To treat or not to treat

[AgedTenor]

In 2017 and 2019 I had SBRT to two bone metastases identified using a PSMA scan. No other sites were identified. By March 2020 this had caused my PSA to drop to virtually undetectable and I decided to come off ADT which I had been on (with some breaks) since April 2011 after RRP and RT to the prostate bed. Prior to radiotherapy ADT was ceasing to be effective and my PSA had risen to 6.75. Since 2020 my PSA has been slowly rising to its present level of 1.14. I am getting some intermittent pain from the site of the met on my rib (the other was on vertebra T10). My consultant has suggested that I do nothing for the moment, go back on ADT or have a new scan with a view to possibly repeating SBRT to active sites. I am 77 and otherwise pretty healthy. I'd be interested to hear anyone's views.

[MateoBeach]

Doesn’t hurt to get another PSMA scan at this time to help clarify your decision. Perhaps also an FDG PET scan since you have been on long term ADT before.

[rhbishop2 in reply to MateoBeach]

Thanks for your reply. FDG is a new one for me.

[Tall_Allen]

I think it is a big mistake to use PSA as a guide for whether ADT is needed after SBRT to bone metastases renders PSA undetectable. He treated PSA instead of your cancer, which was already systemic. Please read this:

prostatecancer.news/2020/07...

[rhbishop2 in reply to Tall_Allen]

Thank you TA - that’s very helpful.

[Hidden]

Please understand that in 2017, he had metastatic disease. This means that micro-metastatic cancer cells were traveling through his vascular and lymphatic systems looking fir a place to colonies and grow - witness the already established metastatic lesions present. Systemic treatment is called for.

There are varying opinions on how to introduce the systemic treatment. However they all call for ADT; initially something like Lupron, Eligard, Firmagon, etc. I am biased ....... to me as a newly diagnosed person with the onset of metastatic disease that meant Lupron/Eligard with six months of chemotherapy and a continuation of ADT for another five years. This was during the time that the “new” 2nd line ADT was being trialed. Fortunately, I have never had 2nd or even 3rd line ADT during all my time. I am 76.

I am biased with ADT with chemotherapy early on as a systemic treatment for metastatic disease, I did not take an ADT break while I had active metastatic lesions. However, listen to your pro. Your pro has a plan. He may vary based on an individual preference. However individual preferences with no medical background is not wise. If there is a medical reason to take a break, let your pro advise.

Best wishes in fighting this bastards disease.

Gourd Dancer

[j-o-h-n]

Okay all else aside............ what has 16 balls and sings?

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 02/22/2023 6:29 PM EST

[Lyubov]

My husband had salvage radiation (IMRT) in 2016 that caused severe tissue damage -- radiation cystitis -- now (likely too late) receiving hyperbaric oxygen therapy. Has had horrible struggle with this horrific side effect. Not everyone hit this hard.