PSMA PET/CT results

[Hailwood]

Prior to scan post RP, PSA's of 8.8, 3.9, 3.3 with T remaining at ~12-13.5

Results:

* Radiotracer-avid lymphadenopathy involving the para aortic node at the level of L2, SUV5.2, 3mm in the short axis.

* Bilateral common iliac e.g. on the left SUV 15.2, 13mm in the short axis and bilateral external iliac and pre-sacral stations.

* Indicating extensive radiotracer-avid abdominal and pelvic lymphadenopathy, in keeping with metastatic disease.

Reported:

There is no evidence of bone or visceral metastases and the disease is confined within the pelvis and abdominal regions. I am on bicalutamide tabs at 50 mg daily and Lupron 30mg every 4 months. I have been referred to MO for chemotherapeutic options as well as trials, possibly using ARAT's. He feels that there is no evidence to support radiation with radical intent but will consider palliative or consolidative radiation to enlarged lymph nodes that don't respond to systemic therapy as in his opinion, radiation would not be curative and would have little impact on my overall survival.

My opinion: The team (GP, RO and Urosurgeon) so far have been supportive and I am going along with their direction. I presume that radiation over this relatively wide area is not thought to be beneficial overall.

[Tall_Allen]

Sounds like the best options for you. You are right that the abdominal lymph nodes (stage M1a) tell you that the cancer is systemic and local radiation will be useless at this point. Early chemo would be a good choice, imo. You can follow it up with Zytiga.

[Hailwood in reply to Tall_Allen]

Thank you so much

[Hidden]

Hey Hailwood! You’ve got this! Get through the treatment and heal yourself up afterwards. I’m routing for your success in beating pc . We all suffer . Just make it through . Scott

[GP24]

"radiation would not be curative"

ADT and chemo will not be curative as well. They just cause more side effects than SABR/SBRT radiation. Why don't you get into one of Dr. Palma's trials and get him radiate these lymph node mets with curative intend? There are several clinics in Canada which offer this treatment based on these trials.

oicr.on.ca/investigators/da...

varian.com/resources-suppor...

[Hailwood in reply to GP24]

This is a question that will be asked but I think that radiation may well be difficult due to the numerous patches and their position. Thanks for the information. I have an appt with the RO and MO on May 12th. Again, thanks so much

[GP24 in reply to Hailwood]

The SABR radiation allows to radiate several small spots in different locations in one radiation session. Just ask your doctors if they could help you to take part in one of the trials conducted by Dr. Palma.

Here is a discussion with him about this treatment:

btjbeacon.libsyn.com/drs-da...

I got this radiation off-trial and am glad I got rid of these metastases.

[Hailwood in reply to GP24]

I will do that. Thanks so much

[RonnyBaby]

I had nearly the same / exact report recently after A PSMA/PET scan.

I was told radiation was risky (been there/ done that as primary treatment) and I've elected to go on 150 mgs of "caso' mono-therapy.

Awaiting my first PSA report - but started 'systemic' treatment after a long 'vacation'.

I started at 9.8 - hoping for good result - it's been about 6 weeks since I started .....

[Hailwood in reply to RonnyBaby]

I'll be reviewing my PSA as well as any bloodwork ordered by the MO and well see how well it goes. Take care

[RonnyBaby in reply to Hailwood]

I just had a complete blood panel done and the results were surprisingly good - I suggest you do it every few months to establish a baseline and to monitor changes - which will occur with any systemic treatment(s).

I also got some excellent news today - my PSA has dropped to 1.37 in 6 weeks - trending downwards fairly quickly and my mono-therapy is almost side effect free.

I'm optimistic after approaching the end of my fourth year as a PCa 'patient' -/ survivor - hoping for lot more runway ahead of me.

We can't predict how we will react to treatments, but we can see some results that certainly show some significant steps and developments along the way.

I thought I was a 'dead man walking' awhile back - I didn't really understand what was happening. Learning what was really happening made a huge difference for me.

Do some homework - some reading - some research - it will help you manage the disease and your mental attitude moving forward - it's far from over for you.

Wishing you well on your journey ......

[Hailwood in reply to RonnyBaby]

Thanks so much, I'm running three years behind you right now with the diagnosis and the initial scare was after the surgery with PSA's of 8.8, 3.7 then 3.3, I'll repeat likely in a month to 6 weeks and post results. no issues with the Lupron/Casodex so far except for hot flashes, which at least warm me riding my motorcycles or working in an unheated shed in the evening...everything has its upsides!

[Hailwood in reply to RonnyBaby]

Recent bloodwork after a course of bicalutamide and a Lupron injection 2 weeks ago, show PSA down to 0.81 from 3.3 and T down to 2.2 from 12.2. Just awaiting pharmaceutical review to start Apalutamide in 2-3 weeks. Off to a good start methinks