I am confused about typical tx in such a scenario.
Suppose someone has say 1-3 small spots on bone. Assume no pain/symptoms.
I've read that one can radiate those spots. I've also read that one should not radiate unless there is pain. Which is it?
Same question, but say more than a few spots (>5). Is radiation even in the picture?
Mel
I have about 6 mets around my skeleton. I have no pain. I asked my MO about radiation and his thoughts were the mets have been there for a while and not to try radiation now.
Radium 223 treatments are considered beneficial earlier rather than later. What does your oncologist suggest?
If you have only 3 metastases they could be irradiated. If the cancer is CSPC it may delay to start systemic therapy, If the cancer is CRPC it should be done along with ADT and other treatment.
I had five mets on spine and all were radiated with success 6 years ago and no reoccurrence while on ADT. Last month two more popped up and those were zapped. Never have had any pain
As far as we know, radiation of metastases is only palliative. Is it growing, and will it cause loss of function if it continues to grow? Is it safe? (Radiation in the mediastinum may not be safe.) If there are just a few, and they are in a safe place to radiate, why not?
The radiation of asymptomatic multiple spinal metastases has shown no benefit, but there may be cases where there is a benefit:
Cool and very informative video! Frightening, too.
Seems reassuring?
Yes, but it's the "0.9-1.5 years" survival rate that's scary.
I have one bone met (<1 cm) in my right hip socket as well as lymph node metastases. I am on the triplet therapy protocol and finished 6 cycles of chemo at the end of October.
Because they consider me oligometastatic, they are also giving me radiation (just had treatment 9 of 28). We had discussions with my RO and decided on not only irradiating the prostate but also irradiating the bone met and the pelvic lymph nodes. It’s a lot of radiation but I figured it would give me the most potential benefit to just go for it.
Triplet plus the radiation you have planned is the full meal deal. Yes, likely to give you the best possible PC control. 👍🤞
My husband was diagnosed with many bone mets in Aug 2017- gleason 9. Did chemo plus lupron at diagnosis. Then switched to zytiga plus prednisone and kept Lupron after chemo. PSA steadily declining as did bone mets. He never had pain from mets on bones. Scans showed no active cancer for a few years then one former spot on his T4 spinous process (end of vertebrae so RO and MO felt a 'safe' place to do one high dose zap) lit up. He had no pain there. He did the one 'zap' to that met which seems to have worked in the follow up scan. He will have his next scan March 2023- but PSA continues to drop (just reached 1 last month- lowest in 5 years- steady drop but SLOW). His doctors are happy with the results of the one spot radiation treatment and will do again if needed.
I recently had one spot on my rib show up on a PSMA scan, which coincides with my PSA becoming detectable again after about six years of being undetectable. I plan on having it radiated, my local MO as well as my PCa specialist Dr. Sartor agree with that. It is in an easy spot to radiate and I’m not going to let it fester. The RO says it’ll be done in three sessions of SBRT. I go for my simulation on Wednesday, hopefully get it taken care of next week.
Ed
Good plan. Good luck.
you could read the PEACE1 study. Some docs start with chemo first then radiation. Many do radiation along with medication.
I had spots on my spine radiated due to leg pain caused by pressure on the nerves. Oncology radiologist didn't think it would work, but was willing to try. Two weeks, after the first week I was pain free, and have not experienced such symptoms since. But that did include pain (and other symptoms...)
I think that everyone will be treated different based on how much radiation you had the first time. I never asked but was told when I got my 39 rounds that it was all I could ever get. Tells me my spots when they come won’t be treated. In my group nobody had the exact same treatment. Mine was proton not sure how different IMRT would have been.
I had RP & EBT & then Lupron for 2.5 yrs., PSA <0.1 (T = 10). Went on holiday for 1 .5 yrs.
T went to 200's & PSA 0.4. 1 lesion on Lamina of T-11, considered Oligometastatic. Had Cyberknifed.
In 3 mon. T went to 330 & PSA 7.3, metastasis throughout skeleton, T-4 of "Neurological Significance". RO wanted to Cybernife but MO started Apalutamide, Lupron & Xgeva & lesion shrunk. PSA went to 0.1 & so far staying there.
So, depends on the significance of lesions as to what to do?
Is radiation to prostate useful if one has bone mets ? 
First steps for treating bone mets
Bone Mets 
How much targeted radiation to mets?
Missed Bone Mets
