I submitted an post an hour or 2 ago asking about choosing Zytiga v. Apalutamide. I forgot to indicate that I was dx at 54 yrs and am now 61. And- also forgot to ask for ibout about getting my 3-4 mets radiated. My largest met (in my "hip") was radiated 6 yrs ago. Posts and responses I have read over the last 4 months seem to indicate that is something I should consider. Any thoughts?And- thanks again for your responses.
Should I Get My Mets Radiated? - Advanced Prostate...
Should I Get My Mets Radiated?
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jfoesq
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Have you talked to an RO about it? Is it safe?
I messaged my doc a short while ago about the radiation and also why she prefers Z over AP.
There is a lot more history behind Z - side effects are well-known, apalutamide is almost brand new - nothing is known about long-term use.
Thx, Allen
Hai jfoeag, I am exactly in the same situation as yours. Have 2 mets on the spine, Others on the right hip, shoulders and on ribs. Am post Zytiga and rising psa at 10.6. Am in that indecisive mode not certain as to what to do. An American doctor in Singapore says that RT spreads the Ca, so no radiation. His wants to put me on Aplatumide which cost a bomb here. According to him it controls the PCa better than Enzulatamide. Please advise me if you can.
Thanks for the info. I never heard anyone say that the RT helps spread the cancer. The ORIOLE study, while limited, seems to indicate that RT is helpful in lowering PSA (although I don't think study has gone on long enough to indicate whether it extended life )- in certain cases. My doc is ready to give me Zytiga, instead of Apalutimde (or one of the other lutamides) as she says that's the SOC. But- I want someone who is forward thinking and aggressive. She told me the other day that she is conservative. I am not sure why MSKCC switched me from a doc who was aggressive with me for 5 yrs (I had my prostate removed when others thought he was crazy) and also was on Lupron and Zytiga INTERMITTENTLY before studies studies supported the use, and early use of Zytiga, and also failed to suppoprt the intermittent use. I didn't care that my prior doc may have been in error about the intermittent use. He provided me with sound reasons for doing so (I was young at DX and he didn't want me to be able to avoid the side effects of the ADT when possible. And- I liked the fact that he suggested removal of my prostate, after explaining to me his reasoning (they remove the breast tumor in breast cancer and they remove the lung tumor in lung cancer) , the risks, and the fact that because I was young I should be able to tolerate the surgery. I am thinking of looking for someone else at MSKCC who has a more aggressive approach.
I would say that that this Dr. called Steven Tucker is agressive by your definition.
Thanks
I have a few small mets in my spine and rib cage that don't cause problems. I had a large 6 cm met in my pelvis area that has now shrunk to 2 cm with chemo and ADT. Both the medical and radiation oncologists advised me against radiation for now because the potential risks outweighed the advantages. That may change as time goes on.
Where are your 3-4 mets?
There is always the potential for collateral damage to other tissues when radiation is used. It depends on where in the body the radiation is targeted.
It used to be common to use radiation to debulk tumours. Recent studies demonstrate that debulking prostate cancer tumours does not extend life expectancy. That is why we decided not do it. Radiation may still be used later on to deal with pain issues.
Mark, the Stampede trial showed distinct advantages for debulking the main tumor (prostate) with radiation for oligometastatic patients:
Debulking tumors on what body parts? I have a new Doctor who wants to use RT on my ribs. I have 2 mets on my ribs at the 5th and 7th. Both are small, I have been on Zytiga for about 3 months, and it has been 5 years since first diagnosis. The thing is, I have no cancer showing on my prostate for those 5 years, just the biopsy on the bone mets showing it is prostate cancer.
I radiated my three Mets. Two in the pelvis and one on the ribs. No side effects and still undetectable. No formal proof yet that it extends life but a lot of very smart smart doctors and radiologist believe that it does.
Schwah
Schwah- where are you treated
I’m in Southern California. My medical oncologist is a prostate oncology Specialist named Mark Scholz. He is very aggressive. I had Lupron, Zytiga and chemo when we found my three small metastasis. My radiation guy was someone he recommended, Dr Henry Yampolsky in Beverly Hills. I got second opinions from An oncologist and a Radiolgist at UCLA. My Blue Shield insurance paid for it all, Except some special imaging I did in Phoenix and at UCLA.
Schwah
Are you still on Lupron?
Nope. On a vacation the last 6 months.
Yes. I will have a Pet on the 28th so my doc has a baseline, before I start Zytiga to go along with the Lupron.
In 2011 I had 30 radiations on my hip bone for mets, but I do not know about 6 years later having more radiations. I would get a second opinion from a doctor NOT associated with the radiation unit. Best of luck.
