Lymph node treatments

Recent CT and PSMA pet scans show mild progression of activity in right superior paratracheal node ( SUV Max 3.2 in march 2023 vs SUV max 2.1 in june 2021) and right Hilar node SUV max 5.5 in March 2023 vs SUV Max 4.6 in June 2022)

what can or should be done about this?

Note my PSA has risen from 0.27 in November to .49 in April

I started Xtandi in June 2022 when my PSA was 0.69 and it quickly dropped to 0.40 in July

but has slowly but steadly climbed back up

Is the rise in PSA a result of this mild progression of disease in the lymph nodes or resistance to Xtandi

Back in 2021 I had SBRT to mets on my L1 T9 and T19 vertebrae and they are stable

[GP24]

There is no proof yet that it will result in overall survival but you can radiate these mets with SBRT. You could wait until additional ones show up.

[Tall_Allen]

I don't think that focusing on visible metastases at this point does anything to benefit you. Systemic treatment gets what you can't see as well as what you can see.

[jbskiatook in reply to Tall_Allen]

What is systemic treatment?

[jbskiatook in reply to Tall_Allen]

Please ignore that question if I had read further down I would know thank you

[tango65]

With bone mets and lymph nodes mets in several places the cancer is disseminated in the body.

The cancer is mCRPC resistant to enza and most probable resistant to the other new anti androgens.

Systemic therapy with chemo, (docetaxel ) or with Lu 177 PSMA, should be discuss. There are clinical trials for Lu 177 PSMA without having chemo.

You could also discuss Provenge a vaccine which has shown to prolong life.

[john205]

My PSA is also rising slowly, but should not necessarily be considered failure until it gets close to 2.0. As a next step, consider chemo. Another possibility is a PARP inhibitor like olaparib, if you have a BRCA gene in your tumor tissue.

[NecessarilySo]

I would assume that there is growth of APC. The locations in the neck and clavicle areas are good for heat treatment with very hot showers.

[slpdvmmd]

Consider radioligand therapy. May not be eligible in USA but could be done overseas. Could couple this with external beam.