Now 11 years post DaVinci and salvage radiation 5 years later and now with abdominal lymph node mets. Realize I am fortunate as am approaching a year on Lupron, nodes now normal size (initial Axumin scan then just CT follow up) and PSA undetectable. Treatment is at Duke and obviously palliative until possible recurrence.
Having recently seen Dr. Eugene Kwon's 28-minute U-tube video of his presentation at the 2014 PCRI meeting, now realizing that not everyone agrees with this palliative approach. He uses the C11 Choline scan and obviously believes in a more aggressive approach, with attempts to either excise or irradiate these small mets when they occur. He seems to have had considerable success with his referred patients' treatment.
Would appreciate any input from the group as to whether I should seek a second opinion with this more aggressive approach in mind.
Hugh
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Blueslover
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Count me as one who does not believe in what you call an "aggressive approach"- but I don't disagree either - I'm decidedly agnostic. And I don't think the approach is particularly "aggressive" either (Chemo or Ac-225-PSMA-617 would be much more "aggressive"). I'm just saying there is no evidence of any benefit of metastasis-directed therapy in prostate cancer (although there may be a benefit for other cancers). So safety has to be a primary concern. With mets in the abdomen, there are some very radiation sensitive organs that may be damaged, so you have to understand that the treatment may shorten your lifespan more than the cancer would.
Perhaps this article will help explain the issues:
No, it did not. SABR-COMET was a pilot study (n=99) of people with any kind of cancer. In fact, only 15 men in the study had prostate cancer, and because follow-up was only 5 years, it is likely that no one died of prostate cancer in that timeframe whether they were treated or not. You cannot draw any conclusions at all for prostate cancer. However 5% of the treated people died due to radiation injuries, and 30% suffered Grade 3 or higher (serious to life threatening) adverse effects.
If you prefer to have your metastases removed instead of keeping them for the rest of your life, you should get a second opinion from a doctor who does metastasis directed therapy. I would recommend Dr. Phuoc Tran at Johns Hopkins:
Thanks for posting this Phase II trial. Do you know if Phase III is underway?
I explored surgical removal of two lymph nodes showing metastasis (via PET with Axumin) before and after chemo. Risk of lymphodema was explained. I chose EBRT after consulting with my RO to cover a broader area than SBRT would cover so perhaps I will not need to lay under a linear accelerator anytime soon (this was my second round, albeit in a different area).
Memorial Sloan Kettering in NYC has a clinical trial underway that we all need to watch unfold. It's in Phase I now. I call it the "remove, irradiate, or drug" (RID) oligometastases trial.
I am not aware of a phase III trial and I do not think there will be one in the near future. The follow-up trial is another phase II trial with a different design. Now they add six months of ADT and whole pelvic radiation. It will take a long time to get results from this trial.
I would say there is "some" evidence of benefit-with the limitations of small sample size, limited time, retrospective, selection bias, etc. Certainly no proof. There is a gulf between evidence and proof.
I’ve radiated mets as they’ve been located by scans . It’s controversial but it’s worked for me. C11 choline is no longer the best type of scan. PSMA ga 68 and others are more effective.
All I can say is that I’ve never had recurrence in any mets radiated. When I stopped ADT I had recurrence elsewhere. So you need to stay on systemic treatment . I’ve been on ADT off and on since July 2014. And it’s still working. See my profile.
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Oligometastatic prostate cancer: Metastases-directed therapy?
No CTCs/oligometastatic 
