Treatment options for local PC that is resistant to radiation

[Eddy-Merckx]

I received radiation treatment to my pelvic area this past spring for castrate-resistant lesions in my prostate and two lymph nodes. A month after completing radiation, my PSA dropped from .22 to .09, but a CT scan showed only a small decrease in size of the lesions. Six weeks later, my PSA increased slightly to .11. Because my cancer spreads without emitting much PSA, my oncologist has ordered a PSMA scan and suspects the radiation was not effective. Has anyone had a similar issue? Are there any recommendations on treatment options? Thanks.

[Tall_Allen]

I suggest you discuss a biopsy of a recent large met followed by histology, IHC and genomics. The IHC should include as many of these as possible: AR (androgen receptor), PSA, PSMA, MSH2, MSH6, STEAP1, PD-L1, chromogranin A (CGA), neuron-specific enolase (NSE), synaptophysin (SYP), DLL-3, CD56, Somatostatin (SST).In your case, an FDG PET scan may show more than a PSMA PET.

[Eddy-Merckx in reply to Tall_Allen]

Thanks! Much appreciated.

[cesces in reply to Tall_Allen]

TA, can you explain what an IHC is?

I don't recollect ever hearing of that diagnostic tool.

[dentaltwin in reply to cesces]

Immunohistochemistry:

cancer.gov/publications/dic...

[cesces in reply to dentaltwin]

Is this something recent, or recently evolving for use with prostate cancer?

I've never heard of it before?

[dentaltwin in reply to cesces]

I'm familiar with it in the context of dealing with my oral pathology buddies (there is some difference of opinion wrt its diagnostic usefulness for certain oral lesions). I am not familiar with its use in prostate cancer.

[Tall_Allen in reply to cesces]

Not recent

[cesanon in reply to Tall_Allen]

TA, Do you have anything about prostate cancer related IHC on your prostate cancer site?

[Tall_Allen in reply to cesanon]

i don't recall. I don't usually write about diagnostic tests unless they are new.

[TJGuy]

Can you describe the cryoablation performed on your liver. I'm aware of liver spheres radiation used for treating liver cancer, and surgery but I wasn't aware of freezing cancer on the liver. What type of doctor performed it?

What sensation did you feel?

How was recovery?

[Eddy-Merckx in reply to TJGuy]

I do not recall the type of doctor that performed the cryoablation but I think he was from intervention radiology at Dana-Farber. I was under anesthesia the entire procedure and there was very little discomfort afterward. I had a 2 week recovery period where I was not allowed to perform intense exercise but could go about my regular activities. It is not part of standard care, but I was willing to take the risk given my age and that I have young children.