MO has not recommended radiation

[Wahoo_]

Back again with another question. I was diagnosed with Mets to the bone in 4 separate areas in December of 2020. I was immediately put on ADT, (Firmagon injections and Xxtandi, 160mg a day.). I am tolerating both well. The question is, why would my MO not mention radiation as a part of my treatment? The ADT has my PSA down to undetectable levels, .001.

[noahware]

My question is: why would he?

My MO never mentioned radiating my mets, and I have to assume that is because there is no proven obvious benefit. If the mets were causing pain, that would be different.

On the other hand, I have no problem with radiating asymptomatic mets, because there MIGHT be a benefit. So while it is something I would consider, I do not expect my MO to suggest it unless or until sufficient evidence comes to light showing a pronounced survival benefit to playing whack-a-mole with mets.

[I am assuming you mean radiation to the mets and not to the primary tumor]

[Shooter1]

Great results so far with current treatment. Save radiation for later pain if needed... I start radiation today 4 1/2 years in after Xtandi failed and pain is now a reality. Ride the undetectable tests for as long as you can and then add something to help slow it again.. Radiation is a wonderful tool for when bones start to hurt and sadly someday they probably will. If that Xtandi gives you to many SE's you can cut the dosage to be able to stay on it, but don't let it make you a complete invalid for the rest of your life..

[Wahoo_ in reply to Shooter1]

Shooter, so far the SE’s are being tolerated quite well.

[Shooter1 in reply to Wahoo_]

That's great. My problems didn't start until I had been on it for 4 mo.

[Rocketman1960 in reply to Shooter1]

In total agreement Shooter. Xtandi has been the miracle drug for me but moving dosage for QOL has been the tricky part. V

[Tall_Allen]

Because when there are 3 or fewer bone metastases, there may or may not be an advantage in irradiating them (the jury is still out). But as the number gets higher, there is certainly less of an advantage. No one thinks there is any advantage when there are more than 5.

The following study may interest you:

prostatecancer.news/2020/12...

Radiation in certain places (like some rib metastases) may be dangerous. Patients often think of it like plucking weeds, but a much better metaphor is plucking mushrooms - the mycelium is extensive (systemic) and plucking mushrooms as they fruit will do nothing to impede the fungus. Still, there is met-to-met spread, so it might help a little when there are very few. An RO can tell you if it is safe.

[6357axbz in reply to Tall_Allen]

In the present context would it not be appropriate to qualify # of mets with those detectable with conventional bone and ct scans?

[Wahoo_ in reply to 6357axbz]

1 in hip…1 in each of 3 ribs.

[Tall_Allen in reply to 6357axbz]

Almost all studies to date are based on conventional imaging (bone scan/CT).

[Balylone]

Dear all. As TallAllen mentions radiotherapy is SOC when Mets < 5.

I am’ G7. 240 PSA and few bone Mets at diagnostic. I have been 4 years under Zytiga with actual PSA at 0,1. I had lately strong discussions with my both oncologists. One would stick to the > 5 Mets no radiotherapy. The other, big French hospital, recommended RX because they lately had good surprises when adding RX to good Zytiga reaction.

I decided to go for RX because I believe “ God do not play dices”. This 5 Mets counting is statistical. It’s is the average of a Gaussian curve. It might work in some cases even if you have more. Second aspect, this 5 Mets counts is at diagnostic. 4 years after, some of the Mets might have vanished.

RX is not so tough treatment (I am 56 and good physical and microbiote conditions)

A doctor needs to go by SOC. It is his duty. But who takes no risks, get no winnings . We Zytiga patients are still writing history and our only target is to win a few months or years of good living condition.

I bet that RX might help my Zytiga treatment to last a bit longer.

Regards

[Justfor_ in reply to Balylone]

You are totally in the dark. Magic number 5 is based in NONE whatsoever statistical analysis, not to mention a normal distribution's mean value. As all magic numbers docs use it is a round, easy to remember, yet TOTALLY arbitrary a number. Alternatively, some in its place use 4, very-very few 3. Five is preferred because it is in line with the number of fingers in one hand. And this is not a joke.

[6357axbz in reply to Balylone]

You say, “.The other, big French hospital, recommended RX because they lately had good surprises when adding RX to good Zytiga reaction.”Can you pls provide details about the “good surprises”?

[Vangogh1961]

I was diagnosed in December with 3 bone mets and lymph. MD Anderson started Firmagon and I just completed docetaxel. MRI and bone scan next week with planned radiation to the prostate itself. They're not indicating they would treat the bone mets as best I can tell as they were fairly small at the onset. My Alk Phos was only in the high normal range and now it's in the low normal range. But I'm just guessing until I see the rad onc after the scans. It's interesting how people with appearingly similar dx have very different treatments.

[Shooter1 in reply to Vangogh1961]

My bone mets were resolved with Chemo..Alk/Phos dropped to 60's for 3 1/2 years. Then climbed to 100's followed by PSA climbing...Scans clear. NaF18 showed my 2 mets which will be irradiated in the next couple of weeks... Tattoos done yesterday.

[CountryJoe in reply to Shooter1]

I recieved RT in weight bearing areas of body (pelvis, spine, shoulders). Seemed make sense.

[Wahoo_ in reply to CountryJoe]

Makes sense to me to. But, I will trust my MO on treatment decisions….for now.