ABDOMEN/PELVIS LYMPH NODES: There is an interval increase of the abnormal radiotracer involving the left-sided internal iliac lymph node at CT image 239 and previously visualized at CT image 245 (current SUVmax 10.6). There is also new mild abnormal radiotracer involving the left-sided external iliac lymph node at CT image 251 (SUVmax 2.9).
HOW BAD IS THIS? Can it be taken care of?
Have you discussed this with your MO and RO?
going on 2/23 to see MO and RO. Genetic consult on 4/24.
It depends on what was previously irradiated. Talk to your RO.
I’m no longer with the RO that did my first radiation treatments. I still have my prostate. I’m now going to Roswell Park Cancer Institute in Buffalo. I’ll be seeing the MO and RO on 2/23
Your records should still be available. The new RO will need your old treatment plan to devise the new one. You will require radiation to the entire pelvic LN area (not just the one's you can see) and about 2-3 years of ADT.
thank you so much. The new doctors do have his previous records.
There's some interesting new data on the optimal duration of hormone therapy given along with salvage radiation. It's usually up to 2 years. A new trial suggested that "intensification" by adding abiraterone and apalutamide to ADT may be able to reduce that to 6 months.
I participated in a trial taking Lupron, abiraterone and apalutamide for 3 months prior to RARP. The outcome was as the team had hoped but the side effects for me were difficult. Significant memory issues, speech issues, major fatigue and the other more common effects of ADT. Tough three months but I'd do it all again if needed.
im assuming you are cancer free NJ Warrior, and for how long. In a very similar situation. But cant take Zytiga. Jus apalutamide.
I'm not sure I'm cancer free. My PSA is slowing rising. I'm waiting a few months for confirmation.
Hi TA - Do you have a reference to this trial? I am in the same situation and am on 2-3 yrs ADT with abiraterone to be added after I complete chemo. Thanks.
Adding both, or just one to the ADT
Can you provide a link to that data please
Hi TA, do you have a reference for this new data?
Consult with RO for whole pelvis radiation and 2 years ADT plus abiraterone based in the Stampede trial
Your oncologist will explain it to you. I always research results and terms used before the appointment to help understand results. Ask questions for anything you don't understand doctor tells you. They are used to the need to clarify.
than you
My understanding. Prostate intact, IMRT radiation to prostate. Persistent PSA now rising.PSMA shows two iliac lymph nodes.
We don't know PSAs, extension, SV involved?
So yes can be treated with whole pelvic IMRT and ADT. Two years is a long time, I'd consider 6 months as tall Allen mentioned.
Will that result in a stable PSA, possibly, but if not I can tell you what I'd do because I've been there already. I'm minus prostate. Below I what I've done, and recommend.
Ultra sensitive PSA testing on monthly and bi monthly going forward. Regular PSMA scans will be normal part of your life.
I stayed OFF ADT, so the scans could find any new mets. I've only been on ADT for 2 1/4 years over 8 years, I live a normal high activity life off ADT.
You want to find new mets with scans and attack them with SBRT. Don't be concerned if you IMRT doesn't result in stable PSA, it will work but you've just have more work to do. You may have SBRT more than once to separate PC mets.
I had 5 mets killed by IMRT, years later one lymph node by SBRT, 9 months later another lymp node by SBRT. Of and by the way you have other options other than SBRT, like cryotherapy.
This resulted in a stable PSMA for the first time after 7 years, were over 8 years now. Still stable.
Still ultra sensitive PSA testing every two months and scanning at least once a year.
You need to find a doctor and hospital that is enthusiastic about this approach. That's a must. Don't fall for " you need to be on ADT for the rest of your life".
It's your life and no doctor cares more about your life than you. Become your own expert. Know your path.
I was adamant that I was to do all I could to prevent becoming castrate resistance by staying on ADT.
It's working for me. If I return to a rising PSA in the future I will continue my same approach. I'm not looking to live forever, just a normal life, a normal death from something unrelated to PC, hopefully at a old age.
PSMA scan results 
PSMA Scan positive
PSMA PET Scan Shows no mets?!
Opinions on my husband’s Pylarify scan results? Is additional radiation possible? 
Need Help Interpreting My PSMA/PET SCAN