Any radiation comes into the "sledgehammer" category, as it does permanent damage. The first question to ask is "If I do not radiate, what will happen?". In many cases the answer is "The mets will shrink with time because the immune system will deal with them anyway".
Radiation is useful if there is a real problem that cannot wait for the immune system to deal with it - like a rotten bone that will break if the cancer is not killed off quickly.
If you do decide to use radiation, remember the trick of intravenous Sodium Ascorbate immediately afterwards. This hits the cancer cells while they are still weak, and increases the radiation kill. In some cases, only one fifth the radiation dose is required to get the desired effect. With 80% less radiation, the long term damage is nothing like as bad and the healing if much faster too.
You may also find that Ascorbate kills enough cancer so the radiation is not needed. I use it in combination with low dose Xtandi.
In other words, try the "non-sledgehammers" first. You will see results in a week or two, so nothing is lost if you do some tests and experiments. You may also save yourself sledgehammer damage you may regret later.
rassusukumaran• in reply to
David, You may have read my reply on this post. I most probably have to radiate my spine. But your mention of Sodium Ascorbate is very interesting information. Can you refer me to the source of this information so that I can read all about it and sensetise my doctors to it.
• in reply torassusukumaran
You will not find any trials as Big Pharma want to suppress "cheap" cures that can damage their business. Look at various Internet sites like "thetruthaboutcancer", Dr James Forsyth, Dr Mark Stengler and others. I have used low dose Xtandi (one capsule a week and up) to potentiate the kill of the Ascorbate (it about triples the kill). I can control my PSA numbers by adjusting the doses to keep things affordable. Now nearly 2 years and counting.
If you read enough, you will find that Vit C is standard practice in much of the world where money is tight. To keep costs down, Sodium Ascorbate is used in many combinations with conventional treatments as you then need less of them. Much lower costs, and much less damage. Better quality of life. And about double the 5-year survival rates too! The USA is not the place to get cancer. Better to catch a plane - as many do!
Nutters85• in reply to
Hello David,
I have had 2 Xofigo treatments and my bone marrow and blood counts are too low and they decided to skip a month to see if they improve. I have had units of blood to get hemoglobin back. I am still taking Xtandi, but half doses. Going to see my MO tomorrow. How often would someone get Ascorbate iv’s? I want to research other options that are my choice.
Thank you!
Nutters
• in reply toNutters85
Once a week is pretty usual. I Use 25grams a week, and 50 grams when I want a boost (that is about 3 times as effective but costs more). If there is a high PSA that needs to be brought down, 3 times a week can be done. It is essentially quite harmless.
I’ve had all my mets radiated . See my profile. My psa is now undetectable. But I’m also using estradiol patches for systemic treatment. Never had recurrence in mets radiated.
Interesting- do you know how I can locate your profile on this site?
I joined the group only a few days ago, I live in Australia, so I’m not quite up with the abbreviations and lingo. It’s now 10 yrs since diagnosed at age 57, PSA 5.9 and Gleason 7. I had the prostatectomy op then and a year later radiation and after a couple of years then onto ADT Zoladex. About 4 years ago when PSA was 2.8 I was then put on a trial of Enzalutamide. It lasted a couple of years before being ineffective. In Jan of 2018 my PSA was 30 I then had radiation to the pelvis area which brought my PSA down to 5 but then in Jan 2019 it was up to 15, more radiation but a couple of months after it rose, another dose of radiation to the an offending lymph node, then PSA dropped to 3 but has now doubled to 6. I had a PET scan yesterday and will see my radiation oncologist on Monday. Radiation is 32 days to the specific spot. I’m just not sure now how effective it is. However, I’ve had no side effects. Hope this helps. Also, is Zytiga (Abiraterone) used before or after Chemo.
Ian
My husband had a lymph node met radiated in 2017 after it was found on a psma scan. It worked for 16 months, psa undectable with no further treatment. I’d ask about this.
Hi jfoesq,
I saw my radiation oncologist today and he showed me the PET scan I had done last week. The radiation done back in Jan had knocked out the cancer spots but the radiation done in June to a lymph node still showed some “colour”. He doesn’t know whether it’s on the way out or whether the cancer is coming back. There are 2 new spots (as my PSA jumped from 3.5 to 6 in the last 3 months since radiation), one of which is in the top of the pelvis area he’d targeted in Jan and another in another area in the same region. He said he can zap these. I’ll talk with my medical oncologist Friday but I think I’ll probably opt for more zapping as I’ve had good results previously and I suppose delaying inevitable chemo is a good thing, though I haven’t done Zytiga yet.
Ian
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