What next?

[Mjex]

RP in Sept. 2014 with salvage radiation May-June 2015. Focal radiation to spot on T-5 in November 2019. Not on ADT and u

ndetectable PSA until April 2021. Rising since then and now at 1.6. Results of a PYL Pet scan last week are:

IMPRESSION:

1. Since August 2, 2016, new PSMA avid left paraesophageal lymph node,

slightly increased in size, suspicious for nodal metastasis.

2. New PSMA avid left lower lobe subpleural nodule, slightly increased in

size, suspicious for metastasis.

3. New PSMA avid intramuscular focus in left paraspinal muscle,

suspicious for metastasis.

So, what are the probable next steps? Will focal radiation be possible?

[Tall_Allen]

IMO, you should have been on ADT from the time your first met was detected. Focal radiation just treats the PSA, not your cancer, as far as we know. The next step is immediate systemic therapy with ADT plus either docetaxel, abiraterone or enzalutamide.

[Mjex in reply to Tall_Allen]

Thx, that is what I suspected. I really appreciate your posts.

[London441 in reply to Mjex]

IMO, which is that of a neophyte compared to TA, you should have been on ADT when deciding on salvage radiation 7 years ago.

But that is idle speculation and couldn’t mean less now. That systemic therapy is needed ASAP is practically indisputable.