Success with SBRT

[Scootman]

I was wondering have many had success with SBRT. I am supposed to start next week mets spreading in my pelvis with rising psa . Have been on Xtandi but did not work now on zytiga even though told chances it will work are slim. Radiologists feels this will help with pain and kill some of the cancer cells. Next step is possibly radium once they see if the zytiga works or not. Appreciate any input.

[Tall_Allen]

Your radiation oncologists are right. It is important to have reasonable expectations - less pain and prevention of skeletal events are the goals of the metastasis-directed radiation. By this measure of success, SBRT has excellent outcomes.

Radium seems to combine well with chemo and with Provenge, but doesn't combine well with Zytiga.

[Scootman]

So the SBRT helps with pain I understand but it also helps slow the spread by eliminating some of the areas too. I know it does not eliminate all of the cancer but does help you from getting worse right now.

[Tall_Allen in reply to Scootman]

"but it also helps slow the spread by eliminating some of the areas too. I know it does not eliminate all of the cancer but does help you from getting worse right now."

That is not at all certain. There is no convincing data on that yet. Please read the section titled "SBRT of oligometastases" in the link below:

prostatecancer.news/2020/07...

With easy-to-reach bone metastases in the pelvis, why not? But systemic treatment is likely to do a lot more benefit.

[Scootman in reply to Tall_Allen]

I read an article recently about the FDA approving 2 new drugs for prostate cancer use . They were parp inhibitors . Do you have any incite on these. Also are they for just use when you have DNA mutations or anyone?

[Tall_Allen in reply to Scootman]

They are only effective in men who have BRCA mutations (or similar):

prostatecancer.news/2019/10...

[leo2634 in reply to Tall_Allen]

Hi TA my doctor told me when the time im a good candidate for parp, inhibitors . I'm a Chek 2 mutation. What are your thoughts?

[Tall_Allen in reply to leo2634]

Maybe. It is a rare mutation, so there isn't a lot of data. In the Triton 2 trial of rucaparib, only 3 patients had it. At 6 months, 2 of them saw some benefit, but only 1 guy stayed on it for a year and he did not benefit. It's toxic stuff.

[Scootman in reply to Tall_Allen]

I was told my pca is aggressive (ductal) has anyone else had this form and had success controlling it or I am just wasting time with these treatments?

[Tall_Allen in reply to Scootman]

Ductal is aggressive and requires more aggressive therapy than usual. It often puts out little PSA, so monitoring it can be challenging. Lacking a good biomarker, you have to use scans more frequently to monitor the success of treatments.

[Scootman in reply to Tall_Allen]

is it treatable though

[Tall_Allen in reply to Scootman]

yes

[Patrick-Turner]

I had EBRT for primary treatment to PG in 2010 and beam paths had 4 directions in a cross formation.

By SBRT I assume you mean stereotactic beam radio therapy which I also had in 2016 as salvation radiation to PG to increase total level from 70 Grey to 101Grey.

I had Cosadex added to my ADT in 2016 and Psa went from 6 to low of 0.4 then up again in 6 months, and I really doubted any of the X-ray beam radiation did much to kill much Pca at all. Cosadex failed so I began Zytiga, and Psa went from about 6 to 2 for 2 months, then up again to 12 and increased mets were seen in PsMa Ga68 scan. Then I had chemo on its own, and Psa went from 12 to 46 after 4 cycles, so it was declared a failure and I began Lu177 in November 2018 with Psa at 25, and after 4 shots of Lu177 and 12 months later while on Xtandi, Psa went to 0.32 lowest, but by 5 weeks ago it came back to 30.

But no soft tissue mets were seen in scans and I now have mainly bone cancer. Doc does not favour Ra223.

I'm having more Lu177 now, 5th shot was 24 July, Psa moved from 30 to 15. Xtandi is not working to slow Pca growth speed and ADT stopped working years ago. But for last shot Lu177, Veyonda was used and both Xtandi and Veyonda are thought to boost PsMa expression hence attract more Lu177 to Pca mets and thus get a better initial response to this second course of Lu177.

