Axumin Results

[JDKotter]

Axumin results today was encouraging but want you opinion on next course of action.

After RP in August 2018 My PSA had risen, from zero, .2, .6, then 1.7 at month 4 months.

Axumin results:

1. Mild focal radiotracer accumulation in the prostate bed, possibly representing local recurrence. No evidence of soft tissue recurrence in the lymph nodes of the pelvis, abdomen or chest.

2. Mild focal radiotracer accumulation in right medial pubic ramus, possibly representing osseous metastatic disease. Linear radiotracer activity at superior aspect of S1, suggestive of degenerative disease. Suggest repeat bone scan for further evaluation.

My question is my RadOnc wants to do radiation to the prostate bed which includes the pubic bone, because there’s no solid proof of Mets. I’ll first be starting Lupron and Zytiga 2 months before the 6.5 weeks of Rad.

I’m going to confirm w my original team at MD Anderson if this is what they recommend?

I’ve been told to perhaps hold back Radiation for now.

Any thoughts experiences is greatly appreciated.

Thanks

Jeff

[tango65]

Discuss the possibility of including the pelvic lymph nodes in the RT plan. The SPPORT trial: showed an advantage in freedom for progression when the the lymph nodes were irradiated:

ascopost.com/News/59414

[JDKotter in reply to tango65]

Thank you for the info! They plan saturation of The entire area.

[JDKotter]

Thank You Nalakrats! They plan to saturate the entire prostate bed area including the LN. some say I should also start Chemo. Kitchen sink...I’ll pass on the info when MD Anderson chimes in

[Tall_Allen]

Your spot in the right medial pubic ramus will shrink or disappear if you are on ADT - it's a good way to know if it was a met or not. it says focal (<3 mm?) - ask your oncologist if it's big enough to biopsy - that is a definitive diagnosis.

If it is a met, you may choose to still go ahead with the radiation to the prostate bed, the pelvic lymph nodes and the bone met (+ about 2 years of ADT), but it is also reasonable to forgo the potential side effects and go straight to lifelong ADT.

If it's not a met, prostate bed radiation will hopefully be curative.

[JDKotter in reply to Tall_Allen]

Thanks Tall Allen, I ask if we could biopsy and the nurse practitioner indicated they would not biopsy. I meet w the MO on Friday and will ask why that wouldn’t change the radiation path.

I believe that pursuing Radiation outweighs the risk, since it’s not clear cut on the Axumin scan. I ask if paying out of pocket for the PSMA scan would make sense and she said “probably not’

I’m getting a second opinion from my original care team at MD Anderson

Thank you again for your input!

Jeff

[Tall_Allen in reply to JDKotter]

When bone mets are equivocal, the Axumin inventor suggests getting a NaF18 PET/CT to confirm. It is sometimes covered if the hospital has a registry (which MD Anderson probably does).

There is also a free trial of DCFPyL (the best PSMA PET) which has begun recruiting at Washington University in St. Louis. They even pay for travel and accommodations.

clinicaltrials.gov/ct2/show...

[Kimmilemo in reply to Tall_Allen]

We live there!

[JDKotter in reply to Tall_Allen]

Wow thank you TallAllen

[Kimmilemo in reply to Tall_Allen]

Don’t think my husband would qualify at the moment . Last we knew his psa was 0.01 after salvage surgery. But curious if they are missing anything because he still can’t sit on his bottom five months later .

[tallguy2]

I recommend radiation or chemotherapy. Please choose one of these!

I had a similar PET/Axumin scan result prior to my chemo last spring/summer. [Mets in the prostate bed and some lymph nodes and one vertebrae.] I chose the chemo. Afterwards, no detectable uptake in the prostate bed and three small areas of mets remained. A Circulating Tumor Cell blood test was negative. Per the results of the STAMPEDE trial I then chose SBRT to try to eradicate as much of the three remaining mets as possible.

Good luck; it sounds like you are getting excellent advice from your care team.

[JDKotter in reply to tallguy2]

Thank you for the advice! Much appreciated!

[JDKotter]

Kim, I’m sorry to hear he’s having additional issues. Is Hyperbaric treatments initiated?