I have 4 bone mets which are quite small (<0.25"). I've asked my Radiation Oncologists about cyber-knife or SABR but they seem hesitant. Has anyone successfully ridded themselves of bone mets this way? I'm currently on Zytiga/Pred/Lupron with essentially zero PSA/Testosterone.
Thank you.
Steve
UPDATE 9/14/22:
I had my meetings with my ROs from MSK and URMC (local). MSK says that due to oligo metastatic they could try radiating the 3 bone mets (one is apparently gone) and suspected lymph nodes in pelvic region (and stay on ADT for at least 2 yrs). There is evidence of greater OS. URMC says stay on just ADT since it is working well. Only been on for 1 year. PSA and Testosterone unmeasurable. There is also a possibility of getting into a Lu-177 trial in the near future at URMC.
So do I take a chance with the radiation which can possibly cause very negative side effects in the pelvic region or just keep on ADT and wait for Lu-177 to hopefully rid myself of the cancer?
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groth12345
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There is no evidence that zapping visible bone metastases extends survival. We will know more in a couple of years. For every bone met you can see, there are thousands more you can't see. But, if nothing else, it would help you feel less anxious. Given the lack of proven benefit, a lot depends on where the bone metastases are. Radiation in some places are too dangerous if there is no proven benefit. You may want to hear what your RO says about the safety of such treatment.
My PSMA Pet scan is today and hoping there are no changes. Then I will discuss with MO and RO and second opinion RO at MSK. Thanks for your input...makes sense.
I was diagnosed with APc with 2 mets ( rib and spine T1) My RO said it was worth trying SBRT whilst ogliometastatic as 30% chance of a cure due to abscopal effect. I actually don’t know the trials she was quoting but went ahead.
It was easy and did work on those 2 original mets but no abscopal effect for me and 6 months later I had another 6 bone mets in different places. So onto systemic therapy but no regrets trying it and after much systemic and mets directed treatments my scans are currently clear and I have had two months of undetectable PSA but now on 2 types of hormone treatment but could be worse off.
If you do hear where that 30% figure comes from, I would be interested to know. I had thought the estimate was far lower (but can't say where I heard THAT, either, lol).
The Stampede Trial proved the skeptics wrong. If you are Oligometastatic, SABR/SBRT can extend time until Biochemical Recurrence. MSKCC agrees with this approach.
I was a bit shell shocked at the time of my diagnosis but my wife took extensive notes. When the PSMA pet scan showed likely met on rib iii and T1 my urologist passed me to the RO who immediately took ‘stampede trial scans’ of a lower quality to see if I would benefit from radiation to the prostate. The ‘stampede style’ scans showed 1 met only and she said I fell into the category who would benefit from radiation to the primary per stampede but first of all she recommended SBRT to the two mets with all crossed by an ‘abscopal effect’ . All went through MDT at UCLH London. When further mets popped up 6 months later she said I had to be established on HT for 3 months before the radiation to prostate. I’ve gone further with radiation based on Finland protocol of early Lu-177, radiation to prostate and pelvic area , two brach’s and further SBRT to T9 which was improved but not vanished after Lu-177. In addition I started degerelix monthly injections, had 3 x Docetaxel infusions post Lu-177 in case of PSMA negative cancer. No idea what has done what given I now take daily Apalutamide as well! Pleased to be ‘< 0.03 for second month though
Consult with a RO. It will depend on the location of the mets.
If the cancer is oligometastatic i there is not evidence yet, that direct treatment of the metastases will prolong life, but it has been shown that it can prolong the time to radiographic progression and the need for new systemic therapies.
So you can get ‘palliative’ high dose radiation to bone mets. It kills cancer. I’ve had most of my mets zapped. Except for tricky spots near spine, back of eye socket, .. Radiation will weaken the bones and is most effective when used in conjunction with another therapy. It can be authorized for palliative reasons (pain) but not as a ‘cure/control strategy. So complain about the pain when requesting your palliative radiation. My 2c
I had SABR treatment to one met within the TRAPTrial 2020 which was successful. However 2 further Mets were identified this year. I had palliative radiation to them 6 months ago and switched from predniselone to dexamethasone .My PSA has dropped month on m th for the last 5 months and last draw it was .24, the lowest level for 6 years
I don’t think you’ll ever “rid” yourself of bone mets, however there could be a benefit depending where they are located so that they don’t cause a skeletal event. You may also want to consider Provenge if you qualify, together with radiation especially with your PSA at such a low level, there may be a benefit of the two when used in combination.I had my prostate and several nodes radiated about 8 years ago despite naysayers telling me it was useless for stage 4 PCa. Radiation was probably the easiest treatment I’ve had thus far. SE’s were only a little fatigue and the 9 week process was a bit of a hassle but I’d do it again in a heartbeat. Provenge was also pretty easy to undergo.
