I have a question for all of us Stage 4 Comrades. Is is a good idea or a bad idea to Zap the bone mets??? I have a lot - 15 on the scan - but the mets on my hip bones are marble size. My MO is not a fan of zapping the mets unless there is a lot of pain. Thankfully, I have very little.
What are your thoughts. So appreciate your feedback.
Thanks Tom
Usually bone mets are radiated in three sessions to mitigate pain. This does not zap them. You could try an Ac225 / Lu177 mix therapy to attack the bone mets.
I cannot answer your question, if you'd like to get rid of your mets, you can try this therapy.
Thanks GP
My bone mets (3, ribs and pelvis) were zapped in 3 session each and my understanding is the the tumors are now gone. This was not palliative as I never had any pain.
Thanks - did it help?????
Tom,
15 mets is way above any definition of oligometastatic disease, which some think may be curable. The feeling is that PCa that is widespread needs a systemic approach.
Regarding pain, I never had pain with my first (solitary) met at L5. However, my radio-oncologist was concerned about the risk of fracture.
-Patrick
Thanks Patrick
My L5 did indeed facture. Two pars fractures.
I ask myself if APC is curable. What is the difference between remission and cured...May be stop adt and see what happens....Are there any blood test markers besides PSA?
And how one my say if oligo PC is curable...which markers one may use...
thanks Pat
"Cured" is when you die before it returns. lol
With a durable remission, one should act as though it will return & do all the things one would do if not in remission. IMO And perhaps those things will keep you in remission.
30+ years & the PSA era continues. In the past dozen or so years, there have plenty of other markers & combinations of markers studied that might have done away with the dreaded biopsy, but the procedure is a cash cow.
-Patrick
Damn
Thanks ..lot of wisdomI need some help in identifying blood test markers which may give some indications before PSA marker. My URO says only PSA is the key....
My GP has no idea except the standard blood tests....
NSE.... does it indicate something....For URO ;...no good as marker
If there is any benefit (unknown right now) it is only in men who are oligometastatic (1-5 distant metastases). With 15, Xofigo is a much better idea - it will also treat bone metastases that are too small to see.
Thanks TA:I am starting chemo in a week. Not looking forward to it but took my MO Advice as well as you and others to not wait now the Zytiga has failed. PSA now 15.
Really not know what to expect concerning side effects. Still in physically good shape. Just some slight hip pain. Did you have chemo???
Just finished my ninth chemo session of Doctaxel. The side effects got worse each time but have been bearable. I lost my hair but no biggie there, didn't have much. The week after is tough with fatigue and a general fogginess. But by week 2 that clears up. Dry mouth occurred for me for a few days as did acid reflux. Acid reflux for me was worse side effect. My hands and feet have never felt numb. I used ice packs on both during treatments. My nails now have turned a great shade of purple. If you have any questions I will be glad to try and answer.
Wow New York - 9 sessions. How are the results?
I do have some questions if you don't mind:
1. I am a very light eater - very bland - only soup and a roll at night - because I too have acid reflux - big time. Did you change your diet before and after each treatment???
2. Please tell me about the ice packs. I have mild neuropathy now in my feet. I heard it gets much worse after 5 - 6 treatments. What about an ice pack for your head??? Just what I read.
3. Did you continue to exercise? I walk 2.5 miles - 4 times a week -lift weights and play golf. Did yo feel like it????
Hope you don't mind the questions. My anxiety is though the roof with questions.
Thanks,
Tom
Results OK. PSA dropped from 30+ to 5. Has stayed at 5 for last four sessions. However alk phos has come way down and scans have been improving, especially bone density. Going to do one more session.
Diet: Bland until I feel acid reflux has improved. Yogurt and vegetables with high water content help (cucumbers, celery etc.). Chicken also ok. Tried pasta with sauce because I thought I was improving that killed me.
Icepacks seem to help on feet and hands. Put your hands and feet into a plastic bag and then put ice pack on top of hands. Also suck on ice during session. Stayed away from ice cap because I wasn't worried about losing hair. Place I am at also offers acupuncture during sessions. I've used that last two times to help with hands.
I try and walk 3-4 miles a day. Light weights. Its sometimes hard in the 3-4 days following my session as that is when pain and fatigue set in. However after 5-6 days very able to walk again and actually feel good. In the 3-4 days I do get what my Doc calls a pain pulse which as it sounds is painful in my joints. Again gone so far after 5-6 days. I like to fly fish and until winter came I was able to get out into the woods and streams with no problem after that initial 3-4 days. Just have to be careful about falls.
So how will I feel during the first session?Sorry for the questions.
