Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Detected via PSMA pet scan

[George71]

" 31.9% were bio-chemically Disease Free (bDFS) at 15 mo. ! ! ! ! !

All patients with Bio-chemical Failure (BF) (n=43 - out of 57) underwent a repeat PSMA-PET scan, which revealed no in-field failures. ! ! ! ! !

Median bDFS was not affected by prostate-specific antigen (PSA) at diagnosis, Gleason score, time from diagnosis to SBRT, site (bone vs LN), PSA doubling time before SBRT, or number of metastases. ! ! ! ! !

Failures were somewhat less common in patients with low PSA before SBRT. Toxicity was rare: no patients developed grade ≥2 late toxicity."

Bottom line for me is: --

(A) even after metastasis occurred -- apparently one third were cured with SBRT alone (no ADT to skew the results) and

(B) all of the remaining two thirds were cured in the treated areas, and

(C) SBRT ends it in that area -- unlike ADT alone that does not cure anyone and causes cancer to become drug resistant 80% of the time.

(D) even though it reoccurred in other areas it could be treated there with SBRT as well.

urotoday.com/recent-abstrac...

[Longterm101]

Seems like progression occurred in most after 15 months

[Break60]

I had sbrt for oligomets to bones twice. I had biochemical recurrence within a couple months but of course elsewhere. So those mets were killed but others became visible . Not surprising since there are millions in your system.

[tango65]

I agreed with your comments. Most of the patients could delay ADT for more than 1 year. It is a good thing to delay the trip to castration resistant and highly mutated cancer which is impossible to stop.

[NPfisherman]

Thanks for posting, George....I believe in Stereotactic Radiation and had my oligometastatic lesion treated....I believe the Phase 2 results will be positive and on to Phase 3... Have a great day....

Fish

[George71 in reply to NPfisherman]

Fish,

Mazdaguy is on the same program you are.

[Mazdaguy]

I’m a g-9 who has been on IHT for 10 years. I get a f18 pet/ct fairly often and when PSA becomes detectable and something shows on scan I radiate those spots and go on some form of HT. My time off HT (with normal testosterone) has been about 3 years two different times. I can’t prove it, but I think zapping those spots adds time to my HT vacation.

[George71 in reply to Mazdaguy]

Mazdaguy,

What was your initial treatment -- surgery, RT, or HT ?

[Mazdaguy in reply to George71]

George - I had surgery and adj radiation in 2009. About 15 months later PSA began to rise and spots were seen on traditional scans...that’s when I started IHT and spot radiation.

[George71 in reply to Mazdaguy]

Mazdaguy,

I'm thinking about whether to -- radiate the prostate bed and surrounding pelvic lymph nodes, or wait and spot weld when they show up on imaging.

Meanwhile I was considering stopping the Avadart and going on continuous super high dose Testosterone for the double strand break.

your thoughts ?

I had surgery 4/2016 --

90 day post pathology found neg. margins -- PCa in 4 of 10 lymph nodes 0.03 PSA -

so far no other treatment but diet/supplements / vitamin D3 - K2 /Dukoral/Doxycycline w vitamin C and started Avadart 9/2017 when PSA reached 0.6 see below.

2/2017 -- PSA 0.2 biochemical failure

7/2017 -- PSA 0.4

9/2017 -- PSA 0.6 started Avadart

10/2017 -- PSA 0.4

8/2018 -- PSA 0.5

6/2019 -- PSA 0.6

[Mazdaguy in reply to George71]

What was your PSA going into surgery?

[George71 in reply to Mazdaguy]

PSA 10 -- G 8 -- 4+4

[Mazdaguy in reply to George71]

What’s your Medical Oncologist say? I would probably consider radiation to prostate bed and nodes in conjunction with HT.

[George71 in reply to Mazdaguy]

2 said wait till PSA reaches 8 or 10 "whatever my anxiety level can stand" then IHT (MO @ M D Anderson and URO)

2 other MOs say radiate prostate bed and surrounding lymph nodes w 3 months HT.

I see so many of these guys on here doing aRT and sRT to no avail, then left with side effects. ??

[George71 in reply to Mazdaguy]

what is your normal testosterone when off IHT

[George71 in reply to George71]

Mine is 545 while on Avodart but I assume I have little to no DHT

[Mazdaguy in reply to George71]

600 or above...I’m on Avodart as well..but probably provides little value...

[NPfisherman in reply to Mazdaguy]

Recently, a post on a new laser to zap CTC's is being brought to trial... I do wonder if combining the 2 might get people 15 years or more... Not sure if you are aware of the new laser treatment....

Fish

[George71 in reply to NPfisherman]

no I'm not, tell me about it.

[NPfisherman in reply to George71]

Henukit posted this 4 days ago....laser for zapping CTC's--U of Arkansas....

healthunlocked.com/advanced...

Lovin' the science, my brother...

Fish

[George71 in reply to NPfisherman]

Thanks Fish,

I will check it out.

[NPfisherman in reply to George71]

As I recall, the article said they zapped what they believed to be about 96% of CTC's in 8 hours....that should add a few years of life I am thinking....

Fish

[George71 in reply to NPfisherman]

That sounds great, I wonder when it will be broadly available -- everyone should do it regularly. who knows that may stop virtually all new mets from occurring.

[NPfisherman in reply to George71]

Medical devices usually take only 18 months---2 years...unlike the lengthy medication approval--Phase 3/4 testing---we might see this soon....I believe they have an expedited version as well--1 year---Exciting stuff !!!!

Fish

[George71 in reply to NPfisherman]

I take it that if considered a medical device rather than a treatment it doesn't have to pass a trial.

[NPfisherman in reply to George71]

There is testing involved....but it doesn't go through the same lengthy process....like I say, if this is the real deal, we can get it likely within 2 years or less....

Fish

[Hirsch in reply to NPfisherman]

Excuse my stupidity. What are ctcs

[snoraste in reply to Hirsch]

Circulating Cancer Cells -

[NPfisherman in reply to Hirsch]

Circulating tumor cells....the basis of metastasis...could be a game changer....

Fish

[George71]

You keep knocking them off when they pop up till they are all gone. I think that is a great strategy. Also, it may be that you kill off the PCa before they can become CRPC.

[Fdccs]

They've got to be close to getting this now.

[407ca]

George71,

Very good article.

I was recently treated to my mets with stereotatic radiation that had been found with PSMA. My goal is to delay ADT and I believe it will help. For a long time there were those who preached it would do no good but now it is becoming accepted. With the advent of more sensitive imaging more focal and precise treatments are possible.

All the best.

[snoraste]

Not sure if extension of the results to PCa from melanoma will be straight forward. I’m more worried about micro metastasis, not CTCs