Next Steps?

[OldChappy]

History: Male 60 yo; diagnosed 2017 with Prostate Cancer PSA 172; Gleason 9. Prostatectomy May 2018; Radiation April-June 2019; Chemotherapy August-December 2019. Was on Firmagon (monthly) and bicalutamide until April 2021 when oncologist suggested I go off it as my PSA was undetectable. Bloodwork every month. Started to rise this summer. it is now 0.30. Oncologist ordered CAT scan and Bone scan (both negative); then PETScan which showed lymph nodes about 5mm in area above where radiation was done in 2019. Met with radiation oncologist yesterday. His statements were:

1) wait and watch to see if it spreads anywhere else.

2) Start Firmagon ADT again.

3) Start Firmagon ADT and do 25 radiation treatments of that area of my body.

4) Do focused radiation of the area where the lymph nodes are.

He had reasons for all 4. Mostly that #3 would allow further radiation treatments if needed in another area.

#4 could prevent the use of radiation in future if it was near the current area.

He stated that surgery was probably not an option because he states that can't necessarily find the correct lymph nodes that are currently affected.

Anyone "been there done that"? Any suggestions or guidance would be appreciated.

Thanks!

[Tall_Allen]

If you didn't get whole pelvic radiation in 2019, get it now, with a boost to the PET-detected lymph node + 24 months of Lupron. Also consider adding abiraterone at the same time if insurance will cover it or you can afford it.

[OldChappy in reply to Tall_Allen]

Thanks. They did the whole pelvic in 2019. And they boosted a different spot in the same area as this one, but a little lower and further to the right.

I’ve been on monthly Firmagon shots with bicalutamide. Is abiraterone different.

[Tall_Allen in reply to OldChappy]

I'm surprised that the RO can safely re-irradiate the area.

Abiraterone prevents the adrenals and the tumors from producing androgens.