Looks like just one bone met. Radiation or not?

[LeeLiam]

I need more advice. For a quick recap, I was treated with seeds and external beam in 2006. PSA dropped slowly over a few years and got to <0.1, It stayed at 0.1 for several years. It started rising a couple of years ago and reached 3.1 last August. Then 3.7 end of November. I had an Axumin scan on 9/10. It showed only uptake in the "center of the prostate likely representing local recurrence." I felt this was good news and was planning some kind of focal ablation. I had a rhPSMA scan 10/23. It showed nothing in the prostate gland. It did show a bright spot on the pedicle of the T8 vertebrae. The doc said that could be cancer or it could just be arthritis. We did a thoracic MRI on 11/4 but it was inconclusive. I then went to an interventional radiologist, Dr. Joe Busch on 11/9. He did a 3T mpMRI on the prostate bed but didn't see cancer so we did a whole body mpMRI on 11/18. Dr. Busch sent all of my scans to a whole-body scan expert, Dr. Anwar Padhani in London. They feel the only cancer they can see is the T8 pedicle. Dr. Busch thought a biopsy on the pedicle was an unnecessary risk and thinks I should hit the pedicle with proton beam or SBRT (he prefers proton beam). After reading Tall Allen's post on 12/10 regarding the Mayo study, I am wondering if this is the best route. Dr. Busch urged me to watch a recent (11/28/20) YouTube posted by Dr. Padhani.

youtube.com/watch?v=u5fiu9i...(Not working as expected?)

He seems to think that, due to the improved imaging now, treating the mets in oligometastatic is viable. I would love to hear from anyone who can watch this and comment (especially you, Tall Allen). Also, there is a newer (12/7/20) video:

youtube.com/watch?v=h3Pj_Pf...(Not working as expected?)

Also, any comments on radiation with or without a biopsy of the pedicle? Also, opinions on proton versus SBRT? As a completely different approach, I would be open to going to Europe for LU-177 treatment. I really appreciate your help.

[LeeLiam]

Nal, thanks for that. But the pedicle is on the T8 thoracic vertebrae. Does that change anything?

[Tall_Allen]

I couldn't get the videos to play. My feeling about metastasis-directed radiation remains unchanged - if it is safe, why not? But it has to be combined with systemic therapy (e.g., Lupron + Zytiga).

Even if it doesn't slow down the cancer, it may prevent future spinal compression. You have to talk to a good radiation oncologist about safety. T8 may be close to vital organs that are easily damaged by radiation. I really don't know and don't want to guess. If it is safe, a single large zap of SBRT may be sufficient for good local control:

prostatecancer.news/2019/08...

If there are safety concerns, and you can travel to Germany, you might want to investigate carbon-ion radiation:

prostatecancer.news/2016/08...

[LeeLiam in reply to Tall_Allen]

TA, sorry. I didn't know it would embed the video. Maybe the link will work: youtube.com/watch?v=u5fiu9i...(Not working as expected?) and youtube.com/watch?v=h3Pj_Pf...(Not working as expected?) . Let's see.

[LeeLiam in reply to LeeLiam]

Ok, that didn't work. How about go to YouTube and add /watch?v=u5fiu9iahhM&t=6s&ab_channel=anwarpadhani to the address line. Also, /watch?v=h3Pj_PfILfw&ab_channel=anwarpadhani. I obviously REALLY want you to see these and get your take. Thanks.

[LeeLiam]

Thanks, Nal. My idea for the LU-177 was because the pedicle was so bright on the PSMA I thought the treatment would attack it with no danger to the spinal cord.

[GP24]

I feel it is unlikely that it is beneficial to keep your mets for later. Zap it with SBRT as Nal said, this needs just three sessions and you are done.

[GeorgeGlass]

Isn't there a good place to do this proton in the states? I met with a doctor at UPenn and they seem to have a good program.

[LeeLiam in reply to GeorgeGlass]

They have both proton beam and SBRT at my hospital, Emory in Atlanta.

[ctflatlander]

FOI I had SBRT to bone T3 along with IMRT to the prostate 1 3/4 yrs ago. I was undetectable for 8 mos and PSA starting to rise. Scans just done showed no further visible progress. Staying on ADT until doubling.

[Mjex in reply to ctflatlander]

I had a similar experience. Post RP I had a rising PSA. After salvage radiation it persisted, but still below 1.0. Did a choline Pet scan in 2016 and it identified a small lesion on T4. Biopsy was inconclusive since the spot was so small and difficult to get to. Radiation wiped the spot out and I was off lupron and nondetect for more than 24 months. I now have a slowly rising PSA, which since 9/19 has gone from 0.09 to 0.48 on my most recent test, last week. So, my personal experience with the whack a mole approach seems to be positive. Any ideas?

[LeeLiam in reply to Mjex]

Thanks for your input. Very happy for you and ctflatlander.

[ctflatlander in reply to Mjex]

I have a slow rising PSA, now at .75 Recent scan is clear. I am on Lupron/Eligard and Aberaterone and scheduling early next year castration, that's if it's safe by then. My MO thinks Chemo or Provenge is next when it doubles every 3 months. I'm 77 and want to eliminate the shots for the rest of my life, chemicals to my body when surgery I believe is best for me. Based on TA's recent post on SBRT, I don't think I would do it again. Bob

[LeeLiam]

I was in a clinical trial for the new rhPSMA scan. It is what picked up the lesion on my T8 pedicle. The trial covered the cost of the thoracic spine MRI. It may cover the cost of the radiation. I haven't talked to them about that yet. I was waiting for the results of the whole body mpMRI.