Day of and two days afterwards I felt fine. The steroids they give you before the chemo helps with that. The third thru 6th day after I felt awful and just rested. Tired and achy all over my body. However after that I felt good until next session. Was able to do anything I wanted to, including exercise but had to watch what I ate. Then the pattern started over again. I lost my hair after third session.
Did you wear an ice cap on your head, hands and feet?????
Just on hands and feet. Also sucked on ice chips to help with not losing taste. I passed on head cap. Wasn't concerned about hair loss.
Sorry - I forgot about your ice description above.So appreciate your input.
Did your Alp and PSA come down?
Why 9 sessions
Thanks,
Tom
Not a problem. PSA came down from over 30 to 5. My PSA has never dropped below 5 on other treatments. Doc feels in may be because I still have my prostrate. My ALP went from over 400 to 63. Reason for 9 is that I seem to be handling them ok and scans keep getting better. He won't go past 10. After next one I take a couple of month break from chemo to let body recover.
Great ALP. Why only take off 2 months? Why not wait until numbers start going up??? Just curious....
Well two months then another scan and make a decision from there.
10-4 I hope you don't mind me asking more questions as I go through this it's so appreciated
Ask away. A ton of people helped me when I started.
Thanks
Hi, If a man has a high volume of bone metastases and lymph nodes after bio recurrence, but after chemotherapy he does not have detectable metastases, in the possibility of appearing again later, is radiotherapy recommended for these metastases?
If you mean SBRT, it is never recommended for high volume metastases.
What I wanted to say was, if the person has no visible metastases after systemic treatment, and then few appear, it makes sense to have sbrt?
Thanks
I understood that. Your cancer is in a polymetastatic state even though you have shrunk them to the point where you can no longer see them.
Ok. The question is to be better informed about my father's possibilities. Thank you.
Thanks
"Is is a good idea or a bad idea to Zap the bone mets?"
Yes... it is a good idea or a bad idea. Unfortunately, nobody really knows WHICH it is.
On the one hand, why play a game of whack-a-mole when the individual mets present no pain? It is a systemic disease. You most likely are in no way "defeating" the terrorist PC community within your body simply by nuking a few of its more prominent outposts.
Or are you? Because on the other hand, there is something called the "abscopal effect" where nuking a single outpost MIGHT signal your body to have an increased immune response to ALL outposts. (I think the effect refers mostly to a benefit of nuking the primary tumor, bet perhaps to nuking mets, too.)
So I sort of disagree with your MO... I will be a fan of zapping some of my mets even if there is only a LITTLE bit of pain (or rapid progression). But with no pain, I will no zap.
Thanks so much for your input
Hi there, tce. I meant to send you this link from a few months back when you recently asked about chemo. There are a number of responses in the thread, "What to know about chemo," that may give you an idea of what chemo may be like, though everyone has his own individual experience. I describe my husband's experience with Docetaxel in the thread.
healthunlocked.com/advanced...
Wishing you all the luck. Please post again if you have other questions.
You are so thoughtful spouse21.Thankful for your thoughts.
Thanks Nal
I would think with multiple mets xofigo would be the way the go.
I have decided to start chemo asap. Will that help???
I would definitely try to zap any bone mets that show up on scans using rapid arc radiation. Lu177 doesn’t do a good job of penetrating into bones in my experience.
I had mine zapped and they came back, Turns out i have the BRCA2 mutation.
When I was recently reviewing a potential course of action should my PCa decide to leave dormancy, my MO (Sartor) was in favor of radiating tumors that became detectable. That said I’m not sure that applies to a large number of them. But I would lean towards hitting the two larger ones if they could eventually cause structural issues and a potential skeletal event. I would think they also have the greatest concentration of tumor cells and would be the greater risk for mutations and additional mets.The tricky thing is timing this with chemo. When I debulked my prostate early on with IMRT and was also considering chemo all of my MO’s felt there needed to be time between the two because of the toll on the immune system caused by each. Most felt chemo should come first. Since I wasn’t 100% sold on having chemo at the time I did the radiation first, and later decided to have chemo about 9 months later. I’m not saying that’s what you should do, I’m just sharing what I ended up doing.
As for my chemo experience, I found it to be pretty rough, the first two or three sessions weren’t too bad but after that it got tougher with each successive treatment. And I still have lasting effects over five years later. But given the effectiveness of all my combined treatments I’m ok with that.
Ed
I chose Zap!! It kills cancer and that’s what I’m trying to do. The radiation also damages the PC so other therapies can work better. For me it helped relieve bone pain also
Suggest you get Provenge now if at all possible. Enhanced anti-PCa immune effects when combined with either chemo or with Ra223. Good luck!
