The shadows of my spine...

[Jvaughan0]

After six months of waiting for my once undetectable PSA (prostate removal 2014, G9 with positive margin, negative nodes and prostate bed radiation 2017) to climb from .2 to .6, my MO signed off on a PSMA PET/CT scan. Lab tests just prior to the scan showed a decrease to .4 (Different lab I guess) and a T level of 316. The scan revealed three areas: tracer avid right external iliac node measuring up to 0.8 cm in short axis, additional smaller subcentimeter tracer avid right external iliac lymph node, 9 mm tracer avid right external iliac node. I am scheduled to meet with MO to map out a treatment plan next Monday. I welcome input from any of you who would like to share.

[StayingOptimistic]

Sorry for the bad news. I am in similar situation but may be worse since I have Mets in the abdomen area too discovered by a psma scan. They start me on ADT. where have you done the psma scan? Is it covered by insurance?

[Jvaughan0 in reply to StayingOptimistic]

I knew it was there. Now I know where it is at the moment. I see it as a new starting point to seek treatment. I have a Medicare Advantage plan. It looks like all but $100 was covered at Duke.

[Tall_Allen]

I guess your prior salvage radiation did not include pelvic lymph nodes. This time, the entire area of the pelvic LNs should be irradiated. They can boost the dose to the known ones, but they ALL have to be treated. Also 2 yrs of ADT with it.

[Jvaughan0 in reply to Tall_Allen]

In 2017, I believe I had 30+ sessions of treatment, three times a week for several months. I prefer to get treated where my MO is located, but it is a five hour drive. Are there shorter treatment options today?

[Tall_Allen in reply to Jvaughan0]

You can have it done locally (the MO doesn't have to be there, and you only see the RO for the planning). It is usually done in 25 treatments. Experimentally, some are doing it in just 5 treatments. What's really important is the coverage area, which has recently been expanded. The RO will need the treatment plan from your previous prostate bed radiation, so they don't overlap.

redjournal.org/article/S036...

[Jvaughan0 in reply to Tall_Allen]

Though the actual treatment was easy, my last experience with radiation was bad. Small hospital close to work so I didn't have to retire, second patient to undergo treatment on new equipment, new radiogist who resented working in a small town and fires her entire staff one week after my treatment began, and lingering radiation proctitis still... Frankly, the departments at Duke seem well networked, so getting all treatment at one place makes sense to me. Unfortunately, Duke is almost three hours away. Staying in Durham for a week or so is doable. Twenty five sessions over multiple weeks at Duke may not be...

[Tall_Allen in reply to Jvaughan0]

There are many places that do radiation. You can have your RO at Duke do the planning (recommend Bridget Koontz) and coordinate with a nearby facility. Unfortunately, it shouldn't be done in 5 treatments outside of a clinical trial.

[Jvaughan0 in reply to Tall_Allen]

Thanks as always.

[Jvaughan0 in reply to Tall_Allen]

I have been mulling over radiation treatments for a few days. Based on my initial MO visit last April, he predicted Cyberknife (same as SBRT, right) plus ADT treatment would be needed before my PSMA scans revealed three avid nodes this week. Is treatment available to combine SBRT with the potential long term benefits of IMRT delivered over the course of less than two weeks? Is this even a possibility and, if so, where do I seek it out? I haven't found any clinic trials. I meet with my MO Monday to follow-up on my PSMA scan.

[Tall_Allen in reply to Jvaughan0]

They boost the IMRT dose to the avid lesions while treating the entire area. It's called a "simultaneous integrated boost (SIB)."

[Hidden]

i am afraid i don't get the "shadows of my spine" reference. But it does seem good that it is not in the bones. The way Kwon described it, the new PET scans are detecting it 7 years ahead of former imaging techniques and it can be curative, I think. Although a friend of mine had an avid lymph node that a doctor at Duke told him was only 20% possibilty of curative treatment, which seems a little low. It might be due to the avidity rather than just low uptake. What was your SUVmax?

[Jvaughan0 in reply to Hidden]

I see no mention of uptake in the reports. My "shadow" reference was to the black and white scan images of myself I was viewing last night. It is rather ghostly with the spinal column dominating the images. I was thinking what can a specialist see that I can't easily see. Spine rhymes with mind and my thought was shadows of the "mind".... I know, too much abstract thinking, but I was a high school English teacher a couple of years ago.

[tango65]

I would discuss whole pelvis radiation and 2 years of ADT plus abiraterone. They need to treat what they do not see and a systemic treatment may help if there is systemic disease.

urotoday.com/conference-hig...

[Jvaughan0 in reply to tango65]

Thank you. What you say makes sense of me. My question is can I get whole pelvis radiation treatment in as few as five sessions as Tall_Allen suggests is being experimentally done.

[tango65 in reply to Jvaughan0]

Discuss the possibility with your RO and see if they have experience or feel comfortable in doing it that way.

Best of luck.!

[Jvaughan0 in reply to tango65]

Thanks for your insight.

[Hidden in reply to Jvaughan0]

They can do it in 20 also about anywhere

[Jvaughan0 in reply to Hidden]

What is the spacing?

[Hidden in reply to Jvaughan0]

I can't say for sure because I had to do more treatments for various reasons, but my impression was it was 5 days a week till done.

[bean1008]

SBRT/Proton I believe is normally just five sessions…perhaps that could be an option for you if you’re needing to travel and looking for a shorter session.

[rscic]

I agree with the Pelvis Radiation Tall_Allen suggests ..... Given known Mets ADT would also be helpful as he suggested.