NEXT STEPS...

[Dummycat]

My husband is almost 8 years out from RP with Stage 3A, Gleason 4+3 (small amount tertiary 5). No follow up treatments so far. PSA returned at .027 after 43 months undetectable. Has been slowly rising and officially BCR at 6 years post surgery. Had PSMA scan in January which showed one pelvic wall lymph node with tracer uptake and a spot on pubic ramus with more avid uptake. We brought in all previous scans from last 8 years from different hospital and doctors agreed that the pubic spot has existed since prior to 2015 and hasn't changed much. The bone scan in 2015 indicated "sclerotic lesion suspicious for malignancy" but the CT scan didn't corroborate that. We are about to meet with RO to discuss steps going forward. She already described this situation as oligorecurrence and suggested SBRT to one or both of those spots. Would appreciate any relevant experience with this situation and side effects from proposed treatment.

[Tall_Allen]

IMO, spot treatment of a single pelvic LN is a big mistake. If there is cancer in one node, there is cancer in many, just too small to show up on a PET scan. In fact, the radiation treatment area was recently expanded:

prostatecancer.news/2021/05...

This should be given along with at least 2 years of hormone therapy. A clinical trial running now uses a Decipher score to determine whether Erleada should be part of the hormone therapy.

As for the spot on the pubic ramus, if it shrinks while using hormone therapy, you'll know it was a metastasis. If not, it is a false positive.

[Dummycat in reply to Tall_Allen]

Thank you so much for your quick, comprehensive and informative response. We are meeting with our RO next week. I believe that she she did mention an expanded field of radiation beyond the one lymph node in our last conversation. We will have more specifics once we meet. Thank you again.

[Jp2sea]

I agree with Tall. I was in a similar position and urged my RO to go as large and strong as possible across the area (I know it sounds crazy). It was too no avail. I did meet with more than one RO and it was helpful. But we really didn't get into specifics about radiation until I had my locating tattoos and mri to map the area and discuss dosing. Psma wasnt available then. I wonder about waiting until your psa hits .5 or .7 and doing a psma scan to get better sense. But Tall is correct about the micro metastases... it's hard to fight a disease that can't be seen. Godspeed