SBRT? PET CT PSMA detected 2 small mets in pelvic bone

[Rickmartin1948]

This is a ques225Ac-PSMA TATmessy due to bleeding dtion for Tall Allen please

I had RP in january 2028, clean margins clean vesicles only perineural invasion on one side, one ercetor spared, limph nodes came clean

Was on ADT form 2 months prior to 4 months asfter RP, 15 days Bocalutamide and then 6 months Eligard. Few months after end of Eligard PSA surfaced at .007 and kept doubling every 3 months.

In 2020 while planning to go to Germany to dborderline.

Planning to do SBRT in 20 days foloow PET PSMA had to do open heart surgery annd new BIO Aortic Valve. Finished the heart business with a pacemaker implant end Feb 2021 and back to tennis.

At that point PSA reached 2.4 and Czech Oncologist recommended Diphereline 9 months and coming out of it PSA went from undetectable to .007 first month and kept doubling every month. Today PSA at.81

Now in Buenos Aires did PET CT 18F detected 2 mets in iliac bone SUV 2.6 and 3.0, almost borderline, planning to do SBRT in 20 days and follow up PSA monitoring since no proper PET CT PSMA can be done for 3 to 5 months.

I have a lot of pain in my hip every morning which I control with stretching and meditation.

DO you think I am wasting my time and should go directly to Chemo?

I love to feel that I am attacking the mets zapping them and makes me feel more confident, but I respect your level of understanding of the general picture and would love to hear from you.

Not placing any responsability on your answer obviously and would love to hear from you

Thanks , Ricardo

[Tall_Allen]

If the metastases in your pelvis are bothering you, you should have them zapped with SBRT. However, don't count on spot radiation alone to help you. It may lower your PSA, but without systemic therapy, your cancer will grow and spread in other places.

I don't think you have enough PSMA-avidity for Ac225PSMA. Chemo may be a good choice, but so are advanced hormonal therapies like abiraterone, enzalutamide, darolutamide, or apalutamide.

[Rickmartin1948 in reply to Tall_Allen]

My friend, I really value your opinion, and it makes a lot of sense. I see that you do not mention Lutetium, which is a therapy that is available to me both in Buenos Aires or Germany, I live part of the time in Prague and part in Buenos Aires.

You do not think that Lutetium is a viable therapy? I find that Ac225-PSMA is much harder and bears permanent side effects, but I imagine you must have a reason for this. Is it because they are bone metastasis?

[Tall_Allen in reply to Rickmartin1948]

You mentioned Ac225PSMA in the first line of your post, which is why I brought it up. But I don't think that Lu177PSMA will do much for you for the same reason - low PSMA avidity. If you aren't providing enough PSMA sites for the radiopharmaceutical to latch onto, it will increase its toxicity.

[Rickmartin1948 in reply to Tall_Allen]

Thank you, next time I will review my text it was all messed up, but what you are telling me is very valuable. My plan is to go with SBRT and monitor PSA monthly which should be a reliable indicator of the effectiveness of radiation therapy and also of recurrence, and enjoy a little while without ADT until I recover. Also have to find out my iron going down pretty fast, I was on Xarelto after heart surgery and suffered bad hematuria, but I controlled it with tons of water and very light food but Iron went down again after I stopped supplement. Plan on having colonoscopy and endoscopy next week to see where I am loosing blood, and after that I will sue J&J :), my oldest son is the CEO of J&J Medical Devices for Russia, Ucraine and a bunch of other satelites, but their Pharma is responsible for Xarelto. Well my friend thank you very much for all your valuable advice

[Tall_Allen in reply to Rickmartin1948]

You wrote: "My plan is to go with SBRT and monitor PSA monthly which should be a reliable indicator of the effectiveness of radiation therapy and also od recurrence, and enjoy a little while without ADT until I recover. " I couldn't disagree more. By treating the bone metastases you will certainly reduce your PSA. But playing games with your PSA is not the same as treating your cancer. Your cancer is systemic, and the only way to treat it is systemically. By forgoing ADT, you will give a chance for all the other cancer in your body (now too small to see on a PET scan) to grow and spread.

[Rickmartin1948]

Now you got me, I thought that my cancer expressed PSA and any growth would be reflected in PSA allowing for further systemic treatment since I monitor my PSA every month doctor or no doctor. Living in different countries has forced me to look out for myself since specialists have a limited vision specially if you are not around. I will have to give this a lot of thought but you got me thinking now, thank you very much Big Guy. I guess that is why they call you Tall Allen. Thank you again and I will consult with my pillow you get some rest too!!

[j-o-h-n]

Well Rick, Good night and pleasant dreams... since Pca is a nightmare. Of course listen to T_A and read his books "Joan of Quebec and Thaw's Hammer"......

Good Luck and Good Health and Good Humor.

j-o-h-n Thursday 03/10/2022 6:19 PM EST

[Rickmartin1948 in reply to j-o-h-n]

Will do that John, thanks