First ever PSMA scan shows two small bone lesions

[mooman80]

I recently posted about my father who had just completed IMRT and three years of Lupron (no mets seen on bone/CT scans). At the time his MO was suggesting adding Zytiga per studies showing its effectiveness with ADT at diagnosis for localized high grade cancer (he is Gleason 9). MO also ordered PSMA scan which is now available locally as a baseline, this is his first. PSA is 0.03.

PSMA scan showed two bone lesions, one on lower back (7mm) and one on upper back (5mm). Given the smaller size these were not seen on any initial CT or bone scan, or any non-PSMA scans done since diagnosis 3 years ago. They may have been there since the beginning hidden. I was surprised with the result since I had read PSMA wasn't super accurate with low PSA.

MO is starting my dad on the Zytiga and continuing Lupron. Plans to do another PSMA scan in a years time to check for any progression while of course monitoring PSA.

Given the discovery that the PCA horse has left the barn at some point, is there anything else that should be done beyond Lupron/Zytiga at this point? Is it worth it to spot treat these newly discovered spots with radiation if they aren't causing pain? Sounds like triplet therapy is only for newly discovered metastatic prostate cancer, correct?

Thanks in advance for the help...this site and its members have been an absolute blessing in understanding all of this.

[Tall_Allen]

Talk to a competent RO. If it is safe to irradiate those 2 spots, why not? There is no convincing evidence of benefit yet, but if it's safe, what is the downside?

[mooman80 in reply to Tall_Allen]

That was my feeling. I'll push him to talk to the local RO that did his initial IMRT treatment at minimum. Thanks Tall Allen.

[Tall_Allen in reply to mooman80]

It's also important to temper expectations and to continue with hormone therapy.

[Engraver68]

have similar and had local SABR treatment to the three . Results have been very promising after 2 years PSA is still at a low level. I also have a six month Hormone injection Zytiga and Dexamethasone meds

[EdBar]

After my initial dx of stage 4 with multiple bone and node mets back in 2014 followed by ADT, chemo and radiation treatment of my prostate and several nodes my PSA became undetectable for about 6 years. A little over a year ago it became detectable again and I had a PSMA scan before Christmas that showed a single highly suspicious area on a rib. I’m having it treated with SBRT next week. From there we’ll see what effect it has on my PSA/scans before moving on to other treatments.

Ed

[Chadsdad in reply to EdBar]

Ed, what was your PSA prior to your PSMA scan at Christmas?

[EdBar in reply to Chadsdad]

PSA was 0.17, it was undetectable on an ultra sensitive PSA test for a number of years. Despite being so low, my MO doctor Sartor felt it was a good idea to get scanned since I was on ADT for so long (8 years). He said he’s seen heavily treated guys like me get a scan and have nothing, a little, and a lot show up on a scan despite low PSA.

Ed

[mooman80 in reply to EdBar]

Interesting, sounds similar to my dad. His SUV Max values for the two spots were 2.4 and 3.6, so low uptake from what I understand from the scan.

[EdBar in reply to mooman80]

Uptake might determine if he is a good candidate for Lutetium down the road, but I’m not a doctor and you would need to discuss with your MO. I believe my report said moderate uptake that was highly suspicious of metastasis. If it’s bone only Xofigo might be a good option. I’m hoping to hold off having to use the next therapy by using SBRT, don’t want to use up all of my bullets.

Ed

[mooman80 in reply to EdBar]

The 5mm 3.6 SUV Max presacral nodule was marked as "uptake of radiopharmaceutical and metabolically active, suspicious of metastatic site". The 7mm 2.4 SUV Max scapular spine spot was labeled "mixed lucent and sclerotic lesion with mild uptake, indeterminate, a potential metastatic lesion." Dr. is treating both as cancer spread.

Current plan is to add the Zytiga to his current Lupron and rescan in a year to gauge progression provided PSA remains low. He is going to ask about SBRT on the two spots outside the prostate. No chemo at this point.

[Chadsdad in reply to EdBar]

Thanks for the reply Ed. Dr. Sartor is on my list if and when I continue to the next step. I’m in Mobile with a Vanderbilt trained Urologist whom I like but also got a 2nd opinion from a local oncologist which agreed with present treatment. I’ve had good luck with Erleada/Eligard for 3 years. I have taken some ideas from your post concerning Statins and Metformin and have read Dr. Myers stuff. Thanks again. Larry

[EdBar in reply to Chadsdad]

Dr. Sartor is a great guy, very down to earth yet extremely knowledgeable and cutting edge. I see him twice a year (I’m in Atlanta area) and he coordinates with my local MO who follows his lead. If needed I can see him more often.

He can be difficult to get in with sometimes if your a trying to become a new patient so you might want to get established with him.

Ed

[Kcski]

Hi,

My Dad has a similar situation. Instead is Zytiga he opted to do Chemo first and it killed a TON of the cancer! The Taxotere is more natural (derived from tree bark) and very effective. He did six rounds. The first couple were not too bad the last one or two were unpleasant, but bearable.

He also exercises regularly and try’s to eat healthy home cooked meals.

Best of luck and love,

Karyn