Radiation, round two

[outdoors48]

I'm wondering about radiation, round 2

One RO says he can radiate my peri-aortic nodes as well as Ext Iliac. He also said my PC may still be considered local as opposed to systemic. Never had ADT, probably a year or two off(very low PSA).

Anyone have radiation to these same nodes?

I hope you see my signature. Thanks for the help.

Jim

[Tall_Allen]

There's growing recognition that salvage radiation of the pelvic LNs may be curative:

pcnrv.blogspot.com/2018/10/...

There's also recognition that the standard (RTOG) radiation field isn't wide enough, and it should be extended to the common iliac nodes and the para-aortic nodes:

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

The trade off is toxicity. The RO has to take care that the small bowel doesn't receive radiation. Modern linacs are very precise, but there is movement. This is one time when belly fat is a good thing.

[Hawk56]

So, here is what my C11 Choline scan at Mayo in Jan 16 found:

1. Enlarged left external iliac lymph node with restricted diffusion

and corresponds with C 11 choline avid lymph node worrisome for

metastatic lymph node.

2. Tiny left para-aortic lymph node with no restricted diffusion is

indeterminate.

FINDINGS: Liver is negative with no focal masses. Pancreas, spleen

and kidneys are negative. Small, 5 mm, left para-aortic lymph node

again (series 2,image 35) corresponds with the C 11 choline avid lymph

node. This does not demonstrate any restricted diffusion and is

indeterminate. There is a 1.5 cm left external iliac lymph node with

restricted diffusion (series 7, image 93 and series 14, image 66) is

worrisome for a metastatic lymph node and corresponds with the C 11

choline avid lymph node on recent study.

I already had surgery in March 14, 2TCNoMx, GS 4+4 margins, ECE, and seminal vesicles negative, BCR Sep 15, confirmed in Jan 16, SRT in March 16 which was 39 IMRT, 70.2 Gya. Interestingly, I had discussed with my radiologist whether or not to include the pelvic lymph nodes in my SRT, she said no, the data wasn't there to support it...The SRT was an epic failure, started at PSA .3, 90 days after, .7, 30 days after that 1.0 by the time Jan 17 rolled around, 3.8.

After the C11 Choline scan my radiologist said the standard treatment field for the pelvic lymph nodes at the time of would not have included one of the ones identified in the C11 Choline scan which is what Tall Allen has given the link to.

My urologist here in Kansas City did not recommend an EPLND based on the results from the C11 Choline scan, neither did Dr. Kwon at Mayo, too difficult to find and determine all the lymph nodes given micro metastatic disease. My radiologist, armed with the imaging from the C11 Choline scan was able to build a treatment plan which had boosts to the four lymph nodes and greater margins around them.

A little over two years after SRT and one after the subsequent radiation which was 25 treatments, 45 Gya I am not experiencing any side affects, testimony to the expertise of my radiologist and the technology!

Happy to say I completed my combined regimen of 18 months of ADT, six cycles of taxotere and the 25 more radiation treatment (last Lupron shot was May 18) my PSA remains undetectable at <.1 and testosterone is returning at 135 with my 30 Oct labs.

I can tell testosterone is returning, the mild fatigue I had is dissipating. Hot flashes and intolerance to heat are still there but maybe my Christmas present...!?

Emerging studies on combining some ADT with radiation to take care of micro metastatic disease, I've seen six months mostly, usually started 2-3 months before the radiation treatment.

From all my wandering around the web, fellow travelers and my medical team, combination therapies earlier in the disease may be more effective than mono-therapies in either the quest for a cure or increasing progression free and overall survival.

You don't say what your PSA is and whether or not you've had enough labs to determine PSADT and PSAV. Nor do you say if and what type of imaging you've had to determine where your recurrence is. The two scans that are FDA approved and thus insurance coverage a possibility are the C11 Choline and Aximum, the PMSA one are in clinical trials.

Knowing where the recurrence is can be invaluable in the treatment plan.

Peace, Kevin

[Break60]

I’ve had three rounds of RT. My second was to all my pelvic lymph nodes done by Dr Dattoli in Sarasota FL back in 2015. No recurrence. He uses low dose and is very careful to not harm adjacent organs.

[cigafred]

Below is my reply from your post in HealingWell, though I recommend HealthUnlocked for greater expertise, especially Tall Allen, Nalakrats, and pjoshea.

Yes, I tried radiation. I was anxious to do it quickly, so I did not give ADT as much lead time as I probably should have. My RO, who previously worked with Zelefsky at MSK, was most interested in this case and he and his physicist spent lots of extra hours planning it all out. I did four months of Degarelix starting early Feb 2015 and IMRT of about 50 grays from 2/16 to 3/25/15. Preceding PSA was 2.77 with doubling time running about 10 months but volatile. After the Degarelix wore off the PSA progression looked like this: 10/21/15=0.04, 1/19/16=0.34 and from there it continued up with a doubling time of two to four months. Autumn of 2016 I was scheduled for a clinical trial of apalutamide at Memorial Hermann in Houston, but that never got off the ground (when I was there in Sept. they said all dox had just been signed, I don't know what happened). So at the end of 2016 I started Degarelix again and went to 0.02 PSA where I have been ever since. The RO is Dr. Tim Hollister at MCSO, mcsodoctors.com/hollister if you or your RO want to make contact.

[the link works on the other site, I do not know how to do it here.]

[j-o-h-n]

to outdoors48: Where are you located and where are you being treated? I cannot see your signature.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/09/2018 5:54 PM EST

[JimVanHorn]

I had 42 radiations in 2007 for localized PCa. I had a bone scan in 2011 and they found metastases on my hip bones. I had a send round of 30 radiations and started Lupron injections. I stayed on Lupron for 6 1/2 years and stopped on July 1st. My PSA is staying at 0.00 and my oncologist said in am cancer free. During the second radiation my colon was perforated and e-coli went throughout my body causing sepsis. I was in the hospital and had to leave on week days, drive to my radiologist's, get zapped, drive back, and go back into the hospital bed. They said I almost died. When you have sepsis you get periods where you are shaking from being cold, yet have a temperature of 106. It was crazy, but I didn't want to die from cancer.

I had no insurance in 2007 and the hospitals wanted $130,000. for 42 radiations, but my urologist had the same machine and charged me what medicare would pay, $30,000.! So I had medicare for the second thirty radiations and they charged me $48.! Good luck with your journey, whatever you choose.