Oligo metastatic BCR, looking for opt... - Advanced Prostate...

Advanced Prostate Cancer

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Oligo metastatic BCR, looking for options.

MichaelGR profile image
19 Replies

Hi, i would like to hear if anyone here has been diagnosed with oligo metastatic prostate cancer. What kind of treatment were you offered? It's my understanding this can be treated with SBRT, but is it common, and is it even an option in any European countries?

Initial diagnosis was in 2017, Gleason score 9. RP performed in 2018. No radiotherapy.

By the end of 2021, my dad had a rise in PSA, from 0.2 to 0.7 in just 3 months. The PSMA pet/CT showed 2 lymph metastases in the pelvic area, between the right iliac externa and ureter. But the only treatment he has been offered is bicalutamide monotherapy.

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MichaelGR
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19 Replies

How old is your dad?

MichaelGR profile image
MichaelGR in reply to

He is 65

in reply to MichaelGR

So the advice I see most often is whole pelvic radiation, with extra doses paid to the identified hot nodes and 2 years of adt.

Tall_Allen profile image
Tall_Allen

He can have salvage whole pelvic radiation:

prostatecancer.news/2021/05...

They can boost the dose to those lymph nodes that showed up on the PSMA PET scan, but the entire area must be treated.

The SPPORT trial proved the value of whole pelvic salvage radiation. It is given with 2 years of ADT. In the US, there is a trial to see if 2nd line hormone therapy improves outcomes:

clinicaltrials.gov/ct2/show...

It is important to talk to a radiation oncologist.

in reply to Tall_Allen

Does the actual 2nd line ADT drug matter? Many have received RT WPRT along with ADT +Zytiga. Using you experience deciphering these types of studies, can results be extrapolated?

Tall_Allen profile image
Tall_Allen in reply to

I have no idea which one or if a combo is best - they started that trial with a combo of apalutamide and abiraterone. They later changed it to apalutamide only, for poor reasons (IMO).

tango65 profile image
tango65

He could request radiation to the prostate fossa plus whole pelvis radiation and 2 years of ADT and abiraterone. He could also request a direct biopsy (if possible) to study the genome of the cancer. The cancer may have mutations which could make the cancer to respond to specific drugs (olaparib, rucaparib, keytruda etc)..

urotoday.com/conference-hig...

GP24 profile image
GP24

SBRT for the affected lymph nodes is an option usually any radiation oncologist will offer who has a machine that allows for SBRT. But you have to visit this radiation oncologist and not your urologist. You dad should continue with 150 mg Bicalutamide and try to get the lymph nodes radiated. SBRT should have fewer side effects than whole pelvic radiation. On the other hand whole pelvic radiation will radiate additional mets not yet detected with the PSMA PET/CT.

NickJoy profile image
NickJoy

Docrates in Finland use SBRT to mets and also LU 177 - could get a second opinion from them.

Brysonal profile image
Brysonal

It didn’t work for me but my radio oncologist did SBRT to my first two mets - rib and T1 spine - in London UK. She hoped for abscopal affect and said for some you are still curable when ogliometastic. I went on to get more mets however but no regrets trying it.

Schwah profile image
Schwah

How long before you got more and how many the second time? Did you try to zap the new ones?

Schwah

Brysonal profile image
Brysonal in reply to Schwah

If this was for me, 6 months after SBRT my PSA was rising again and a new PSMA PET scan showed 6 new mets on the spine st various points. The RO said about 30% ogliometastatic are cured with SBRT but I was not one and was referred to the MO to plan systemic therapy.

Hope that helps

Brysonal profile image
Brysonal in reply to Schwah

Re the zapping my London RO said no more SBRT to the new ones. She said it was too dangerous and I needed systemic treatment. I have started Degarelix and Lu-177 in Finland. I have had 2 infusions. My PSA before infusion 2 in January was 0.79 down from 17.6 pre treatment on. 25th November 2021.

I head for treatment 3 this week and due to start Abiraterone too. PSA test will be pre treatment.

Engraver68 profile image
Engraver68

Hi

I have the same situation although I am now 12 years into this cancer. I had SABR treatment to one metastasis in August 2020 and the PSA reduced for the first 6 months and now is slowly on the climb.

My last CAT scan has identified a further 2 spots on my spinal cord and in the groin area, I am having radiotherapy to reduce the pressure.

I am in UK so not able to have SABR as systemic treatment, I was on a trial for the for the first treatment.

If I have SABR to the 2 new spots I would go to Latvia. I researched this before the trial and due to Covid could not travel.

Have a look there very reasonable prices

Awb824 profile image
Awb824

My husband was diagnosed in 2008 with Gleason 9. He had robotic surgery and radiation about 6 months later. He had one hormone shot before his radiation. About 6 years later his psa started rising. They wanted him to start hormone therapy. That was about the time Dr Kwon at Mayo was doing the choline psma scan for ogliometastic disease. He decided he wanted to go that direction. We found Dr. Almeida in Phoenix who was doing a similar scan. He is about to have Cyberknife for the fourth time. The first two times he had two lymph nodes, the third time he had one node. We are getting results from a pylarify scan he had in Dallas this week. He feels great and he has no side effects from the cyberknife treatment. As long as this works he will keep doing it. He doesn’t want to take hormones until he has to. It’s been 14 years and you would never know he has cancer.

Kittenlover50 profile image
Kittenlover50

Bill was started with chemo.. ( 6). Then 6 mo of zytiga, Lupron and prednisone, then 37 radiation and meds, then a year of the meds.

j-o-h-n profile image
j-o-h-n

A lot of responses and some questions for you to respond to.

Please tell us his bio. Age 65 Location Denmark When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help him and helps us too. When you respond, copy and paste it in his/your home page for his/your use and for other members’ reference.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 02/07/2022 7:50 PM EST

MichaelGR profile image
MichaelGR in reply to j-o-h-n

He was diagnosed when he was 61, he is now 65. He is being treated at Aalborg University Hospital in Denmark.

He was diagnosed in late 2017. Gleason score 9(4+5).

In January he had RP, the biopsy revealed it had spread to 3 of 8 lymph nodes, nevertheless they told him they believed he was cured.

No additional treatment afterwards.

PSA remained low and stable until September 2021, where it had rised to 0.2.

For unknown reason they waited until December to take another blood test, this time it was 0.7.

Between Christmas and New year he got a PSMA PET/CT. They found 2 spots in the same area, between the right iliac externa and ureter.

They said he wasn't a a candidate for radiation, and he is now on bicalutamide indefinitely.

j-o-h-n profile image
j-o-h-n

Thank you sir for your quick and detailed response. Good to have his data in his home page it will help when other members need his information. Give your Dad my regards and God Bless him (and you too).

Held og lykke, godt helbred og god humor.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 02/07/2022 9:47 PM EST

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