Burnett1948 Update

[Burnett1948]

Saw Urologist after PET scan. Shown 2 spots in pelvic area. Told there would be more probably throughout my body that didn’t show because too small. I have 3 options to think about. 1. Do nothing2. See RO to see if spot Radiation will help.3 . Have hormone treatment, I Am favouring both Radiation and Hormone to-getjer Your thoughts please?

[GP24]

My opinion is radiation to the pelvis plus six months of Bicalutamide as ADT. If you do nothing, your rising PSA value will make you nervous. If you just do ADT this will be probably life-long which causes a lot of side effects. After the six months of Bicalutmide your PSA will be so low that you can just observe it for a long time.

[Burnett1948 in reply to GP24]

Thanks GP24. What is Bicalutamide?

[GP24 in reply to Burnett1948]

This are ADT tablets which may be less efficient than an injection but do not cause that many side effects. Your URO will usually give you these pills before starting with Lupron. But you can contine with just that at a dose of 150 mg.

I mentioned these because one trial used them after salvage radiation. For a longer period though but I think six months is enough.

[Burnett1948 in reply to GP24]

Thanks GP24

[noahware in reply to Burnett1948]

I am taking it, with very few SE's, but I also take it with 10 mg tamoxifen to prevent breast growth/pain, which is the most common SE.

The bicalutimide blocks the androgen receptor rather than the actual production of T, so that lets you keep high blood levels of both T and estrogen (hence the lesser the SE's).

Just watched a lecture by Dr. Kwon (at Mayo) who is a big proponent of finding the most ACTIVE mets with precision (PSMA?) PET scanning and then nuking them (or more rarely, cutting them out). He and his patients appear to have much success! (I will add, he is NOT in favor of irradiating the general area, but only the precise location of known active mets.)

[Burnett1948 in reply to noahware]

Thanks noahware.

[Magnus1964 in reply to Burnett1948]

Bicalutamide is casodex. It is an older ADT drug. It's milder with fewer side effects. You should start casodex at least 3 months before radiation. Don't put a timeline on it. Keep taking casodex as long as it is working.

[Burnett1948 in reply to Magnus1964]

Thanks Magnus.

[pjoshea13]

The old view, as expressed by my urologist many years ago: "If you have one met, it's everywhere." Many men ended up on continuous ADT prematurely IMO.

However, you have oligometastatic disease at this point & do not need systemic treatment (ADT) IMO. Radiation as monotherapy may buy you many years.

I had a met at L5 zapped 5 years ago. My radio-oncologist was wary of treating mets when there is no pain, since there was no proof that it would affect survival, but he has now become a believer.

If you do start ADT (now or in the future) consider BAT because it may delay castrate resistance.

ADT (Lupron, say. Not Zytiga or Xtandi) as monotherapy fails within 18-24 months for most men, and is not a cure, so should be delayed if possible IMO. Many here will disagree. Some have been on ADT for years, but it is the nature of the group that the failures are poorly represented.

Casodex (Bicalutamide) is a good alternative if you are worried about the PSA doubling time. I see that GP24 has recommended that.

All of the above is just my 2 cents.

Best, -Patrick

[Burnett1948]

Much appreciated Patrick

[Tall_Allen]

I agree with you. I don't know if the spot radiation will help, but it sounds like a safe place for radiation, so why not? The really important thing is aggressive hormone therapy - Lupron (or similar) + Zytiga. Trials have proven that the combination can add years to life and many men and delay castration resistance.

You should be seeing a urologic oncologist now rather than a urologist.

[Burnett1948 in reply to Tall_Allen]

Much appreciated Tall_Allen.

[Schwah in reply to Burnett1948]

Tall Allen is right on all counts.

Schwah

[Burnett1948 in reply to Schwah]

Thanks Schwartz.

[Burnett1948 in reply to Tall_Allen]

Burnett1948. Tall_Allen, This is your advice on aggressive hormone treatment which you said uses two hormones to-get her. I tried to reply to your advice previously and it didn’t get to you. I hope this works.

[Burnett1948]

Thank you Noah ware.

[RonnyBaby]

I am probably facing the same situation - my PSA is rising while I'm on an ADT holiday.

I had radiation and ADT as my primary - was G9 / T3B - 3 years ago.

My next option (after scans confirm) would be long(er) term Casodex and some radiation to the pelvic nodes that show up.

It could be much worse - keep the faith - you are in a situation where you could be optimistic that the treatments will make a difference.

[Burnett1948 in reply to RonnyBaby]

Appreciated. Burnett1948

[jedgar1]

My pet showed flashes in my lymph nodes and my Urologist sent me for a 3T MRI and the lymph nodes were fine. The Auximen Pet isn't always right.

[Moespy in reply to jedgar1]

2 years ago on the same day at an NIH trial I received a CT, MRI and a PSMA Scan. The CT and MRI showed nothing but the PSMA showed a flash in a Pelvic Lymph Node.. NIH did a quick Biopsy and it was positive for PCa; I then went on to having full pelvic radiation sessions and have been undetectable since.

[Hidden in reply to Moespy]

Oh yah! Stay under the radar!

[Burnett1948]

Tall_Allen Thanks. Burnett1948 some questions. I am seeing my RO early this week to put your recommendation after casodex before spot Radiation . Also I like the idea of taking tamoxifen for Brest pain etc. Also your comment on my GP comment That hormones will give me 5 to 10 years

of

[Burnett1948]

Thanks RonnyBaby.

[ctarleton]

If you've never seen this, it might give you some things to talk about with your doctor over the coming months and years. See Chapter 8. ADT + early Abiraterone (Zytiga), as previously mentioned, is a common option.

NCCN Guidelines for Patients Prostate Cancer

nccn.org/patients/guideline...

[Hidden]

I agree ☝️

[Bangkok]

If you can afford it (and are able to travel) look into Radioligand therapy. I went from a PSA of 9.8 to O.14 in 3 treatments. I am now in remission.

[Hidden in reply to Bangkok]

👏🏼

[DavidDundas]

First question: was it a Choline PET scan or a Ga68 PSMA PET scan, as the choline PET scan only shows areas of high metabolic activity which might not be prostate cancer, so the Ga68 scan is more useful. Once the locations of the cancer have been identified, you can consider radiation therapy to deal with it; either way, taking Bicalutamide which is an anti-androgen (male sex hormone) will lower your PSA to a very low level because it inhibits the growth of prostate cancer, but it may cease to be effective after several years and the cancer could start to spread, so longer term you need to destroy the cancer.

[Burnett1948]

Burnett1948.I had a PSMA 18F (FLURINE 18F DCFPYL) PET scan. I look forward to your further comment if any DavidDundas thanks.

[Burnett1948]

Burnett1948 to ctarleton after reading about the negatives of Lupron. What other ADT hormone/s with less side effects will do the same job as Lupron? I am about to have my first Lupron injection on Thursday. I am seeing a MO for the first time to find out when I can add Zytiga . I am Australian .