In year 7 the ups and downs are down again

[Timfc]

Four years ago my PSA came back and a non-SOC PSMA PET scan found one lesion on my spine at T9. My local doctor refused to treat based on the non-SOC scan, MD Anderson declined, and I ended up at Mayo in Rochester for SBRT, one session. Two years of ADT, and two years of vacation brings me here (4 years undetectable), with rising PSA, up to 1.3. Last week I had the Pylarify scan (now SOC) and the lesion on T9 lit up like crazy. It has doubled in size. Also noted is a 2cm mass on my right kidney, but they do not seem to be overly concerned about that. I am leaving today for a 10-day trip out of the country and my doctor said to have fun and we will deal with this in June. I am ready to re-start ADT but he says no, let's wait until he can study the images with his colleagues. I know that the concern is the proximity of a very important nerve that runs through T9 but nobody has mentioned that yet. So, the story continues.

[Timfc]

1 year of relugolux and 1 year of Eligard.

[Timfc]

Thanks Nal! Actually the relugolix was free in the phase 2 clinical trial. I have had PSA check every 3 months for about 8 years. The recent rise started around March of this year and my doctor wanted to wait until it was over 0.5 to do the Pylarify scan. It ended up going over 1.3 before we could get the scan done. I like your suggestions and I am surprised that my doc said to wait until I get back to start the drugs (after June 5).

[Timfc]

As always, your kind advice is appreciated!

[Schwah]

Nal can you explain why you think0.1 is the right # to end a vacation?

Schwah

[MateoBeach]

So you are still oligometastatic at T9, even after they treated it with one (ONE!) SBRT treatment. Usually it is 3 to 5 treatments to cover possible variations in setup day to day. That would make me dis-angry-pointed. If there are no other lesions elsewhere, and the kidney may need to get cleared on a high resolution MRI, then I would go back for proper SBRT. If they are worried about proximity to structures-at-risk then the best would be the ViewRay Mridian MRI guided RT system. Here is a link with map of locations that have this technology.

viewray.com/find-mridian-mr...

[Timfc in reply to MateoBeach]

Thanks for the tip about viewray, it sounds very promising!

[Schwah]

It does. Very thoroughly. Thank you. Do you use replacement T during your “vacations”. If so please provide some color. Thx Nal.

Schwah

[j-o-h-n]

Applause for Nal......

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 05/26/2022 11:22 PM DST

[Atlpapa]

Nal, I've always read your post on adaptive theory we great interest and was curious about your t level during your vacations so I'm glad someone asked. My psa tests only have 1 decimal place, i need to see if my dr can get it to 2 decimals. Did you have any bone met with your Pca?