It's Back - The Way Ahead

[Hawk56]

Here's my clinical history, diagnosed in Jan 14, Surgery in March 2014, BCR in Dec 15, SRT in Mar 16, taxotere, lupron and PLN IMRT starting in Jan 17 and now...

Saint Luke’s Plarify 27 March 2023

FINDINGS:

Physiologic distribution of tracer is seen in salivary glands, lacrimal glands, blood pool, liver, spleen, pancreas, ganglia, bone marrow, bowel, kidneys, and urinary tract.

Prostate bed: No focal PyL uptake in the prostate bed to suggest local recurrence.

Lymph nodes: There is focal PyL uptake in a posterior right pelvic lymph node measuring 3 to 4 mm (4-176).

Skeleton: No focal uptake of PyL in the skeleton

IMPRESSION: PyL binding in a pelvic lymph node compatible with metastatic prostate malignancy

Wife and I met w/Dr. Corum yesterday, he is a medical oncologist focused on treating prostate cancer at Olathe Medical Center here in Kansas.

Discussed:

My clinical history, outcomes we were seeking:

Cure (third time's a charm...!), if not, durable long term remission.

Do not let PCa get to bones or organs.

Going in thought was six months ADT and SBRT. He doesn't think six months of ADT combined with SBRT to the one pelvic lymph node will get the outcome we're seeking. Says data is more for localized PCa in prostate being radiated.

He believes 24 months of ADT + ARI and the SBRT is best, most likely to produce durable long term remission given my clinical history., so...

Triplet therapy - SBRT, Orgovyx and Xtandi, the latter being an "ARI," androgen receptor inhibitor, preceding the PCa cells from binding with testosterone, their fuel.

He's checking with TRICARE For Life on cost...don't see an issue., I checked with Express Scripts, monthly co-pay $14.

We can assess throughout, stop if too arduous or PSA undetectable and stays there much like Kwon at Mayo did in 2017-2018, stopping at 18 months ADT vice the 24 planned.

He'll coordinate with my radiologist on frequency of labs, prescriptions....

After our consultation and discussion, wife and I agree with what he thinks we should do.

Would prefer the doublet therapy and six months but willing to give the medical oncologist's recommendation a try!

More to follow, took my loading dose on Tuesday, daily pill since, no issues yet. Did the SBRT simulation on Tuesday. will start next week, five treatments every other day

As before, continue to exercise - ride my bike, swim, lift weights, travel - trip to Iceland, Oregon and Colorado planned this year, keep an eye on my diet (all things in moderation) and just live!

Kevin

[PSAed]

Best wishes.

[PGDuan]

Sounds like a solid plan! Enjoy the travels.

[Tall_Allen]

It looks like a great chart, from what these old eyes can tell.

I'm trying to understand what radiation was done in 2017. You wrote: "boosts to the four sites with wider treatment margins around them." In 2020, the recommended treatment area changed:

redjournal.org/article/S036...

It's not surprising that your recurrence was in the pelvic LN area, given our current knowledge. But it's important that the entire rest of the area gets treated this time.

There is also new knowledge that 3 years of ADT+2 years of Zytiga have to be used along with it:

ncbi.nlm.nih.gov/pmc/articl...

You cannot stop earlier. That would only select for the most resistant cancer cells and cause a worse version of your cancer to accelerate.

[Hawk56 in reply to Tall_Allen]

The radiation in July 2017 treated the entire PLN system. The wider margins and boosts were to the four PLNs identified in the C11 Choline scan at Mayo in January 17.

The good news, I have had the same radiologist since 2016, she is overlaying the 2016, SRT to the prostate bed, the 2017 to the PLNs, the plarify scan and the SBRT simulation to develop a treatment plan. Her concern was if this PLN was in a previous treated field, she may want to switch to Proton therapy. I'll discuss with her this week the 2017 treatment field but she has said it was pretty extensive.

Thanx for the article on the 3 years of ADT+2 years of Zytiga, will discuss t with my medical oncologist this week.

Kevin

[GeorgeGlass]

so, you are still castration sensitive?

[Hawk56 in reply to GeorgeGlass]

yes, still castrate sensitive

[GeorgeGlass]

Good rundown Hawk. I pray for good results for you.

How is Olathe these days? I used to date a woman from there, when I was attending CGSC at Ft. Leavenworth, in 2001-02.

George

[Hawk56 in reply to GeorgeGlass]

George

Olathe is fine, like all the cities in Johnson County, great place. The Olathe Medical Center is impressive both in its footprint and its specialties.

[GeorgeGlass in reply to Hawk56]

Good to hear. Keep on trucking.

[j-o-h-n]

Thanks for Hawking your wares here............Good Going

j-o-h-n <===<<< Senior management is about to spike my spikes....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/16/2023 11:30 PM DST