Radiation to lymph nodes after failure of SRT to prostate bed

[bitittle]

I have researched to the best of my ability to find out if radiation can be done to lymph nodes in general or to specific lymph nodes(based on advanced scanning results showing metastasis) after prostate bed SRT failure. I am most likely heading towards a BCR in the near future after my SRT of 40 months ago which followed a previous RP in 2013. I just want to understand any other options out there in lieu of ADT should a BCR occur. See profile for history.

[Tall_Allen]

Yes, salvage pelvic LN radiation can be done.

[bitittle in reply to Tall_Allen]

Thank you Allen!

[Ralph1966 in reply to Tall_Allen]

Hi TA how much it is successful? Is it curative or just palliative?

[Tall_Allen in reply to Ralph1966]

The intent is curative.

[Blueslover in reply to Tall_Allen]

I am getting treatment at Duke. I have five retroperitoneal and pelvic lymph nodes involved (Axumin scan), but they tell me that treatment of these nodes is futile as the tumour always recurs further up the body.

For now, the nodes have shrunk with ADT but what should I do if/when they re-appear on scans. I'm very confused!

[Tall_Allen in reply to Blueslover]

Retroperitoneal nodes are iffy. Once the cancer has gotten that high, it may be elsewhere. Your cancer is staged M1a, which means that you qualify to get additional systemic therapy (either docetaxel or Zytiga or Xtandi) in addition to just ADT.

[Blueslover in reply to Tall_Allen]

Thanks a bunch.

The radiologist described it as multilevel retroperitoneal and right pelvic lymphadenopathy.

Scan done 5/18 and nothing other than Lupron had been suggested to me

[tango65]

It could be done.It is done in many cases with SBRT. I was in a similar situation and I went to Germany and got treated with Lu 177 PSMA, since I also had retroperitoneal metastases. One Lu 177 PSMA treatment was enough to control the node metastases.

[bitittle in reply to tango65]

Tango 65

Did you have ADT along with Lu 177 PSMA treatment? Did your insurance will cover the overseas treatment?

[tango65 in reply to bitittle]

Yes , I had ADT . My insurance does not cover this type of overseas treatment.

[NOCanceros in reply to tango65]

Hello Tango

If you please tell how much it costed you to make 1 session of Lu177 PSMA and which hospital Thanks.

[tango65 in reply to NOCanceros]

The cost was around 9K euros. The place was The Technical University of Munich.

[NOCanceros in reply to tango65]

Thanks

[Hawk56]

I had surgery in March 2014, T2CNoMx, ECE, SV and margins negative, 10% prostate involved and GS8. PSA readings for the first 18 months were <.1 then .2, .3.

Did SRT in March 16 to the prostate bed only. I talked with my radiologist about whether or not to include short term ADT and include the PLNs base on data Mayo was collecting about the location of recurrences and emerging clinical trials about adding ADT to deal with micro metastatic PCa.

She said no, there wasn’t “long term data...”

SRT failed so as PSADT and PSAV. Combined with GS and time to BCR indicated aggressiveness I went to Mayo in Jan 17 where the C11 Choline scan (PSA was now 3.8) showed four PLNs but no organs or bones.

We hit it hard with six cycles of ADT, 18 months of Lupron and 25 mire radiation treatments.

Armed with the imaging data my radiologist built a treatment plan that included all PLNs with boosts and wider margins around the four PLNs.

Last treatment was May18, by Feb 19 T was back at 482, labs in Jan 20 had PSA at .06.

Long answer to your question...

Yes, they can treat the PLNs after SRT.

Imaging can make a difference in the radiation treatment.

Consider combined therapy as there may be micro metastatic PCa outside the radiation treatment fields.

Kevin

[bitittle in reply to Hawk56]

Thank you Kevin! I have already had SRT for prostate bed only 40 months ago. PSA has slowly increased to 0.066 as of Jan 2020. It looks like I am on my way to another BCR. Trying to be prepared for discussions with RO when BCR is more definite.

[Hawk56]

At that PSA I would just actively monitor. My urologist and I agree on labs and consult every four months.

My PSA results this year:

.36

.24

.05

.124

.06

.07

So, he and I talk briefly about any new developments in the treatment of PCa and agree to meet again in four months.

We’ve discussed possible trigger points to make decisions...

There is no set PSA level at which we would go back on treatment.

We want a few readings to gauge doubling and velocity times.

We would image using the C11 Choline it Aximun which are FDA approved or consider PMSA currently in clinical trials.

Informed by clinical data, GS, PSADT, PSAV and location we would then decide on treatment, when and with what, most likely combination therapy which would be a function of the standard of care from NCCN guidelines at the time or emerging therapies finding their way into clinical practices.

Kevin

[bitittle in reply to Hawk56]

Kevin - I agree with your approach. Exactly where my head is. Thanks for the info.

Bill

[MateoBeach]

If I am to understand that you are not yet BCR at this time after the SRT to the prostate bed.

Therefore you don not know yet if further treatment is required. In order for an advanced scan such as Ga-PSMA to be reasonably able to identify further disease sites/nodes (and assuming PSMA expression) one's PSA needs to be at least 0.20. This is the cutoff at UCLA.

So until then it would not seem possible to plan metastasis direct therapy (MDT).

As for pre-emptive RT to the entire pelvic lymph node chains, without any current confirmation of disease there, I have no idea if that would be considered.

[Rocketman1960]

I have had SRT post RP and also SBRT at LN near L5. It was successful however PET scan showed activity with no mass at LN down stream. Basically wack a mole at this point. Currently on 6 month Lupron plus Xtandi. PSA nil. Steady as she goes.

[RCOG2000]

Had bcr and scan identified specific lymph nodes. Had Radiation via tomotherapy to the affected nodes. Psa nadir .08 at 8 months post treatment. 0.2 at 12 months post tx. No other systemic or surgical treatments

[j-o-h-n]

Caution: There may be collateral damage that appears years later.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 02/26/2020 6:41 PM EST