Advice on Treating Liver and Lymph Node Mets

[Eddy-Merckx]

Hi Everyone,

I was diagnosed with PC that spread to my regional lymph nodes and liver in October, 2019. I have been on Lurpon/Eligard from the beginning with six cycles of chemo from November 2019 to March 2020. My oncologist added Zytiga and prednisone on top of Lupron immediately after I finished chemo. My PSA dropped from 56 at the beginning of this journey to undetectable (< 0.02) in February of 2021. My most recent CT scans showed that my liver and lymph node mets have shrunk as described in the report shown below:

"Liver: Again, the dominant hepatic lesions have decreased in size: The lesion in the medial segment of the left lobe, 7:27, now measures 1.0 x 0.5 cm, previously 1.4 x 1.1 cm. More inferiorly, the lesion on 7:33 now measures 0.8 x 0.9 cm, previously 1.2 x 1.0 cm. Several other smaller lesions appear to be cysts. There is a nonspecific triangular shaped area of low attenuation in segment 6, most likely benign 7:29."

"Lymph Nodes: Further decrease in size of multiple lymph nodes: A left para-aortic lymph node on 7:53 is barely visible, with a short axis dimension of 4 mm. A right external iliac lymph node on 7:68 measures 1.7 x 1.2 cm, previously 1.9 x 1.1 cm. A left external iliac lymph node on 7:68 measures 1.0 x 0.4 cm, previously 2.1 x 0.5 cm."

Does anyone have any recommendations on additional treatments that I should consider? Or should I remain on Lupron and Zytiga until the treatment fails and then select other treatments? I am meeting with my oncology team on Monday (May 24th) at Dana-Farber and I want to be prepared to discuss my options.

Thank you,

Craig

[Shooter1]

Looks like you are doing well with treatment plan you are on...keep it up, Best of luck with treatments...

[Tall_Allen]

Good response!When Zytiga stops working, you can try Jevtana+Carboplatin. Have they biopsied any of your metastases?

[Eddy-Merckx in reply to Tall_Allen]

Yes, they biopsied the liver mets shortly after I was diagnosed to confirm it was PC (which it was) and to rule out small cell. Thanks.

[tango65]

They could consider to treat the liver metastases with SIR microspheres or similar:

sirtex.com/us/clinicians/ab...

sirtex.com/us/clinicians/ab...

ncbi.nlm.nih.gov/pmc/articl...

You could consider treatment with Lu 177 PSMA abroad if financially feasible (Europe, Australia, South Africa, Israel ...)

[RCOG2000]

Radiation. Specifically tomotherapy might be something to consider. .

[Turt713171]

Seems to be working. Stick with it

Good luck

[MarkBC]

I was diagnosed almost three years ago and had chemo right away. Since then I have only had ADT injections with bicalutamide added a few months ago. My scans last month continue to show additional shrinkage in my lymph node and bone mets since the last set of scans. Bone mets are now no longer visible. It is possible that you may continue to have reductions in your mets over time as well. Best of luck.

[Eddy-Merckx in reply to MarkBC]

It is wonderful and reassuring to hear that your mets continue to shrink on ADT. Thanks for sharing.

[Nokoko]

Hi Eddie. I underwent six weeks of radiation last June and gave been on a three monthly dosage of Lupron. My PSA dropped from 9 to 0.1 and stayed there since June. I am due for a a shot in a few weeks, with my last shot in October. Have gotten used to the side effects, except putting in weight around my midsection, and around my breasts. Fighting it with exercise , but very stubborn to get rid of. Hang in there. It shall be well.

[Johnstonearch]

Sounds like you are on the right path and should stay the course. Don’t get ahead of your Doctors, everyone dislikes a Google Expert.