Can it spread directly from an existing bone met, e.g., pelvis, or does it spread only from the prostate tumor or the lymph system or bloodstream. What I’m trying to understand is if there is an advantage to zapping a specific met now as apprised to waiting for it to cause symptoms.
Thanks
Yes, it can spread from a bone met, from the prostate, from lymph nodes, from organs. Once mets have appeared, there are countless micromets that you can't see. They are in reservoirs in organs, the blood, the lymph, bones. Once some of the mets are large enough to be detected, there are hundreds of thousands more that are too small to be detected by any current technology:
pcnrv.blogspot.com/2017/05/...
Treatment of metastases has been compared to weeding a garden - keep plucking the dandelions until they are gone. This metaphor is wrong. It is more like plucking morels from under an oak tree. The mycelium of the fungus is everywhere, and plucking mushrooms doesn't stop it at all.
Is there any benefit in zapping what you can see? Maybe. But there is no proof of that yet, and it can be unsafe. What we know is that the appearance of metastases follows an exponential curve - starting off very slowly (probably as the "soil" changes to accept them) and later takes off. It isn't unusual for a single met to be detected and the next one not for years. So without a control group, it is impossible to know if it has really slowed progression. The other confounders are that:
• eliminating the largest mets reduces PSA (PSA isn't appreciably leached into serum until the tumor is large enough to develop its own blood supply), so after such treatment, we can't use PSA progression to monitor effectiveness.
• local control (of the zapped met) is very good - but does that slow down disease progression, given the large number of reservoirs?
• New PET scans can detect smaller mets (down to about 4 mm) earlier, and their elimination will undoubtedly lead to a longer time until the next met is detected (compared to historical controls), but is that a real delay or just "lead time bias."
On the other hand, zapping mets is a positive action patients often request, and helps them feel more in control. That is an important advantage. There is benefit in zapping weight-bearing bones, which the cancer will weaken over time to prevent fractures, spinal compression, and pain. I think this should be carefully discussed with your RO, paying attention to possible safety issues.
Thanks TA. Your perspective is much appreciated.
This really answered my question that has been rolling around in my head for the last few days. Is my dad getting the best treatment by not having his mets zapped and just being on zytiga, lupron, prednisone combo.
This makes me feel a bit better knowing that he maybe didn't lose out on anything by not having his 4 bone mets zapped with radiation.
I'm a big fan of systemic therapy - Lupron and Zytiga kill off the cancer you can see and the cancer you can't see.
When do they add the Zytiga to the Lupron... is there a specific point in time..
My doctor said for mHSPCa it needs to be added within three months of the start of ADT...
I question that as well
3 months is what they did in the STAMPEDE trial.
STAMPEDE results: add Zytiga only in the case of existing bone mets, for others no advantage with early start
Any Mets, not just bone
the trial used a specific time but many patients have added it after using adt for years. When the adt started to become less effective, then the zytiga was added and sometimes with great success for years.
Thanks George. Good to know.
I think based on studies that taking zytiga with ADT will give longer survival for most butother factors need to be considered such as do you have any kind of heart disease which does IT guy puts pressure on your heart. plus side effects of zytiga is sometimes or bad for people sometimes or not if they end up being bad for you if your liver can't take it then it's not going to work for you or your quality of life will be lower sometimes you know I guess every time you just don't know until you try it says I take a first and see how it works for you.
Thank you I'll keep that in mind to ask the doctor if things go south.
T A
About six months ago I cut back xgeva from monthly to quarterly after a normal bone density scan .Is that sensible? And about two months ago I switched to estradiol from trelstar to reduce the possibility of some side effects like CV events and osteoporosis.
I had a femur met in 17 which i hit with 30 grays of sbrt so I’m especially leery about skeletal events on weight bearing bones. I also used sbrt on a rib and scapula.
I’m still castrate sensitive having used IADT since 14 and see no reason to add second line therapy. But I don’t plan on stopping estradiol until Psa and T start to rise. Am I leaving anything on the table? I also take metformin, celecoxib, avodart, rosuvastatin.
Bob
Bob you mention IADT. Is that a typo or is IADT something more than ADT (typically lupron (Eligard) or degarelix)?
iADT means "intermittent" ADT -- maybe 6 months on ADT then 9 months or a year or so until PSA rises back to prior level then start iADT again -- and so on
That's what I'm doing but I usually get about 5-6 months when off of adt
In the past I’ve gone on adt for 13 months and stopped until it rose to around 2.0 then gotten a ct pet scan to find the mets radiated them and went back on adt.
It hasn’t worked well for me because my psa doubles in two months when I stop adt. So I’ve been off adt for no more than7-9 months which is not enough to give much relief from side effects. Now I’m on estradiol patches and plan is to stay on them until they no longer keep me castrate and keep my psa very low. Side effects are much less than standard adt which is why I switched . Google PATCH trial in UK.