The way I understand it, radiation is used only if there are a few (oligometastasies), and only if they're situation so the radiation doesn't cause an unacceptable amount of damage to important healthy tissues.
Thanks so much.Tom
I was given a choice by my oncologists whether I wanted radiation to zap some of the cancer. Logically my mind thought I should knock some of it out. The current science however, seems to say that there is no benefit to overall survival. Since radiation is not "harmless", I chose not to do it. That is also what both of the oncologists advised me.
Thanks Mark for the info.Tom
What's the difference between a "zap" and radiation?
Same thing. Just slang term for irradiate
If you can count 15 bone mets there is very high chance you have a much bigger number but many may not have reached a size any scan can see.Using EBRT on its own to "zap" bone mets that are marble sized, say 5/8" in dia would mean having a lot of RT beamed in which is likely to cause bad side effects, and it all may not work.
I had many bone mets where two largest were pea sized in pelvis and femur but I had Lu177 which worked well in such big mets, and also has seemed to work on countless visceral mets in lymph nodes.
After 6 doses Lu177, many big mets were healing up, completely zapped. But then came a wave of new bone mets which made so little PsMa that I could not have a 7th dose of Lu177.
So now I am due to start Ra223 in about 10 days because it is targeted to bone areas where high calcium turnover is going on. Perhaps this may kill all my bone mets without reliance on PsMa expression. If that happens, my Pca may well go back under control but at the moment Psa is about 80 and doubling in a month - out of control.
Ra223 can't be used where lots of visceral mets exist.
Ac225 works like Lu177 but gives off alpha particles instead of Lu177 beta particles, and side effects of Ac225 will be more severe, but it depends on PsMa expression at tumor mets. Anyway, I am going for Ra223, it seems like the best bet IMHO.
In 2009, at 62 yo, I had diagnosis of Gleason 9, Psa 6, which was inoperable so I was started on 2 years ADT and given 70Grey EBRT which had 90% of not working, and it sure didn't, as I saw when I quit ADT after 2 years. I went back to ADT 2013, which lasted until 2016, then had Cosadex and had extra 31grey IMRT to PG which also did SFA.
Then I had Zytiga added to ADT and got 8 more months of kicking the can down the road, and then I had 5 chemo doses which doubled Psa before I quit that to begin Lu177 with Psa 25, and numerous mets all over. With Xtandi added to Lu177 after 3rd dose, Psa went to 0.32 at 1 year after I began Lu177, but then 8 months later Psa as 30, so I had 2 more Lu177 doses.
Xtandi seems to have given up doing anything and I don't know why docs want me to Anyway, now its just Ra223 ahead. But I have no idea if my bon mets are busy spreading vigorously in my bones and back into visceral tissues. If that is happening, I may be forced onto Cabazataxel maybe with Carboplatin and serious side effects and reduction of QOL.
I do not know if my marrow condition by that time will allow this, so if not, there may be some experimental unproven things without any proven efficacy, and I can't have much faith in all this now.
I am having Ra223 because there's a chance I get a few more years, not because I know definitely know I will get the extra few years.
I'll know when to hoist the white flag if I have to, and get on with pain relief when it comes, and get my affairs in order in palliative care.
But at the moment I am able to cycle 200km+ per week with no Pca pain or side effect discomfort.
Patrick Turner.
Has he offered Zometa(zoledronic acid) to get rid of them?.Its a bisphosphonate. It has some cautions to it but its been around a long time. I took it once but it was to build bone. I have osteoporosis. Does the lesion affect bone strength? At what point will he say to irradiate them. Will it be targeted and low dose? I believe in the least first and first do no harm.Zoledronic acid is used as a support medication to treat symptoms of cancer such as hypercalcemia (high blood calcium levels) or to decrease complications (such as fractures or pain) produced by bone metastasis (spread of cancer to the bone). It can be used for prostate cancer as well as breast cancer.
Brand name: Zometa
Chemical name: Zoledronic acid
Class: Bisphosphonate. Aredia is another bisphosphonate.
How it works: Bisphosphonates limit the activity of certain bone cells, called osteoclasts, which help cause the bone weakening and destruction that can happen when breast cancer spreads to the bone. Bisphosphonates also can help keep blood calcium levels normal — important because destruction of bone may increase blood calcium.
Uses: Zometa typically is used to reduce bone complications and bone pain caused by advanced-stage breast cancer that has spread to the bone. It's usually given with other chemotherapy medicines.
How it's given: Zometa is given intravenously.
Good Luck and keep me posted...Dom
Spinal mets. 
Is rebounding a good idea?
PSA down but mets increasing?
Rib pain from spine mets?
