Scan after SBRT

[Brightman]

I recently had a CT scan 10 weeks after SBRT on my T10 vertebrae after my metastatic PCa returned after 4 years with a negligible nadir. The report I got from my MO last Friday said “the lesion on the T10 has increased in size, which may represent a response to treatment with increased sclerosis making the lesion more visible.” Also, “Note is made that the sclerosis extends into adjacent anterior osteophytes.” I am hoping that someone on this forum can explain this to me. Also, my Psa has come down to 0.11. My MO said that my nadir would never come down to less than 0.01 again. Why would this be the case?

[Tall_Allen]

The CT is showing the bone response to the SBRT radiation. It is responding to the irritation by growing more bone (sclerosis) and the bone is growing around the front (anterior). Whenever you zap metastases, it brings PSA down because that's where most of the PSA comes from. Some PSA comes from metastases that are too small to see on any kind of scan, which is why it doesn't become undetectable.

[Brightman]

Your response is much appreciated. Thanks once again.

[Schwah in reply to Brightman]

Tall Allen as usual is correct. Which is why you should also be on systemic treatment and not just the SBRT to the one visible met. Are you ? If so, what kind?

Schwah

[Brightman in reply to Schwah]

Thanks. Yes I am on Eligard every 6 months. I have been since 2016 when I was first diagnosed with 4 mets. I have had radiation and chemotherapy since then too. Recently I had SBRT on a new met on T10.

[Hidden in reply to Brightman]

What a long strange trip it’s been ? This pc is a long winded s o b .. Keep swinging the bat at it . 💪

[Brightman in reply to Hidden]

Thanks so much. Yes it certainly has been a strange journey. Inspite of that I remain positive and find that daily exercise helps a lot. Still it is a b........ nuisance at times !!

[Hidden in reply to Brightman]

Exercise and staying positive are most likely the keys to your

Survival .

[Concerned-wife in reply to Brightman]

Has your doctor discussed going on a second drug like abiraterone too? I of course don’t know if that would be appropriate but it seems like that is the new standard of care in many cases.

[Brightman in reply to Concerned-wife]

Thanks for your reply. My Medical Oncologist has told me that there are other probable treatments down the track. But at the moment she feels that there is only one metastatic spread present. All my previous scans have shown that the 4 areas of spread when I was diagnosed in 2016 have all disappeared.

[Concerned-wife]

Great news! Here is one example of why I mentioned another drug. asco.org/research-guideline...