Second phase with Zytiga....then what?

[icanwintwice]

Well hello again my friends. As mentioned before, I had previous PC 2010, Proton RT in 2016. In May my PSA went to 2.0. Recurrence in two obturator lymph nodes. Im 64 years of age. Started Lupron in May, Zytiga this month. Met with some radiologists and they are ready to "go nuclear" on my lymph nodes. Most are saying around 25 treatments. Did 39 before on my prostate. No recurrence there.

A surgeon at Mayo said he could possibly pluck the nodes out and do a lymph node dissection after the Lupron wears off. Im afraid that might be more invasive than the radiation...

Im reading and hearing that two years of hormone therapy, radiation, then taxotere gives me a 30% to 50% chance of non recurrence, if that. So its down to this.....

Any options Im not aware of....PSA is now at 0.06. Testosterone at 10. Any way to beat this animal......

[Tall_Allen]

I agree that pelvic lymph node dissection (PLND) is much more invasive. It is also less effective. Radiation to the entire area gets the lymph nodes one can see as well as the one's one can't see.

[icanwintwice in reply to Tall_Allen]

thanks for the input. Hard to make the right decision at times through this process. Understatement. Most people want to do Proton Radiation. Im confident that 'might' lessen the side affects? Also if my liver isn't tolerating the Zytiga, which could be an issue, what is my fall back....

[Tall_Allen in reply to icanwintwice]

To my knowledge, the pelvic lymph node field is too large to treat with protons. But even if it can be done, there are no clinical data that show it is any less toxic than X-rays. I have no idea who "most patients" are. The pelvic lymph node field gets a low dose (45 Gy in 25 treatments) with a boost to known cancerous lymph nodes. Even when dose is escalated, side effects are mild and not increased:

redjournal.org/article/S036...

I don't understand what you mean by "if my liver isn't tolerating the Zytiga, which could be an issue" -- either it is an issue or it isn't. Are you making up problems that aren't there?

[icanwintwice in reply to Tall_Allen]

thanks for your comments. 'Most people' meaning most radiologists. or two out of three were considering proton. I could be wrong but they acted like proton 'might be better'. When it comes down to it they might consider IMRT better. Sounds like IMRT might be the best option looking at that study. thanks for that report..

Any other articles you can find on lymph node radiation would be appreciated,

As for the Zytiga and my liver. My liver numbers shot up when I took the Lupron. My oncologist acted like I might have 'fatty liver'. They will be watching my text results closely to determine whether I have liver issues or not..,

[Tall_Allen in reply to icanwintwice]

I think you mean "radiation oncologists (ROs)" Radiologists are doctors who read scans. I would hope that every RO who does protons, thinks it is better, and every RO who does photons thinks it is not. Otherwise they are in the wrong profession. There are NO clinical data supporting that one is superior to the other.

[MateoBeach]

your last best chance is indeed to go for the full pelvic LN SRT and 2 years ADT. Go for another win. 👍

[icanwintwice in reply to MateoBeach]

thanks for the encouragement. def feel more solid about my decisions based on what Ive learned here...