primary SBRT failure , now Stage IV

[reconjj]

5 yrs ago SBRT . PSMA-Pet , pylarify recently at VA . Scan showed 1 hot lymph node in the pelvis . My RO said we should give the 1 hot spot 3 sessions of SBRT . Then 25 sessions of IMRT . VA gave me a 6 month jab of eligard last week . My RO DR. Hirsch want to start in January . My PSA is rising rapidly , (see signature from 1.7 to 4.19 . What can I expect after IMRT is finished ? Has anyone been down the same path ?

[Tall_Allen]

Hopefully, it will be curative.

[slpdvmmd]

If you have a visible PSMA positive lesion then the question is whether there are micro PSMA positive lesions not appreciated by the scan. This as I understand it is one of the theoretical roles for 177 Lutetium PSMA/radioligand therapy. It could and has been used in conjunction with the type of RT you will be receiving in other countries exactly because of this theoretical possibility of unimaged micro metastasis.

[MateoBeach]

Yes. I had similar, just 2 PSMA avid nodes in pelvis and no other activity seen. Consulted 3 ROs. All agreed best was full IMRT to pelvic LN fields with “boost” to the 2 nodes ( equivalent to SBRT). Plus short term ADT (duration was debated). Now, 2 years later, PSA remains low but not undetectable 0.090. Repeat PSMA Pyl scans at VA show no new lesions yet. I believe your proposed treatment is appropriate. Save Lu177 until More PSMA avid lesions if needed down the road.

[reconjj in reply to MateoBeach]

Hello mateo , I talked to my RO and she wants me to have fiducials placed in the lymph node tumor . She says there is a chance that the tumor can shrink because of the Eligard jab I received last week . Did you have fiducials placed into your lymph node ? Thanks

[MateoBeach]

I did not have fiduciary placed in pelvic nodes. Full pelvic (well hemipelvic) IMRT with boost dose to the nodes with .5mm margins. Fiduciary are probably better if achievable technically.