With or without ADT?

[StayingOptimistic]

I have a 4 mm suspected lesion on a hip bone. It was suspected on MRI scan but didn’t show on 18F dcfpyl scan. RO Is suggested to treat it without biopsy with 5 sessions SBRT. I have 2 questions please,:

1) should I treat it despite the fact it was not confirmed because it’s hard to do a biopsy there? May be it’s nit even cancer

2) if I treat it with SBRT, should I do short course of ADT or no ADT?

Thanks for your input.

[LearnAll]

"suspected" lesion ? The risk of no treatment is equal to risk of overtreatment...That's just my personal belief....let our fears not cloud our good judgement..

[Magnus1964]

It is a difficult call, I am sort of in the same spot. My Research Doctor asked if I would do a pelvic bone biopsy or a biopsy of the prostate bed. I know he is leaning toward a biopsy of the pelvic bone and I am leaning toward the prostate bed. To be treated blindly is scary but not to be treated at all is scary. If I were you, I would go for treatment without the biopsy.

[StayingOptimistic in reply to Magnus1964]

Thanks, magnus

How about the ADT? should I take it?

[Magnus1964 in reply to StayingOptimistic]

Lupron is usually used before radiation depending on the individual.

[tango65]

What was your PSA value when you had the DCFPyl PET/Ct?

[StayingOptimistic in reply to tango65]

My psa was .6

Thanks

[tango65 in reply to StayingOptimistic]

I would not get irradiated a suspected lesion which so far is PSMA negative and very small. I will request to follow the lesion. If your PSA is going up consider to have another PSMA pet/ct with a PSA greater than 1

[StayingOptimistic in reply to tango65]

Exactly, this is my feelings about it Tango

[Schwah]

I was in the same boat. Three small lesions found on the most advanced (at the time ) scan. “Highly suspicious for mets” they said. I considered a biopsy but the location and size made it difficult. Very possible to get a false negative. So I did the SBRT. No side affects at all from that. If you can afford the PSMA test (insurance doesn’t cover it-too new) you could get a much better idea. Virtually every Dr in the know now considers it the best scan for detecting early mets. About $2,800 out of pocket. You may find other small mets to hit at the same time.

Schwah

[StayingOptimistic in reply to Schwah]

Thanks Schwah

I did the scan on 3/15, psma 18 f dcfpyl at NIH. actually NIH did both, the MRI and the PSMA. that is almost 4 months ago now. The mri found it but the psma was negative, nothing there. So, not sure what to do.

[Schwah in reply to StayingOptimistic]

I’d get a second opinion on the scans and see if two Radiolgists agree it’s likely the cancer. I’d talk to the dr who’d do the sbrt on the spot and ask about any risks at that location. If he feels kind the risks are extremely low, and two radiologists say over 50% chance it’s cancer, I’d do it but then again I’m pretty aggressive on my treatment.

[middlejoel]

I would do ADT, can't hurt. A few years back, I had a couple of similar "suspected lesions". SBRT was recommended without biopsy. I opted for ADT and today those suspected lesions are not seen although others have taken their place.

jal

[Tall_Allen]

4mm is at the limit of detection for either scan, and artifacts are very possible. Why would you expose yourself to radiation for something that may not be there and for which there is no proven benefit even if it is there.

[StayingOptimistic in reply to Tall_Allen]

Thanks TA, I know you have the studies that treating oligometastatic disease is questionable. The thing is I consulted with MO at MSK and initially he suggested starting ADT and I think when I went and got the psma scans he said said, now let’s refer you to RO In MSK also and suggested SBRT, then I went and got a second thoughts from RO at mount Sinai who also suggested treating it with SBRT. now, I can’t make up my mind which way to go and am going crazy. This is MORE difficult than making the RP or the SRT.

[Tall_Allen in reply to StayingOptimistic]

I would ask those ROs a simple question - "What is your evidence of benefit?"

[StayingOptimistic in reply to Tall_Allen]

Sounds good, TA. I will ask that on this coming Tuesday. Happy holidays all.

[jdm3 in reply to StayingOptimistic]

I had one hip met detected by PSMA scan and radiated that with SBRT. The oncologists at Johns Hopkins and Dana Farber Cancer Institute recommended starting ADT in conjunction with the SBRT. The presumption is that if you have one detectable met, there may be other micro-metastases that should be treated systemically. We settled on 15 months of ADT after the SBRT. Good luck

[GP24]

I would trust the 18F dcfpyl scan and just continue with observation. A single lesion on the hip bone can be treated next year if need be.

[StayingOptimistic]

Thanks, Nal.

[tallguy2]

Our goal with APC should be to not see ANY metabolic activity on the relevant scans. You stated that the 18F scan was negative. Personally I would wait 6 months and ask that the scan be redone. The RO will likely acknowledge that there’s no proof of benefit to irradiating the lesion when the time comes. This is true, but...Nonetheless you might wish to be aggressive with your treatment plan. I have done so myself.

Best wishes!