Hello good people
I did PSA blod test it was <0.1 ofcourse i'm on bicalutamide 150mg until 18/11/2020 and then i will stop it according to my Oncology Dr.Carsten in Germany then waiting for his next advice.
Hope every body here live long life.
Thanks for reading.
George
Why your German Oncologist wants to stop Bicalutamide when it is so effective for you ?
You wrote four months ago that your doctor recommended intermittent ADT. So it seems that your doctor is recommending a break now.
By the way, did you get your lymph node mets zapped? Prof. Marnitz-Schulze in Cologne did that for me: strahlentherapie.uk-koeln.d...
She has a Cyberknife radiation machine for that.
Hi GP24,
Did you have just the one node zapped or the 2 chains (rows) of lymph nodes nearest the prostate bed done? With or without ADT? I don't have any showing on PSMA scan -- only one 1/4 inch spot in prostate bed area ... I am considering what to do ? just shoot the one spot or do the lymph nodes too. they are saying do 36 IMRT radiation treatments. I was hoping to find a trial with immunotherapy and hypofractionated radiation (one low dose burst of radiation and then let the immunoT kill the rest). I'm trying to avoid ADT .. current PSA 1.37 only taking Avadart every other day and various supplements. 4 years post RP.
You have nothing written in your profile so it is difficult to provide a recommendation. I assume you have a PSA recurrence after surgery and the current PSA is 1.37 because you did not follow the advice of your doctors to radiate the prostate bed when the PSA value reached 0.2 to 0.5 ng/ml.
If this is true, than you should do a radiation to the prostate bed with a higher radiation dose to the visible spot. Should lymph node mets appear on a PSMA PET/CT at some point in time you can get these radiated then. You do not need ADT when radiating the prostate bed. If you are high-risk, six months of ADT would put you on the safe side.
I had four visible lymph node mets and got these zapped. Whether whole pelvis radiation would have been the better treatment I do not know. This trial currently tries to find out:
ncbi.nlm.nih.gov/pmc/articl...
RP 4 years ago -- There was no consensus on what to do -- 6 doctors with 6 different opinions -- anywhere from prostate bed and whole pelvic radiation of lymph nodes with 2 years ADT -- to RT to prostate bed only no ADT -- to RT to bed only and 6 months ADT -- to no RT just 2 years ADT -- to wait til PSA reached 1.5 to 2 and do scans. (Dr. Kwon @ Mayo Clinik still won't even see me till PSA reaches 1.5 for scans) Two PCa doctors @ Houston Methd. said they had seen patients whose PSA had risen to 1 or 2 and just stayed there. Another said if PSA doubling time was slow enough it would not matter you out live it. My Onc. at NIH Maryland put me on a trial to do just that -- a trial designed to slow the doubling time with immunotherapy and out live it. Currently my M D Anderson Onc. is saying do nothing till PSA is 10 or whatever my comfort level is then intermittent ADT. The Radiation Doc. at M D Anderson is saying RT to everything plus ADT. One told me early on, that they can't cure it if it gets out of the prostate, so they are trying to treat PCa as a chronic disease -- like blood pressure or diabetes.
Meanwhile it is possible an immunotherapy will come along that can spare all the irreversible damage caused from salvage RT that may not cure me anyway.
As per the trial you noted -they still don't know what to do - do the whole pelvic? -- do only the lymph node showing? -- do with ADT?- do without ADT? Some say forget it and only do ADT -- some say chemo -- who knows?
If they radiate the prostate bed and the spot in the prostate bed, I can't see what would have been lost other than 4 years of side effects a possible blown out colon and bladder, edema etc.
George,
as a patient you want to get rid of the recurrence. But as long as there are no mets this recurrence will not cause problems for years. So to wait for a PSA value of 10 and then start intermittent ADT is a valid way to go, at least the the NCCN guidelines do not recommend against it. This could be done if you want to avoid ADT now.
