I had the appointment with my RO to go over my PSMA scan to determine if additional RT is warranted.
To review, I’ve been on an ADT vacation for almost a year. Prior to that I had 20 rounds of RT and was on ADT for about 18 months after the RT before the vacation started. This is my second vacation. I had a PSMA scan in May to see what’s what. I thought the PSMA scan showed a small bone met on my ilium very near to the mets that were previously treated with RT. The hope was that the new met could be treated with additional RT.
Well, it turns out I have 4 small mets, very small and close together but they are separate mets. My RO pointed out it’s possible that they were there when I had the original RT but were not seen to be radiated because of the limitations of CT and bone scans and are now visible with the PSMA scan. Or they could be new mets. I have no symptoms. Because of the multiple mets my RO does not feel that RT is the way to go right now. He said the latest research does not currently support RT use as curative treatment for this many mets. Instead he feels ADT is the better current treatment option.
So it appears I will be going back on ADT for a third time. I have an appt with my MO in a couple of weeks to discuss the options. I assume that I will be back on Lupron with the possibility of throwing in Zytiga as well.
Oh well, I knew the vacation had to end at some point. It was good while it lasted.
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fireandice123
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Thanks. He sounds thoughtful. Probably thinks there’s a good chance the ADT will slow those suckers down or even shrink them. He could always zap them later. This oligometastatic thing and MDT is all over the board. Will wack-a-mole slow things down in the long run???
Yes, I believe those are his thoughts. He doesn’t believe the wack-a-mole approach is a viable long term treatment plan. And he didn’t rule out RT in the future if there is research to support it. Or particularly if the mets start causing pain.
Good advice. I'm not sure that RT to bone metastases accomplishes anything. All anyone can say for now is it makes the patient and doctor feel like they are doing something. It's really hard to do nothing.
The ACIS trial showed that adding Erleada to Zytiga slowed progression in men who were castration resistant vs Zytiga alone.
I would expect it would do even more for men who are not yet castration resistant, like yourself. It would be hard to get insurance to buy in, but worth a discussion with your MO.
That’s not like you TA to encourage a use not yet proven by clinical trial yet logically appears that it should help? I always think that way but you’re not prone to. Any reason this combo is different ?
My attitude has always been to use informed judgment when there is no evidence to fall back on. Why do you suppose I recommend MDT to patients, if safe?
I believe erleada has been proven to slow progression..esp. oglio presentation...see spartan/ titan trial.....not a payed spokesman ... a 5 y rsurvivor of said treatment ...titan trial participant
There is discussion what to do when new images techniques (PSMA PET/CT) are used to stage the cancer. These articles discuss these situation when low volume in conventional imaging goes to high volume with the new imaging techniques:
Going to triple therapies with abiraterone and apalutamide even when it may offer a radiographic progression free survival advantage, does not offer an advantage for overall survival. This is quoted from the full article:
"The median overall survival, a secondary endpoint in ACIS, surpassed 3 years with apalutamide plus abiraterone–prednisone versus abiraterone–prednisone (36·2 vs 33·7 months), although the difference between the groups was not significant. "
"So far, the phase 3 studies that have shown a survival advantage used a single active therapy plus androgen deprivation therapy compared with androgen deprivation therapy alone."
The aggressive ADT plus AAR drug approach would be the default SOC. Will surely slow the cancer for some unknown time, then will surely fail. My approach has been to keep that as a fall back in reserve as long as there is a reasonable (possible) path for effective treatment first.That is why I favored metastasis directed RT therapy for oligometastatic disease (which you are). But then have followed it up with Lu-PSMA-J591 treatments (2) in Australia in May. This is to go after, attempt to clean-up micrometastatic sites and circulating cancer stem cells, wherever they may be.
This is not SOC but there is a clinical trial enrolling in Australia now.
You can read my summary and experience so far with this in my posts, starting with: Why I Choose an Unproven Treatment.
The contact and treating physician, Dr. Nat Lenzo, is available for virtual consults. You could set an appointment and ship him a disc of your PSMA scan via theranosticsreception@genesiscare.com.au.
ADT, Erleada & Xgeva shrunk my large T-4 lesion enough that cyberknife was no longer needed, in 2 months. PSA dropped from 7.3 to 0.3 in 3 months. Minimal SE's so far (knock on head) & still castrate sensitive. Will have PSA checked in 2 wks.
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Purpose of ADT Vacation?
ADT vacation
ADT vacation
Update after a year on vacation
ADT Vacation 
