It’s been a trip but I want to say thank you to all you guys out there for some really incredibly insightful and encouraging posts over the last 3 years I check in monthly and think this is a wonderful resource.
My own story started with a relatively low PSA 3 years ago of bouncing around 3 with 3 bone mets spine + hips and after much research and discussion, elected to have a comprehensive kitchen sink treatment of adt / Docetaxel / RP followed by SBRT to the 3 mets all within 6 months of dx.
My PSA went to undetectable during month 4 somewhere after my first or second taxotere session. My T dropped to below .2 quite quickly as well. I had negative margins and extended pelvic lymph dissection at surgery with negative nodes.
I stayed on ADT for 15 months tip to tail and was scanned using MRI and Pet every 6 months regardless of the undetectable PSA.
I stopped ADT in September 2019, had full T back within 5 months, and was undetectable with full T for approximately a year.
PSA rise in March of this year of .24 brought me to a quick PSMa pet where the visualized met was blasted with 18gy in one session.
Out of an abundance of caution, my care team did a number of labs to rule out neuroendocrine and thoroughly hunted for any other mets using other tracers as well as traditional imaging. No other uptake or mets.
The radiation was painless, quick, and I got to choose my Spotify mix during the session. The toxicities of SBRT compared to standard of care are quite good, and with the dozens of papers on Google Scholar on this, i suspect anyone who steers people away from SBRT and pounds the table for systemic therapy just is a rogue agent paid by Janssen.
Like Break60 and a few other guys on here, my particular care team has sold me on the value of metastasis directed therapy for macro cancer, although I recognize it’s not curative by itself. Seems like zapping a met is ok / and zapping all mets seen by PSMa is better and really does make a difference as far as progression. But dealing with micro disease as well as the macro seems to make a real difference as far as progression. No overall survival data yet, but aren’t we all just buying time till they figure out immuno for this anyway?
A few months out, PSA is back down to undetectable and on the basis of progression free survival time for any studies out there looking at “concomitant” ADT, I’m ok with going back on Lupron and Xtandi for a while - length tbd.
In my own personal situation, on the hundreds of hours of research I’ve done, I believe this is the best course of action for me.
The reality is that anyone who pursues metastasis directed therapy as a form of tumor management is playing roulette with a hypothesis whose data has not matured sufficiently to make a compelling argument for long term survival benefits.
But when I punted this point to a global leader in the field (top institution, h-index of 100+) - he basically said - look YOU are the data set. I don’t have 10 year survival data because we’ve only really been doing this for 5 years. But I can tell you this - for low volume metastatic guys, let’s say I have 70 of them, almost all are alive at 5 years and the majority of them still castrate sensitive- so go ahead and compare that to the standard of care. And yes I know Stampede OS is compelling for the low mets subgroup, but staying castrate sensitive at 5 years as a group is surely a nice point of differentiation. I remember when I started on here, some of our in house scholars were declaring “there’s no evidence whatsoever that treating the primary helps at all in M1 disease”, which basically most oncologists at the Mayos and MDs and JHH and Martini Klondike of the world would tell you by now is nuts
On a personal note, I drink the seed to soil kool-aid, as well “whole person” naturopath philosophies, have a nice bag of my own supplements, believe in visualized meditation, hypnotherapy, acupuncture, the endocannabinoid system, Dr. Moss, New German Medicine, the placebo effect, and a bunch of other things too weird to mention.
I’m happy to serve as a resource, particularly to any around or under 50 year olds freaking out and looking for a peer in the age group to kibitz with.
Cheers.