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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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:
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?
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).
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)..
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.
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.
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.
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.
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.
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.
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.
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).
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