My Bio gives full details, but in a nutshell, I was diagnosed with APCa with extensive bone mets last year, have been on ADT for 7 months and Xtandi for 4 months. I had a CT scan in December which showed little change from the previous one in August except for some progression in a pelvic lymph node met from 14mm to 21mm. My PSA is still dropping, currently at 0.21.
My MO ordered a PSMA PET/CT scan last month to see how much active cancer there currently is hoping that it would only be active in the pelvic area indicating that radiation to the prostate and active tumours there would be the next appropriate treatment. He said the scan, however, shows there are still active tumours in other bony places such as ribs and spine. I questioned what he meant by “active” given they are not growing and it appears to be the fact that they are expressing PSMA.
So he offered three options:
1. Just continue the ADT + Xtandi for now and reassess in a few months' time
2. Continue as above but add RT to the prostate (which has a large tumour), the increasing pelvic lymph node and a large met on my pelvic bone (which is giving me some discomfort)
3. Start Chemo (Docetaxel)
There is a fourth option that I would need to self-fund which is to start a course of Lu-177.
His advice is to go with option 2.
My questions are:
- Given that my PSA is dropping and the bone mets/tumours are stable (i.e. not growing) but do express PSMA, does that make them “active” in the sense that they would likely respond to Chemo now after 7 months of ADT + Xtandi?
- Forgetting about the cost, would it likely be better to start Lu-177 rather than Chemo now or should I go with the MO’s advice and have RT to the pelvic areas listed above for now?
Thanks for any inputs!
Mets to lungs and lymph nodes need some advice 
Decision time Lutetium or AM509
Decision Time is Coming