Bob
You might want tamoxifen to prevent gynecomastia.
Thanks but I’ve already got nice little boobs . Sore nipples have stopped so maybe I won’t need anything more than an A Cup🥴
Did u use estradiol patches while you were on Lupron ?
They are supposed to be good for hot flashes
Thoughts
Yes I used one .1 mg patch twice weekly for hot flashes for years. Work very well. Then I heard about the PATCH trial and did away with adt and just use the patches albeit three not one.
I'll match mine with yours anyday... Now my wife is trying to feel them up....
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 04/08/2019 6:29 PM DST
A cup? Tea or Coffee? Forgetaboutit mine are a huge beer stein size.
Good luck, Good Health and Good Humor.
j-o-h-n Monday 04/08/2019 7:01 PM EDT
OMG, now that's funny, from a man chest to boobs. My wife is jealous too..
And with the nipple tassels they're gorgeous....
Good luck, Good Health and Good Humor.
j-o-h-n Tuesday 04/09/2019 11:08 AM EDT
My MO has had me on Lupron/Zometa for 2 years with four small pelvic mets. Doing very well at this point. But can anyone answer whether adding Zytiga at this point would be of any benefit? G9
Probably some, if your insurance will cover it. It's approved for newly diagnosed and for castration-resistant, but not for "in between"
Thanks for your reply.....I'll do some checking.....
How would u define “in between”
I start Lupron on Jan 25 and psa went from 17 to .19 as of Friday
I was considering adding Zytiga but I’m 3months in
Any data ?
3 months is newly diagnosed in STAMPEDE
Thank u
I think I’ll take the advise of my MO and start Zytiga
I’ve also read your posts and it seems like you would recommend it as well. Correct ?
Pelvic mets are very amenable to IMRT if you get a knowledgeable RO to do it. I had it in 2015 with no recurrence there.
That combo is working for me 15 months now..
My dad is coming up on 6 months on 4/30. This is when he is going to get his blood work done and get another shot of lupron. I still make my self sick some days worried that his PSA is going to come back higher. As of 2 months ago, it was less than 0.02.
Try not to worry about the PSA number. My MO said right off the bat that if the Zytiga quits working that we'll go to something else. This was at 5 months. And yes I was worried too at the time. From this forum, I see that there all kinds of ways to trick this beast. Some have been doing it for many years. I went from a death bed to 15 months of great living. Lost my man strength, hot flashes and fatigue are common. I fight the side effects. Try to eat healthy. Never smoke or drink alcohol (mets in organs too) Hope that we can trick this beast long enough to see that cure. In the mean time I'm going to enjoy life with my wife and friends and enjoy a nice bowl of ice cream now and then. I wish you and your father well. BTW chocolate chip is the best..
Nice explaination.
That's a reply I find very useful indeed. I've been considering these very issues - should I have a 5-day course of radiation to mets on spine (T7). My sense is this gives me a feeling of control without fundamentally changing the course of the illness. And I'm going to wait until I have pain affecting QOL. Thank you.
My understanding is that yes it can spread from all of the Mets. That’s why it’s so important to keep the PSA down ,that meaning that the cancer is under control for now. Good luck with the monster 🙏🙏🙏🙏🙏
I had 2 mets on my spine and 2 on ribs in the back and Dr Keon recommended cryoablasion on those spots. Did that and started Xtandi and now nothing on scans for 2 years and 0 PSA.
Gleason 9 with seminal vesicle and nerve bundle involvement, and lymph node involves well just a few short years ago
Allen is correct. Most people do not understand micro-metastatis nor have they even heard the term. They are simply treated with the best “proven” protocol in an effort to delay terminal onset. Standard of Care, if you wish. Admittedly I don’t know much about Zytiga or any of the magic bullets developed since 2004. But I am the school of early aggressive systemic treatment to kill the little bastards and was fortunate to be included in a six month trial of chemotherapy with ADT to kill the little bastards while my body was strong and the tumor burden minimal. I don’t not believe Taxotere is sufficient to do the job. I took weekly infusions of Taxotere and Ketonazole alternated with Adrimyacin and Estrustimine plus Predisone and Lupron/Eligard. Hardcore? Yes. All of these drugs have cancer killing properties. It is not standard treatment. And, the results depended on the immediately treatment upon discovery of metastatic lesions and the body's ability to withstand the poison. In the trial. Men with a much larger scope of metastatic spread and a weakened body, were not as successful.
I recall my best friend from college, happy with his doctors in Seattle until he was told that he lost the battle and would not see Christmas three months hence. He went on this protocol and had three years with his family before brain metastasis.
Antidotal? Maybe. However, I don’t think so. Faced with 2-4, maybe 5 years to live, I was willing to be a guinea pig in research. I wish you the best in killing the little bastard with a long and fruitful life.
Gourd Dancer
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