Radiation to mets?

[Noel91]

Hello everyone and thank you very much for all the knowledge you provide yo this site.I wish I could help more but I am still learning.

We have been through a Month with great news.

Father's test show PSA less than 0.02 so he is Now undetectable.Last week we celebrated his 62 birthday ,when 9 months ago ,we didn't know if we would as I didn't know anything about PC.

You can see his story in my profile but to sumarize: Father has an adenocarcinoma and has lymph nodes and 2-3 pelvis Bone mets involment.He has prostate and nodes micro surgery removal (we already know that It wasn't a popular treatment when there are already mets)and Now he is currently on ADT, Zytiga and Predisone,he is Also diabbetic so sometimes sugar levels are too high or too low due to Predisone but tests are okay.Testosterone is also on good levels.

He is doing very well without pain and minimmal side effects and he is still so strong.He Will Also start doing exercise thank yo all of the posts I showed you recommending It!

He Will have scans on October but MO said she Will probably recommend radiation to mets(he already had It due to Lymphocele but at the beggining I thought It was Also for mets)

Do you think does It make sense when there is no pain?We already went through radiation and he suffer from diarrea and stomach ache. Also shall We Talk with MO to ask for more sensitive Blood tests for the undetectable PSA?

He went really quickly to PSA Nadir so I am afraid this is not good as somebody posted that so quickly response to ADT meant worse prognosis.

Thank you very much and sorry for my English,I Hope you could understand me well.

[Tall_Allen]

It depends on the purpose of the radiation. If its purpose is to relieve pain, obstruction, or prevent bone fracture, it doesn't seem to be useful now for him. If its purpose is to get rid of the remaining cancer, I am doubtful that it can accomplish that because he already has mets in his bones and lymph nodes - it is systemic. You deserve a clear explanation of the purpose of the radiation.

I don't know what you saw on this site that leads you to believe that achieving a rapid nadir to undetectable PSA has a poor prognosis. It is the opposite. There was an observational study at Harvard that found an association between time to PSA nadir and survival, BUT ONLY FOR MEN WHOSE NADIR WAS GREATER THAN 0.2. It also did not include men taking Zytiga.

ncbi.nlm.nih.gov/pmc/articl...

[Noel91 in reply to Tall_Allen]

Thank you very much Tall Allen for the response and the explanation as always as I know it is not always easy to undertsand what I say.

I will definetly asked Mo about the purpose and I will also talk with my father to seek more opinion in case MO´s answer is not satisfactory because I think he did already a lot of radiation.

There was a post a couple of day ago :

ncbi.nlm.nih.gov/pubmed/288...

Thank you very much!

[Tall_Allen in reply to Noel91]

Thank you for that link. It shows that the time to castration resistance is proportional to the PSA nadir in men using ADT only. It did not show the relationship with survival, as the other study did. The men in this study all had ADT as primary treatment and it did not include men who had a prostatectomy or Zytiga, as your father did. Prostatectomy and Zytiga are likely to cause a faster and lower nadir than treatment with ADT only. I would ignore this study if I were you.

[Noel91 in reply to Tall_Allen]

Thank you very much!!

[Break60]

RT to mets is a good idea . Don’t wait for pain!

[Noel91 in reply to Break60]

Thanks for your opinion Break60

[snoraste]

there are a few research pieces dealing with PSA nadir whose conclusions vary in the absolute level and time to nadir. But the gist is the same: gradual falling off of PSA to very low levels is a positive prognostic. You also have to be careful about reading too much into them. Most of the reports exclude patients who have been taking Zytiga/Enz concurrent with ADT.

Regarding radiation, I would recommend getting two other opinions. I know more aggressive MOs do it as part of a multimodal therapy, but that depends on the patient.

[Noel91 in reply to snoraste]

I Will definetly Talk with my Father to consider other opiniones at least to allow him to be without radiation for some months more!Thank you!