First PSA reading to give baseline in March 2022 before starting Enzalutamide PSA 0.2
Bloods taken again 3 weeks later after Enzalutamide started PSA .001
Scans that I’ve had MRI / CT / Nuclear Bone scan have showed only the one Met.
CT scan is booked for next week to then discuss scan later that month with Oncologist to look at Radiotherapy treatment to the Prostate and the metastasis assuming no progression.
This is being described as with a view to “consolidating” the disease
Could this mean a long durable remission ?
What treatment should I expect
SBRT ?
EBRT?
Can this only ever be palliative and not curative.
Should I have a PSMA pet scan which I would need to pay for plus if I did and this resulted in micro mets showing it could take me from low volume to high volume and migrate to the point where I would get no radiotherapy so a double whammy.
What side effects can I expect it seems fatigue is again mentioned but there seems to be mixed information / advice in Google land.
Tall Allen has said that in the UK the radiotherapy is given once a week over 6 weeks but I may not of given as much information at the point of his commentary
Any thoughts and comments ?
Thank you in advance
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Farn
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Wow that is a great response. As yours appears to be low volume then you should qualify for radiation (us higher volume unfortunately do not). You really need a radiologist to explain the 'best' treatments available in the UK. It maybe worth going for a private consultation. I'm unsure if your low PSA rules out a PSMA scan but my understanding is PSA needs to be at least 0.10.
I would recommend to try and do weights and resistance training for the loss of muscle mass that occurs with ADT and Enzalutamide.Good luck, I think you can be aggressive now to try to go for very long term remission.
In the UK STAMPEDE trial on such treatment, patients who received prostate radiation, got it in one of 2 ways: either 55 Gy in 20 daily treatments, or 36 Gy in 6 weekly treatments. If you have a choice, Alison Tree would be my top pick. She uses the Elekta Unity, MRI-guided linac now.
Fatigue is related to the number of treatments - another reason to opt for the 6 treatment protocol if you have a choice. Many of us who had such a protocol (mine was 5 treatments) had no fatigue whatever.
Here is a patient handout I give to new radiation patients about expected early side effects:
The rule of thumb is that the worse your status is going in, the worse it will be after radiation. For example, men who are having urinary problems at baseline, will often see those conditions worsen afterwards. If you are having urinary problems, take an alpha-blocker and daily tadalafil (it is known as an ED med, but also preserves urinary function). I also took daily NSAIDs throughout my treatments. This is the time to increase your exercise regime - run or bike farther and do it everyday, especially before treatments, if you can.
You can expect to survive a third longer after the prostate radiation. No one knows whether the radiation to metastases improves survival, but as long as you keep on taking ADT and enzalutamide, why not try it? It is not curative, but it may slow the cancer down quite a bit.
I was diagnosed with extensive bone mets December 2017, psa 63. I had docetaxel, then onto aberaterone which started to fail. I had six sessions radiotherapy starting December 21. It’s bought me 15 mths of good quality extra time. Probably look at steroid change next.
I'm in the UK I had salvage RT on my prostate 5 days a week for 7 weeks +1 =36.For the Spinal Met I had total of 3 high doses either 2 or 3 days apart can't quite remember. 😜 On both occasions I just had a little fatigue, which was slightly worse with the 36 doses. Probably because it was every day M-F for 7 weeks..
I had 20 treatments no fatigue made urinating more difficult for awhile but flomax once a day has taken care of that…some pain in the rectum towards the end of treatment that went away… right now I feel great exercise 5 days a week…RO says mine cannot be cured but the radiation will hopefully give me more time…
I had 39 session of SBRT/IMRT over a period of 8 weeks, for the first 3-4 weeks I had no symptoms. starting week 5 I had diarrhea for which I took some meds that took care of it. The last two weeks I had urgent and frequent urination and some burning at the tip of my Pinus. all symptoms went away 2 weeks after completion of radiation.
I had 37 treatments of EBRT M-Fri with 0 side effects throughout.Oh, the thing that did happen was i was seeing a naturopathic doctor and we had increased my NK cells to double normal values and after the radiation it was knocked in half which ended up being at normal levels. We used a bunch of mushroom products like shiitake, turkey tail and more. I will look back at my supplement plan from 2015 to be more specific.
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