Whole pelvic salvage radiation may be... - Advanced Prostate...

Advanced Prostate Cancer

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Whole pelvic salvage radiation may be better than precisely targeted lymph node salvage radiation

Tall_Allen profile image
31 Replies

Last week, there was an open question about the precisely targeted treatment of recurrent pelvic lymph nodes at the Mayo Clinic. This European study suggests that patients did better with whole pelvic salvage.

prostatecancer.news/2020/12...

Here's last week's Mayo study:

prostatecancer.news/2020/12...

Note: they were both retrospective studies.

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Tall_Allen profile image
Tall_Allen
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31 Replies
JPnSD profile image
JPnSD

Thank you. I appreciate greatly your support to all the participants on here. You are an incredible resource. Thank you for all you give of yourself to this community....and best wishes for a great 2021!I am schedule for pelvic RT in 2021....your post feels like a holiday gift :)

Ahk1 profile image
Ahk1

Thank you so much TA for posting this and for your hard work following these complicated issues which most professional DR’s have a hard time answering them. The questions that has not been answered in the trials, as you mentioned them in your article, are what makes me hesitant now to pursue radiation in general in my case. Happy holidays.

Tall_Allen profile image
Tall_Allen in reply to Ahk1

I suspect that future RCTs will only show a benefit if there are very few small metastases in pelvic lymph nodes only, and whole pelvic treatment and long-term ADT is given. Otherwise, life-long ADT (the current SOC), perhaps augmented with second-line hormonals, will certainly prolong life and quality of life.

garyi profile image
garyi

Most interesting data, TA. Thanks. As usual, excellent write-up.

The more we find out, the more we discover how little is really known.

Howard53545 profile image
Howard53545

Great, my oncologist decided to light up the entire pelvic area. Hope it works

Justfor_ profile image
Justfor_ in reply to Howard53545

From the original:

"Conclusions

ENRT reduces the number of nodal recurrences as compared with SBRT, however at higher toxicity."

No free lunch here...

treedown profile image
treedown in reply to Howard53545

Mine lit up pelvic and lower abdomen. I am starting to think I am the poster child for over-treatment.

Tall_Allen profile image
Tall_Allen

Oligometastatic is usually defined as 1-5 detected by a bone scan/CT. With the newer PET scans, there are many metastases smaller than the 1 cm limit used for CT or MRI. In the ORIOLE trial, there was no advantage when more metastases were detected on a PSMA PET than showed up on a bone scan. And in this European study, neither radiation technique had an advantage if there was more than 1 LN met on a C-11 Choline PET - perhaps that suggests no MDT advantage for more than 1 met, perhaps not.

monte1111 profile image
monte1111

Tall_Allen's opinions, posts and replies always matter to me. As does the opinions of many of the other posters here. Except j-o-h-n. I was sure I wrote rosetta on that stone I threw through your front window.

j-o-h-n profile image
j-o-h-n in reply to monte1111

I respect Tall_Allen's opinions but subconsciouly despise them, similar to my opinion of you......

youtube.com/watch?v=rQMVqMA...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 6:47 PM EST

monte1111 profile image
monte1111 in reply to j-o-h-n

Holy Taylor Swift Bat-j-o-h-n!!!*%# Did you see the mouth on that gal? I'm ordering my Oculus today. We could all use a little reality. Some more than others. Excuse me now, I need to go clean off my front porch.

j-o-h-n profile image
j-o-h-n in reply to monte1111

Don't forget to take them off and remember do not look at yourself while you're naked. .... BTW that gal is Deep Throat's younger cousin....

Leave it on the front porch it'll save you from using up your fly paper.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 7:12 PM EST

monte1111 profile image
monte1111 in reply to j-o-h-n

The flies have all gone to New York City for the winter. My days of "Mirror, mirror on the wall, who's the longest of them all?" are long gone.

j-o-h-n profile image
j-o-h-n in reply to monte1111

Me <----- giggling..... last time I had this much fun was when I was arrested for being a peeping Tom......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 8:21 PM EST

Boywonder56 profile image
Boywonder56 in reply to j-o-h-n

Hey you guys knock it off in the back of the class...or youll write the golossary in back of science book three times.....

j-o-h-n profile image
j-o-h-n in reply to Boywonder56

Can we trace the playboy centerfold instead?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 10:01 PM EST

Boywonder56 profile image
Boywonder56 in reply to j-o-h-n

Nuns wouldnt like that....

j-o-h-n profile image
j-o-h-n in reply to Boywonder56

Nun of their business....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/23/2020 5:07 PM EST

monte1111 profile image
monte1111 in reply to j-o-h-n

What are you tracing Barbi Benton with?

j-o-h-n profile image
j-o-h-n in reply to monte1111

With the tip.........difficult using the stem.........(blurry)....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/23/2020 5:09 PM EST

j-o-h-n profile image
j-o-h-n in reply to monte1111

FYI Barbi Kenton:

BornBarbara Lynn Klein

January 28, 1950 (age 70)

New York City, U.S.

OccupationPlayboy model, recording artist, actress, interior decorator

Years active1970–1986

Spouse(s)George Gradow ​(m. 1979)​

Partner(s)Hugh Hefner (1969–1976)

Children2

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/23/2020 5:13 PM EST

BruceSF profile image
BruceSF

TA - in your blog I think you meant ‘PSMA” in the sentence ‘metastases smaller than 4 mm, and those that put out only small amounts of PSA remain invisible.’

Tall_Allen profile image
Tall_Allen in reply to BruceSF

No- it is correct. Detection increases with increasing PSA. When PSA < 0.2, no PET scan has good detection rates.

Karmaji profile image
Karmaji

Diagonised in May 2019. T3b Gl 8 PSA 30nothing on bone scan

With Choline 2 tiny spots on pelvic thus M1 oligo

Started ADT Firmagon in July 2019

RT in Nov 2019 20 boost sessions

with RT boost on tiny pelvic spots..

In Dec 2019 nothing on Choline sure under ADT..

Since Jan 2020. psa <0.03

May u express your opinion on this choice

URO went for reducing load using RT

...his gut feeling. RO agreed

One PC Onco is not sure and other goes for this.

Thanks for some clarification

I am on 3 month ADT now...

excellent QOL so far at 80 years

Thanks and enjoy year end...

Tall_Allen profile image
Tall_Allen in reply to Karmaji

Sounds good. STAMPEDE showed that RT to prostate in oligo situation is beneficial. Glad you are sticking with ADT.

NOCanceros profile image
NOCanceros

Hello Tall_Allen

When i had a 3 spot cancer cells in my LymphNodes ,i asked my oncology Dr.Weise from Germany about to treat the 3 spots ,he told me we will irridate not only the 3 spots all the area surrounding .Ofcourse he showed me the spot on his computer and how will treat it.

Very good Dr.

Merry christmas to you and to all members of HealthUnlocked.

George

Tall_Allen profile image
Tall_Allen in reply to NOCanceros

This study suggests that it is better to treat all pelvic LNs than just the cancerous ones with an area around them. Some top ROs treat as high as the lymph nodes at the aortic bifurcation.

j-o-h-n profile image
j-o-h-n

I admit it...........(turd on front porch) Monte put it there........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 6:50 PM EST

j-o-h-n profile image
j-o-h-n

I know, he transferred it to you..... (Christmas present)....

me <===== puts down joint....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 6:55 PM EST

j-o-h-n profile image
j-o-h-n

Wait till you get the fruit cake.........(Originally addressed to A. Lincoln)

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 7:05 PM EST

j-o-h-n profile image
j-o-h-n

minus the nuts..........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/22/2020 7:13 PM EST

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