ADT and the add-on drugs of Cosadex, Xtandi, Zytiga did not seem to kill many Pca cells in my case, but merely slowed Pca growth and lowered Psa for awhile.

Any form of beam RT with X-rays may work well for some men but not others who are radiation resistant, and there is a strict limit on how much beam RT can be used less it damage bowels and other organs. Much more than the limit may be needed at PG to kill Pca there.

Doc mentioned he might add Ac225 to Lu177 for a 6th shot due in about 4 weeks, but he can't decide yet because we don't know how much response I get from the 5th shot. If Psa goes way down, doc may delay having more Lu177 for awhile. I cannot have too much Lu177, there is danger to a few organs having to deal with expelling Lu177 from body.

Patrick Turner.

[Wife32 in reply to Patrick-Turner]

Thank you for the information. Where do you go for your treatments?

[j-o-h-n in reply to Wife32]

FYI.... Patrick-Turner is located "down under" Australia..... (but don't hold that against him)...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 08/19/2020 4:37 PM DST

[Patrick-Turner in reply to Wife32]

I live in Canberra, a small city in Australia and 300km southwest of Sydney, so my primary Pca treatment was at Canberra Public Hospital. But for salvation IMRT using the Calypso RT machine I went to Epworth private hospital in Melbourne, 800km south of home. For Lu177, I go to Waratah private hospital at Hurstville, a suburb of Sydney.

The public hospitals do not have nuclear therapy treatments yet, and had no SBRT in 2016, so my oncologist was happy to refer me to get what I wanted at private hospitals which cost a lot of $$$$. He thought that chemo would not work for me, and it didn't, and thought Lu177 would be a better option, after he'd read up about what Lu177 is capable of doing.

But BTW, last year I also had some EBRT to my right hip joint area where I was given 20 Grey over 5 days to a rectangular area that included two 10mm dia mets, one in pelvis above hip joint and one below joint in femur. I don't know if that made sure the last 4th shot of Lu177 in May 2019 worked better, but I accepted the local hospital's offer for that RT, but first I checked that the total RT given to that hip joint didn't exceed what was the allowable maximum, something the doctors didn't mention. I did have some pain in right hip, which was mis-diagnosed to be a worn out hip joint or RT damage. I went for MRI and Xray of hip and a orthopedic doctor at Calvary Hospital had a real good look at scan result and proved to me the hip joint was just fine, and I could keep on cycling. Pain was not from Pca, but from doing some building work at home some 4 months before where I must have injured bursa surrounding a muscle and that took 3 months of no cycling to heal. Its now all OK again. Maybe slow to heal because of radiation. I was lucky not to have side effects from the 20Grey to hip area. They just did vertical beams to the hip while I laid flat, but X-rays go through some healthy tissues, but not much, so I was OK, but where RT is given to mets all through pelvis the side effects on bowels can be bad.

Patrick Turner.

[Wife32 in reply to Patrick-Turner]

Thank you! We are now looking at lu-177.

[jdm3]

I had SBRT to the hip. It worked for that spot and I'm glad I did it. I was also on ADT at the time so can't say if the SBRT alone would have been effective in eliminating the metastatic lesion, but no more pain. Worth a try.

[sjpoli46]

Like you, I have PC in my pelvic region and Xtandi stopped working after 9 mos. My oncologist (from UCLA) put me on Lynparza (olaparib) which is a PARP inhibitor it knocked my PSA down immediately but then went up a month later but after that it steadily went down and continues to go down. No side effects, no pain and I feel great. I would ask your oncologist about it.

[Patrick-Turner in reply to sjpoli46]

Last Tuesday I cycled 12km up hill and against a headwind to visit a geneticist lady who works in a suburban branch of Canberra Hospital, Govt owned and funded, and free for all who are admitted.

I spent a very pleasant 40 minutes talking with the bright minded doctor - geneticist,and she wrote down all I could say about my family history which is riddled with cases of melanoma, ovarian and breast cancer, and I suspect I have DNA that is positive for Brca1 +2 genes which means perhaps PARP like Olaparib might give me the winning edge in my war with my Pca, ( aka Puff The Magic Prostate Grenade, continuing to explode slowly ).