As I wrote, the SOC would be to radiate the prostate bed plus the recurrence. You wrote that you do not want to do that because you are afraid this may cause side effects. Radiating just the prostate bed has a low risk of side effects. If you add radiation of the whole pelvis to that, the risk is significantly higher.
So the recommendation of your MO and your RO are both valid ways to go and you can decide. If you decide for radiation, I would avoid radiating the lymph nodes without detecting affected lymph nodes on a PSMA PET/CT. As I said, this RT has a higher risk of side effects and could be done in a second step after radiating the prostate bed when affected lymph nodes are detected. You could also zap these lymph node mets with SBRT then. This has a much lower risk of side effects than IMRT in this case.
Your original question was, can you zap your recurrence with SBRT? It is seldom done, but possible. I had a recurrence in a seminal vesicle which was not removed during the operation. I got my doctors to put fiducials into this seminal vesicle and then had it zapped with SBRT. The recurrence is removed now, SBRT provides good „local control“. You do not need to combine SBRT with ADT in this case.
GP24
GP24,
Thanks for the input.
Is the quarter inch spot found (on PSMA scan) in the seminal area of the prostate bed not considered metastatic. Or is that considered locally advanced. The radiation Dr. thinks there is a 40% chance he can cure me with radiating the lymph nodes and the prostate area. That sounds very enticing to try. What are your thoughts?
I need to know your Gleason score to discuss that.
pre surgery biopsy 3 + 4= 7
second opinion of pre surgery biopsy 4 + 5= 9
post surgery examination of entire prostate tissue 4 +4 =8
I would consider the quarter inch spot as a recurrence and group it as locally advanced. It is not metastatic because it is no affected lymph node.
Whether the RO can cure you depends on the definition of cure. What he means is that you could be biochemical progression free for a number of years. The recommendation for a salvage radiation in the NCCN guidelines is based on the Stephenson study. He showed, that a certain percentage of patients will have no rise in their PSA value after the radiation of the prostate bed:
ascopubs.org/doi/10.1200/JC...
In this study he states: forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer.
Since you have a Gleason 8 cancer your RO was refering to the 41% mentioned here.
However, you have a higher PSA value than the 0.5 ng/ml which are assumed for the 41%. The patients in the study had no visible mets or lesions, just a rising PSA value. The radiation was directed to the prostate bed and not to the lymph nodes. I guess your RO thinks a Gleason 8 usually has spread to the lymph nodes so lets radiate these as well. However, ROs never radiate all lymph nodes and there are lymph nodes outside the radiation template which can be affected just as well. The radiation to the prostate bed is done assuming there is invisible cancer which causes a rise in the PSA value.
I do not know when your last PSMA PET/CT was done. If it was more than six months ago, I would get another PSMA PET/CT before the radiation suggested by your RO. If a met shows up outside the area that is planned to be radiated the RT cannot be curative. In this case I would do SBRT to the visible lesions.
As mentioned before, you have the option of just radiating the quarter inch spot with SBRT after placing fiducials. However, this will not destroy invisible tumor in the prostate bed and surrounding lymph nodes, should this be present. After the SBRT it is difficult to find an RO which will radiate the prostate bed and the lymph nodes should you then decide to do that. You have to continue to radiate the lesions which become visible with SBRT.
Helllo
Welcome
Are you taking ADT
My brother did a psma pet ct and they found in the seminal area cancer cells ,DR.shipra and dr. weise recommended for him HDR - Boost Gy how much it depends on the patient cancer degree.Plus external beam radiotherapy with GY how much it depends on the ocology Dr. his estimation.
N.B: If the patient have a heart problems should the oncology DR. know about that because HDR treatment have risky for bleeding.
This clinic they have experience of treating their patients :
strahlentherapie-koeln.de/
My question is your Oncology Dr. did he has the experience ,other wise i gave you the adress of the clinic ,you can always discuss your case with them and tell them i will compensate your advices.You will if you want give them the last result and the last advice from your Oncology Dr. tell them where the spot are located.
I hope they will help you.
