen
in reply to Moespy

Was it + the pelvic lymph nodes or - the pelvic lymph nodes?

Moespy
Moespy
in reply to Tall_Allen

Documentation only mentions IMRT so I will assume -pelvic lymph nodes.

Tall_Allen
Tall_Allen
in reply to Moespy

Well, then there is still a possibility of cure if the recurrence is only in the pelvic LNs. Ask your RO.

Moespy
Moespy
in reply to Tall_Allen

Very encouraging. Thought that horse left the barn with the second recurrence. Thank you for the information, appreciate it.

Tall_Allen
Tall_Allen
in reply to Moespy

Maybe, maybe not. It would depend upon detecting small mets in the pelvic LN area, which even with the best PSMA PET scans is difficult:

pcnrv.blogspot.com/2017/01/...

There is a trial of the DCFPyL PET at NIH, which may be able to find something. If so, it is important to irradiate as broad an area as possible, and not just treat what you can see. There may be limitations due to the previously irradiated area, but modern linacs should be able to not overlap the treatment zones substantially.

pcnrv.blogspot.com/2017/02/...

Moespy
Moespy
in reply to Tall_Allen

Great info and again appreciate the data. I am hopeful that because I am at Hopkins that I may receive the DCFPyL PET scan. If not I will definitely ask about the trial. Would you consider going to the Netherlands if in my current position? Thanks!

Tall_Allen
Tall_Allen
in reply to Moespy

Yes I would if I could afford it. Jelle Berentz at Radboud University in Nyjmegen is the only expert at Combidex MRIs and he claims to be able to detect lesions as small as 2 mm.

Moespy
Moespy
in reply to Tall_Allen

I think out of my league for expense. Hoping Hopkins can find what's there and keep prolonging the march.

j-o-h-n
j-o-h-n
in reply to Tall_Allen

As I've said before ... You're an angel for us... Thanks again!!

Good Luck and Good Health.

j-o-h-n Friday 07/06/2018 4:38 PM EDT

My husband's history.

Prostatectomy in Feb 2011 at 52 years old.

PSA undetectable until 2014, 0.5

37 sessions of radiation on prorate bed.

Unfortunately PSA continues to rise July 2017, 8.7

Axumin pet scan showed metastasis in 2 iliac lymph nodes in pelvis area.

September 2017, Firmagon( Degarelix) shots once a month, for 3 months. Zytiga 1000mg daily with 10mg Prednisone.

PSA >0.1

December 2017, switched to Lupron every 3 months. Even though his PSA is <0.1 he decided to do 6 rounds of Taxotere in January 2018.

Our prayers are for a long remission. I hope I didn't overwhelm you with all this info. My prayers for you. Stay strong.🙏

Moespy
Moespy
in reply to Chiquis

Thank you for that information. Understanding the path of others helps me in my discussions with my doctors. Much appreciated and best wishes to you and your husband. Jim

I had a similar history to yours albeit much quicker recurrence. SRT via IMRT to bed only in 38 fractions then IMRT to all pelvic lymph nodes 15 months later in 50 fractions. Plus of course ADT3.

Bob

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