Now that I’ve become castrate resistant my onco, Dr. Sartor has recommended spot treating any mets that are visible on a PSMA scan once my PSA reaches a level where the scan would be effective. His recommendation is good enough for me.
Thanks for the info. I did have radiation of the prostate about 4 months ago. Went well. I will check into Provenge. I wonder if you have to be castrate resistant to qualify?
There is a lot of talk about PSMA scans being effective related to PSA value..However, my URO says ...get PSMA scan even low undetectable PSA as he has seen many surprises...depends on personal journey of patient.
I had Choline pet scan even at psa <0.03 as in France the protocol says I can get scan after 2 years..of RT.....
Any clarification regarding this is welcome....I may be wrong....again why not ?
Yes Doctor Sartor has said the same, he may order one when my PSA hits 0.1. He said since I’ve been on ADT for over 8 years there’s a possibility of a low PSA tumor. The tricky part is that Medicare may limit the number of PSA scans annually so you have to choose carefully when to get one. This is what he said back in May.
I just had my largest of 4-5 Mets radiated. After 10 yrs of Lupron and Zytiga my PSA began to rise and the doubling time was fast so my MO did a PSMA and felt that the PSA increase might be the result of this larger tumor (which was also radiated 8 yrs ago). So, it was radiated again in late June. One month later, my PSA had dropped from about .32 to .05. Labs are scheduled again for next week. I am keeping my fingers crossed and we will see what happens.
Steve, although you are right on the limit of whether or not SABR/SBRT can be effective, I say go for cure. It may not be possible here, but SABR along with some new Ligand like J591 being used in Australia may be a combo that turns out to extend life (OS) in a meaningful way. The target is constantly moving. Some bone Mets turn out to be injuries from previous accidents or moments in physical sports. You are undetectable PSA. Dr Kwon of Mayo says these are opportunities for cure while most of the PCa cells are asleep. No one can calculate the power of the mind to heal.
My humble non professional opinion, if you can get an RO to hit those 4. Go for annihilation! Get back to No Bone Mets here, and let the chemicals deal with the micro Mets.
If your RO says No (I was told No at MD Anderson, and Orlando Health), first tell her about Stampede Trial Results (I believe Arm H), which proved that w Oligometastatic Men (fewer than 4 bone mets, and 1 or 2 lymph nodes outside of the pelvic region), that there was meaningful extension of life.If she says No after that, contact Dr Sean McBride at Memorial Sloan Kettering. Mike
My RO says that she will meet with the "tumor board" to discuss zapping the mets. She said that I am in a good position to possibly go for a cure, even though the chances are very low.
I have responded well to the prostate radiation and ADT (0.02 PSA, <5 Testosterone). The mets have shrunk slightly each time after each PSMA PET (Nov 2021, March 2022 and Aug 2022). Low volume as follows respectively: right 5th rib (4.3 - 2.1 -2.1 SUV). Left 4th rib (2.0 - 2.0 - 1.8 SUV), left scapula (2.4 - 1.5 -1.3 SUV).
MSK IMPRESSION:
(Comparing to last PSMA PET March 2022)
1. No suspicious PSMA activity in prostate gland.
2. Further decreased size and resolved PSMA uptake in a few right
external iliac nodes.
3. Unchanged low level PSMA uptake in a few previously PSMA avid osseous
sites.
4. No new suspicious lesions.
I have a video appt with my MSK RO (2nd opinion) on Monday 8/29. Between the two of them, a decision will be made.
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Opinion on radiation to bone mets.
Very low psa with new bone mets
Bone mets and no Recommendes treatment 
Radiation to mets?