She sure agreed with my oncologist that my DNA may well justify trial of PARP drugs. There are now a range of these things.

But at near consultation conclusion she'd written a list of about 12 other equally dangerous gene mutations which all have names, and all these would be looked for to find out just what chemo or PARP agent would be more likely to work wonders at killing Pca cells, and far better than chemo and other chemicals ever had. She said the info on gene defects for cancer patients is rapidly building up, so treatment is become better aimed at Pca and other types of cancers. The DNA analysis may predict other forms of cancer or other diseases I might get in future years ( If I live long enough ) and and said it would be wise to have DNA examined in 3 to 4 years because the information on genes is building up at such a fast rate.

After we finished our talk I gave a blood sample, and cycled home, propelled well by a following wind and elated to have spent time with such a pleasant lady full of intelligence. It was a WOW time. But system of DNA analysis is a bit slow because there are So Many ppl being referred to this service and so few experts doing analysis that I won't know results for another 6 weeks.

Meanwhile, I wait and see how the last Lu177 infusion brings down my Psa. I had 4 x Lu177 shots last year with last one in May 2019, and Psa went down to 0.32 nadir, but then rose again to 30 just before 24 July this year when I had 5th Lu177 shot with help from Veyonda and continuing Xtandi to boost PsMa expression and thus make uptake of Lu177 gathered at met sites much greater. Psa is now about 15, and already slight symptoms of some aches and pains have eased down. Next Lu177 is about due on about 24 September, but if Psa goes real low the docs might wait awhile to see what happens before offering me a 6th shot of Lu177. So I'll know DNA test results by about end of September, and it would not take long to get appropriate treatment started on that flank of the battle, and its going to be soon enough, because luckily I don't have rapidly growing Pca, and it seems all my Pca is PsMa avid, so all should respond to Lu177, and recent FDG PET scan found no Pca that does not make PsMa and Psa. It is probably stupid of me to ever think that I may wake to a dawn where Remission rises like the Sun. But I can't help but dream just a little.

Today I cycled 75km, and it was a cold blustery windy day, but I felt so well, and enjoyed my cycle ride.

I find the spirit of My Team, ie, all the doctors and nurses I have to deal with is superb. None are perfect ppl, any more than I am, but they all enjoy helping other ppl stricken by Nature's slings and arrows.

Always be positive, open minded, and never make your team members angry and you get a better result.

Patrick Turner.

[Rocketman1960]

Hello Scootman; I am 10 years in on the journey and had SBRT for Lymph Nods that got big enough to see. Worked like a champ! no activities in the lymph nods they shot at. Im not out of the woods but its reassuring that they have a plan to combat when scans indicate to do so! I would go again without hesitation. Very little downside, lots to gain.

[Kevinski65]

I M not a good example. I' m almost like 8 years out 2.5 lupron, 5.5 lupron and Xtandi. Last PSA was .04 by local oncologist. I took a lot of supplements. I'm in a study at NIH. Stage 4 and was told to get affairs in order. Study was Prostvac and Xtandi or Xtandi alone. I'm in the Xtandi alone arm. NIH wants me to stay on Lupron. Have had 2 year doses of Reclast ( Zometa). I currently take zyflamend, NAC , vitamin D and calcium. Good luck.

[Kcski]

My father had a lot of cancer kill with chemotherapy. He did Docetaxel for six sessions. It really eat the cancer down. He also exercises everyday and eats a Whole Foods, low processed diet.

Best wishes!!!!!!

[Kevinski65 in reply to Kcski]

The thing about these add on approaches, it's hard to prove that they did anything. Washington state did a study on zyflamend whole body but I don't know the results.

[Shanti1]

My husband had SBRT to 4 bone mets. No idea if it worked or helped as he is on ADT/Zytiga and PSA is undetectable. We decided to do the SBRT because the mets were in the pelvis and one rib and and they were small, so the side effects were negligable.