Continuing intermittent ADT? or more?

[whitebird]

I appreciate having learned much following this site. 74 year old, very active, runner, hiker, retired ER RN, married, sexually active

Brief long hx: Diagnosed 2001 PSA 3.2 (high velocity), RP Gleason 3+4, one nerve spared, negative margins and nodes.

2015 BCR,

2016 salvage radiation to bed for PSA 0.41, no ADT PSA 0.11 post radiation

Oct.2018 clinical trial OHSU but ended up on SOC arm with Degarelix x12mo

PSA undetectable for ~18 months then gradual rise

Oct 2021 PSMA Pylarify scan with multiple mildly enlarged L iliac external iliac, internal iliac common iliac, and retroperitoneal lymph nodes, most prominent L internal 2.2x1.3 (SUV max 36), most superior at L4 (SUV mas 8.8), prominent l common iliac 1.5x0.9 (SUV max 31)

Started on Lupron April 27 (bicalutamide 2 weeks pre and post injection). Plan - 9 mo Lupron then another vacation.

Just wondering if anyone has any suggestions about whether I should explore additional treatment at this point

[Tall_Allen]

All your mets were in lymph nodes? Have you talked to an RO about salvage RT to entire pelvic LN area?

[whitebird in reply to Tall_Allen]

Thanks TA. Yes, all in lymph nodes. Will discuss with Med Onc at virtual visit tomorrow. I appreciate your knowledge and input.

[Tall_Allen in reply to whitebird]

Recommend you discuss with RO rather than an MO. Main issue is whether it's still worth doing when it is no longer oligometastatic.

I have less concern with the location. In fact, this just in. Email to RO - not yet published:

RT to Common Iliac LNs (M1a) just as effective as lower (N1) lymph nodes

[whitebird in reply to Tall_Allen]

Thanks much. Very interesting. I do understand RO would be the consult. Just happen to have an appt with MO tomorrow. Will have to reconnect/find RO since it's been a while. Is it important to find an RO specializing in this?

[Tall_Allen in reply to whitebird]

No one specializes in pelvic LN radiation, but ROs who have done a lot of it are better than ROs who haven't.

[whitebird in reply to Tall_Allen]

Saw OHSU MO virtual today. She was happy to refer to OSHO RO. Will email to them with study when we get the appt. Thanks TA

[Scout4answers in reply to whitebird]

There are ROs who have Prostate radiation as a focus of their practice but you will have to look for them. As Allen says an experienced ROs will give you a better chance of a favorable result.

[whitebird in reply to Scout4answers]

Thanks for responding. Will fu with RO at OHSU

[j-o-h-n]

2001 RPD, open type I bet. Good Going for 21 years..... now another 21 years to go....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/10/2022 1:14 PM DST

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

Yes, open but a great surgeon. It's been quite a ride