Plenty of lymph node metastases (also outside of pelvic area): treatment and success?

[Daughter17]

What kind of treatment do you have/had in situation when cancer has spread already to many (distant) lymph nodes? My dad’s aggressive prostate cancer is newly diagnosed and it is already advanced. He has plenty of para-aortic and iliac lymph nodes and also one clavicle lymph node. Biggest ones are about 2.5cm. Diagnosed via CT. Bonescan was clear. No PSMA PET-scan. I know that PET-scan would be much more informative but it is not available for him. I am also interested to hear if your treatment has succesfully shrunk your lymph nodes. My dad has started enanton and is going to start Erleada. They said that radiation and chemo are not possible.

[Tall_Allen]

It appears that he has only one met (clavicle LN) that is completely outside the pelvic LN drainage area. That indicates that the cancer is systemic and he requires systemic treatment - Erleada+Enanton is fine.

I think, however, you should discuss debulking the cancer with radiation. He can get whole pelvic radiation including the para-aortic LNs per NRG Oncology guidelines:

redjournal.org/article/S036...

The prostate itself, with a wide margin, can get a boost dose of radiation.

The clavicular LNs can be treated separately with SBRT. It may not be beneficial, but it seems like it is in a safe place to irradiate, so why not?

[Daughter17 in reply to Tall_Allen]

Thank you! Sounds promising to me. I think public health care won’t do radiation because multidiciplinary doctor meeting already decided that no radiation in his case. Anyway we will ask and another alternative is private cancer center (Docrates). We are located in Finland. Unfortunately there is a huge price difference between public and private healthcare. Public healthcare is almost free and in Docrates he will pay all real costs (no insurance). In Finland healthcare is usually high quality and enough but of course sometimes you may get better treatments if you use a private center.

I read some research articles of prostate radiation in metastatic case and I am a little bit confused of terminology. I am now wondering if his case is low volume metastatic or high volume metastatic? I think he may be low volume because there are not any known bone or viscelar metastases. But can he be low volume although there are plenty of lymph node metastases? I assume that he is not oligometastatic.

[FormulaRob]

I assume that you guys are located in Canada? I’m in Toronto Canada and my fathers team unfortunately turned him down from getting a PET scan despite pushing for it.

My father has Gleason score 9 with a few lymph nodes. One suspicious spot on pelvic bone as well

He did whole pelvic area radiation with a booster. He started ADT before the radiation treatment. He completed 5 weeks of radiation with booster and now continues the ADT every month

[Hailwood]

I obtained a PSMA PET scan here in BC that identified 7 x 6-7mm abdominal/aortic lymph nodes and I have been on Erleada/Lupron for almost 3 years now with no elevation of blood levels and health remains stable. Thankfully no bone mets

[NecessarilySo]

I suggest that you read my profile and posts, (click on my name), particularly 8 months ago post about "Lycopene, Heat, and Magnets."

[MateoBeach]

Lu-PSMA treatment has overall better results in lymph node only disease. PSMA PET scan is required first to see if appropriate. I know it is available in Finland though I don’t have the contact info. You could PM Brysonal here on HU who went there for treatments.