Stage 4a-m1

[reconjj]

The question is does anyone with this stage , Stage 4a-m1 ever get down to a lower stage with treatment or even cured .? Or is this stage a lifetime of treatment ? I received the news yesterday from my pylarify scan at VA . The RO started with an injection of eligard . I have 1 tumor in lymph node in pelvis area . They want me to start on a Starport trial . Will meet with docs today to discuss trial . My thoughts down the road in months ahead is to have all the pelvis lymph nodes radiated with maybe a higher dose of radiation to the bad node . This is all new to me and finding this site was a blessing . Thanks everyone .

[Hidden]

If there are no mets on a bone there is a chance for a cure. You are the beneficiary of some new tech! Without that newish scan you had, they may not have found that hot node, but now that they know about it, they can tailor your primary treatment. Good luck!!

[Hidden in reply to Hidden]

👏👏👏🥳

[Hidden]

WelCome recon . You’ve found the best place here for pc info. Good job finding us early on . I don’t know what m-1 is? But I was #4 gl4+4=8 T-4 meaning my Prostate exploded with pc tumors . I did 8 weeks imrt and double adt to put it to sleep . You can do the same . Don’t listen to doom or anyone that says different. God bless🙏✊🏻

[Tall_Allen]

N1 not M1, may be curable.

[reconjj in reply to Tall_Allen]

Hello Allen , So I just came back from VA . I took a psa draw yesterday at VA 12/9 and that reading was 4.19 ouch! .On --7/13 -1.7-- On 10/28--- uPSA .3.07---On 11/12--2.6--O11/26---2.9 then Dec 9, 4.19 So im a little freaked . The Eligard started yesterday ( 6 month jab ) a few hours after that blood draw . They asked me to join the Starport study in which some guys are treated with ADT only to see how that works and the other to start with radiation . With the sudden rise in PSA i think cut to the chase give eligard a few month to work , then radiation to all the pelvic lymph nodes with continued ADT + another . I have a 3pm phone consul with Dr. Hirsch , she has reviewed the pylarify disc and report . Thank You John

[Tall_Allen in reply to reconjj]

Let me know how it goes. I believe your lymph node may still be within the prostate lymph drainage area, and curable with radiation. The PSMA PET scans has many ROs re-thinking which ones are curable and which aren't. The N1/M1a distinction doesn't make a lot of sense at the fringes.

[reconjj in reply to Tall_Allen]

Hey Allen , I had a long talk with Dr. Hirsch yesterday . I decided to pull the trigger . phase 1 : insert fiducials in lymph node site , insert them she said maybe by the pelvic bone ? . She will radiate that in 3 days ( lymph Node ) tru-beam SBRT . Then 25 sessions of IMRT to the pelvic lymph nodes. Would you know what machine might be used for IMRT ? Im just too freaked to wait for trials at VA due to my surging PSA #s, but VA did say they will do what I want . DR. Hirsch said we could start as early as mid january . Any thoughts ? Thanks John

[Tall_Allen in reply to reconjj]

Truebeam is also used for IMRT.. The problem with fiducials in soft tissue like that is there's nothing to hold them in place, but worth a try. Did you discuss hormone therapy- how long and whether to add abiraterone?

[reconjj in reply to Tall_Allen]

Thats a good question holding the fiducials in place in soft tissue ? Did not discuss HT , or adding zytiga > That is probably the way to go . Talking to a MO at VA this week , and another Jan. 7 at the University of Chicago . Thanks Allen you are a guiding light .

[Tall_Allen in reply to reconjj]

There's a new kind of linac that uses MRI instead of fiducials/CT. The MRI tracks the position of organs (called "gating") instead of fiducials.

[tango65]

Discuss having a multiparametric MRI to determine if there is residual cancer in the prostate which could be treated with brachytherapy or other procedures. The PSMA PET/CT used in the USA are not really good to identified prostate lesions, the mpMRI could complement the study of the prostate.

Discuss also radiation to the lymph nodes at least until the bifurcation of the main iliac artery with a higher dose to the lymph nodes identified by the PET/CT. One has to consider that PET/CTs miss any lesion less than 4 mm, so they have to treat what they do not see. Systemic therapy with ADT and abiraterone should also be done for 2 years.

If I understood correctly the Starport trial the radiation treatment is only to the metastases detected by the PET/CT, only mets that the PET/CTs can "see" those larger than 4 mm.

[timotur]

It's a gray area, but some consider oligometastic Stg-4 ( < 5 mets and no distal mets) to be curable.

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