Johnko in reply to Tall_Allen2 years ago

Ok thanks for the info

Hailwood in reply to Justfor_2 years ago

I think this is the direction that my RO is doing. PSMA PET/CT done last week, results this week, then radiation based on results of the scan starting in a week or so. PSA still at 3.9 despite RP though.

Justfor_ in reply to Hailwood2 years ago

At PSA of 3.9 the PSMA PET/CT has a detection rate in the mid 90%. The remainder to 100% is more due to tumours' lacking PSMA avidity than actual size, hence, bellow detection range. If distant metastases are thus revealed, then we are not talking of an ordinary sRT to the prostate bed +/- pelvic nodes.

The issue of irradiating distant metastases' usefulness is still very controversial, that is why I urge you to thing about it twice. You may get the late toxicities due to the irradiation, albeit the very slim success probabilities (18-40% according to the graph of Figure 2A of the paper already shared). It goes without saying that a RO with suitable past record should be brought in.

My best wish is that tumours confined in the pelvis will show up. Either negative or distant tumour detection will be worse news.

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Hailwood in reply to Justfor_2 years ago

That’s my thought as well. The recent study gives a very disheartening 3 year prognosis if there are distant Mets. It’s all conjecture until Thursday and here the sun is shining, the Kawasaki has a new Maxton shock and fresh tyres, so everything is good. Thanks for the information

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Blackpatch in reply to Justfor_2 years ago

Thank you very much for posting this paper - I had seen the earlier ones describing the early part of the study, but not the 3 year results. I'm extremely fortunate to be in the "negative PSMA" group, despite being pT3b with a short doubling time post-BCR. Given the pT3b and a very high Decipher score, I went ahead with eSRT (at PSA=0.12) + 12 months ADT - and so far, 25 months post-eSRT, my PSA remains undetectable.

It's quite surprising to see that only 11% of negative PSMA scan men adopted a similar course of action, given I was making my decision in the "Australian PSMA treatment" setting characterised by the PSMA results in this paper. This really proves the point often made on this forum that we each need to remain vitally interested in our own treatment strategies - we are most certainly our own best advocates. Despite being treated by people involved in the work reported in this paper, after receiving the negative PSMA result, the path of least resistance for me would have been to put off eSRT + ADT - and from the results presented, I would almost certainly have fairly quickly moved beyond where a durable "cure" would have been achievable.

All that said, it would be vert interesting to see if the negative PSMA group in the paper who report FFP at 30 months still continues in this state - progression many years post-eSRT is reported by some in this forum, and is a continuing concern for many, I'm sure.