Regards
George
hello
I did anradiation with the same DR.i was in germant for 36 days and i took the biculutamide untiloctober 2019 and he told me to stop it after a period my psa start rising from <0.1 to 0.16 later to 0.4 though he told me to start bicatulamide 150mg again until november and i will be 6 months period.then i will ask him what to do......!
George
Hello
I did my treatment från 2010 until 2019 in the strahlentherapie-koeln.de/
First prostate enlargement,in 2007 in the AM RING CLINIC in cologne Germany it was with green laser.
In sweden they discovered in 2010 samples from my prostate it was a cancer with Gleason 3+4 within the prostate area and they recommended to take away the prostate,i refused.
Gleason it was 3+4 then in 2010 i did brachytherapy with 42 seeds to my prostate in Germany then after 6 years it comes back with Gleason 4+3 then they did imrt/igrt in 40gy with integrated interstitial HDR - Boost 2*10GY in 2017..
In 2019 the oncology dr. he did external beam radiotherapy in IMRT/IGRT technology to a dose of 47GY .when the psma pet ct discovered 3 spot on my lymph nodes,the oncolgy DR. he showed me the spot on the screen .
All these treatment after my reccurence ofcourse i did in uniklinik Köln(Cologne) psma pet ct 3 times of course they discovered the spot on my lymph nodes then as i mentioned in 2019 treatment.
now i have been treated in 10 years period .
Last time my Oncology DR. carsten weise to start intermittent therapy according to his experience.Thats my case now.
To take Bicalutamide 150mg for 6 month period then under this november2020 i will contact him for further information.
Healthy to all people here
George
Let me give you some background on Bicalutamide therapy in Germany and why Dr. Weise may recommed that. The European guidelines recommend a late start of ADT in case of a recurrence. E.g. when bone mets start to cause pain.
The German guidelines say, do not treat a rising PSA value with ADT while CT and bone scan (not a PSMA PET/CT!) show no metastases. You may start if the PSA value reaches 10 ng/ml.
However, most urologists start with ADT at any PSA value, e.g. 0,27 ng/ml, when their patient becomes anxious. Good doctors like Dr. Weise think, the anxiety of the patient is no good oncological reason to start with ADT. So a few doctors use intermittent Bicalutamide therapy to keep the PSA value below 10 ng/ml for a long time with little side effects and avoid that the patient becomes anxious.
The American cancer statistics report that patients with lymph node mets seem to live just as long as the patients without these. However, I have to admit, I prefer to zap these anyway. These tiny lymph node mets detected with a PSMA PET/CT are not really dangerous, they do increase the PSA value. As I said, you can get these zapped at the Uniklinik Cologne, the clinic that treated you does not have such an expensive machine.
Seems the brachytherapy was done by Prof. Machtens.
If bicalutamide is working, don't stop taking it. I never understood why doctors would have patients stop a medication if it's working.
Hello
May be in the long term it will be a resistant to my body maybe.
George
If bicalutimide fails you can always move to other ADT drugs, i.e. zytiga, xtandi, etc. I was on bicalutimide for 5 years.
Glad to see a low PSA for you. Still curious... has your doc said WHY only 6 mos on 150mg, rather than 12 mos or even more?
Hello
Well he told me its our experience in this field,other wise i have no another option.
George
Hello
I asked already and he told me the oncology Dr. its our experience.
George
Great news sincanceros ! 👏🏼😎But many of us here,that are on longer term
ADT will ask why stop it , if it’s working? I’ve been on the adt train over five years.. I’m not saying it’s without side effects. But from my perilous Start with APC I’m lucky to still be kickin . Follow professional advice . It is true, there is no known cure for stage #4 .. APC... Some have lived for decades ... Take care
Thanks
Hello
Struggling for life.i will not give up and i'm happy to read all the information from this good peoples.
I'm drinking some times my Beer and my vodka and trying to be happy and visting my children and their children .Never give up.
Have a nice day
George
Children and their children are one of the greatest reasons to endure whatever comes .. Peace to you
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j-o-h-n Saturday 09/05/2020 5:06 PM DST
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