Metastatic Lymph Node, Recurrent PCa

[Mooserj]

Recently did the 18F PSMA1 007 PET/CT scan as result of rising PSA after prostatectomy in April 2016. PSA at 0.91 now and doubling every 5 months. Scan showed one small 4 mm avid right internal iliac lymph node that favors metastatic.

Consultations with 3 urologists, 3 radiation oncologists all have recommended whole pelvic IMRT including lymph nodes and SBRT to avid node along with 6 months ADT (Lupron). Rational is to get in now that the source is known for the cause of the PSA rising and treat it along with any (likely) micrometastisis that might be lurking (but not seen on scan). Hit it now before it spreads

This seems standard of care from my research and seeing this approach commented on this site. Discussed this approach with a medical oncologist who understands my concerns for radiation and ADT side effects (now and in the future). He, like all medical practitioners, can only recommend and leave the decision to the patient. He said if you don't treat now it could spread or it may not for years - it is up to you. He said it is difficult to make decisions when no painful symptoms are present. While good to chat with - as usual it's up to me.

Any thoughts on my clinical situation and the approach being recommended would be appreciated from the many more experienced members on this site? Regards

[mlabrams54]

I would go with the standard of care recommendation: ADT plus radiation. Do it before it spreads more. I am currently doing EBRT, while on ADT, after previously doing chemo and then having RRP.

[Tall_Allen]

It sounds like an excellent plan. Good luck!

[Mooserj in reply to Tall_Allen]

Thanks for the feedback. Was concerned about overtreatment too early. Guess its best to try and eliminate it with this appoach.

[Tall_Allen in reply to Mooserj]

I agree. Once it's out in a lymph node (and it's probably in more than one), it can spread anywhere. Best to treat ASAP.

[G9doingfine in reply to Mooserj]

Sounds similar to my situation. (But yours is slightly better !) I am 1/2 way through a 2 year Lipton protocol following salvage radiation a year after prostatectomy . Axumin scan suspected local recurrence and local nodes only hence the radiation .

I will do another year of Lipton and then hope for a cure or long durable remission (maybe 30 years of durability ! LOL)

One thing that is a very good sign for you - TALLALLEN called your treatment an “excellent plan.” That is GOLD !!! He is the most knowledgeable person on this subject and we are lucky to get his input here .

Good luck my brother ! Live long live strong !

[G9doingfine in reply to G9doingfine]

My apologies for Lipton vs Lupron !!!!! I love tea , but they are definitely injecting me with LUPRON , not Lipton !!!!

[cesanon]

"whole pelvic IMRT including lymph nodes and SBRT"

So what is included in the pelvic imrt and what's excluded? That can't mean they are shotgunning your whole pelvis? The coming back to use the sbrt for the lymph nodes?

[Mooserj in reply to cesanon]

IMRT to prostate bed and pelvic lymph nodes then SBRT to avid node

[cesanon in reply to Mooserj]

What is an avid node?

[cesanon in reply to cesanon]

I always thought sbrt, being more precise was automatically better than imrt. I guess not.

[Mooserj in reply to cesanon]

The PSMA scan report refers to the node that was identified as cancerous as an avid lymph node (the one that lit up on the image),

[cesanon in reply to Mooserj]

Do you understand why they are choosing sbrt for one use and imrt for another use?

[Mooserj in reply to cesanon]

As I understand it SBRT to the one node they can see that is cancerous to kill it off and IMRT for pelvic lymph nodes and prostate bed to treat any micrometastisis that can't be seen. With PSA rising it could be just the one lymph node causing it or it could also be other yet undetected micrometastisis. The use of ADT with the radiation seems to improve outcomes from many studies. This approach is a second chance a possible cure or durable remission? - time will tell.

[rococo]

You are in the best worl right now. You have a target and a plan for possible cure or durable remission. Better than dragging it out for years with meds and their side effects because they live in an area like buffalo n.y where advanced imaging is scarce. Rocco

[larry_dammit]

My dad has been fighting high and low PSA for the last 20 years, his PSA will go up last time 250 they will give him a Elegard shot it will come down usually to 2 or 3. Last time it came down to 12. Urologist was concerned so ordered a ct scan and a bone scan. Found a shadow in the pelvic area, Dad has been having trouble walking he is 86 , thought it was just old age. Doctor ordered a Pet scan with Auxium, found that there is a enlarged lymph node and Mets in a pelvic bone. Question I have is why the bone scan didn’t catch the Mets, meeting with medical oncologist in a week to see what if anything he wants to do about this. Any ideas

[Mooserj in reply to larry_dammit]

Probably best to start a new post on this topic to get most replies

[Break60]

I had IMRT to all my pelvic lymph nodes back in 2015 by Dr Dattoli in Sarasota. He’s great at treating sensitive areas with IMRT.

[Hidden]

I had the radiation in the pelvic area with Eligard after my surgery as well. My PSA he referenced as persistence since my PSA was an uncommon 20 after surgery. The hormone treatment was much harder on me than the radiation. It is a common first line that works. Your call, but when you are ready build a team that works for you.

[Jackpine]

Moser just,

I would concur with the others on this site and go with the plan your oncologist has laid out. I am a firm believer to hit this beast hard when it’s small as it is a sneaky little bastard.

Good luck in your journey!

[George71]

how did the RT go -- we need an up date

[Mooserj in reply to George71]

Well after the scan that found the Lymph node metastasis, and many consults with different doctors I went for 33 sessions of whole pelvic radiation (prostate bed and lymph nodes) along with 6 months of ADT (Anentone - a luproline acetate - same as Lupron).

Radiation is over and last 3 month injection was November, that lasts until end of February. Radiation side effects are pretty well gone - (urination/bowel) some occasional discomfort when peeing. ADT side effects have been minimal, just the odd hot flashes and occasional fatigue. PSA on last read was .3 and testosterone was 2.5 down from 450.

Next test is end Feb again when I see rad onc again. It will be too early to get meaningful results. Expect about August when testosterone has 6 months recovery to see how PSA is going.

I read an ASCO report the other day on a study about post prostatectomy treatment involving radiation to prostate bed & pelvic lymph nodes combined with short term (4 to 6 months) ADT has indicated a success rate of 89.1% freedom from progression at 5 years.

Hope I end up in this group. Time will tell. While life goes on and I am generally tolerating treatment, the whole experience of this journey is starting to wear thin. I am looking to finishing and trying to forget about it all for awhile, hoping to have a cure or long term remission.

[Mooserj]

Well after the scan that found the Lymph node metastasis, and many consults with different doctors I went for 33 sessions of whole pelvic radiation (prostate bed and lymph nodes) along with 6 months of ADT (Anentone - a luproline acetate - same as Lupron).

Radiation is over and last 3 month injection was November, that lasts until end of February. Radiation side effects are pretty well gone - (urination/bowel) some occasional discomfort when peeing. ADT side effects have been minimal, just the odd hot flashes and occasional fatigue. PSA on last read was .3 and testosterone was 2.5 down from 450.

Next test is end Feb again when I see rad onc again. It will be too early to get meaningful results. Expect about August when testosterone has 6 months recovery to see how PSA is going.

I read an ASCO report the other day on a study about post prostatectomy treatment involving radiation to prostate bed & pelvic lymph nodes combined with short term (4 to 6 months) ADT has indicated a success rate of 89.1% freedom from progression at 5 years.

Hope I end up in this group. Time will tell. While life goes on and I am generally tolerating treatment, the whole experience of this journey is starting to wear thin. I am looking to finishing and trying to forget about it all for awhile, hoping to have a cure or long term remission.