Im now getting confused with all these terms.
See my bio.
So 1 week into my EBRT, my RO stopped in and asked why Im still on abi+pred.
He said when scheduling EBRT I could stop it. I told him my MO said not to stop.
In the beginning, my RO intended for me to do Lupron, and only 6 months
abi+pred., do radiation, then see if maybe stop Lupron.
He feels if the hot lymph node and the prostate fascia (he considers the invisible source) are radiated,
I might be free of ADT etc for a few years.
RT to the entire pelvic LN area (not just positive LNs)+ years of ADT+2 years of abi are now SOC if there are positive lymph nodes. Email this to your RO:
ncbi.nlm.nih.gov/pmc/articl...
The RT dimensions have expanded, so make sure you are getting them all:
prostatecancer.news/2021/05...
Stopping early might select for resistant strains.
Yes, the whole lymph node area all the way to the commons
And yes, my MO quoted to me the STAMPEDE protocol she will follow.
Sounds good! Your RO is a little behind, but your MO has got you covered.
to give my RO credit he did send me to MO, and mentioned abi in his notes.
Not sure I understood your last sentence. Stopping early is bad in his case? Sorry, the terminology threw me a curve.
Maybe. The most vulnerable strains are killed earlier, the most resistant strains, later.
I understand PCa cells only get killed with RT and Chemo.
Not ADT as in abi and Lupron
No, it gets killed by ADT.
I keep hearing "stops, or slows PCa growth".
Also as an old Russian saying goes, trust but verify. I walked into the control room before walking into the "reactor" room. Asked to see my contours, she responded, you already asked, I responded, I would like to see the pretty picture on the computer screen!!! She obliged "see all the way to the common iliacs"
Now I owe her some baked goods!!!
Thats gonna do a number on my iliac arteries!!
One week, so far no SEs, Im waiting.
You are trying to come up with a black and white statement, which won't work. ADT kills cancer cells, but maybe not all of them, depending on the situation. ADT+radiation is usually curative if localized. ADT controls distant metastases, but there are always some metastatic cells that are not killed. N1 is somewhere in between.
Im hoping its curative, my MO says "it in a lymph note, its in the blood"
Lymph isn't blood. Blood circulates quickly, so I agree that if metastases have traveled to distant sites, it got there via blood. But when it is confined to pelvic lymph nodes, it may not be systemic yet. Lymph doesn't circulate like blood. It is a sluggish fluid that hangs out in lymph vessel networks in the drainage area for a while. If it hasn't gotten into systemic circulation yet, there may still be an opportunity to kill the buggers.
🤞
Ahhh got it now thanks!
To your question, yes, you are high risk. But with the revised standard of care described, your odds are much improved. At least that’s what my team is telling me (in a similar situation). The data on long-term outcomes is not in yet (for obvious reasons) but judging by the early returns on the “kitchen sink” approach, it seems to work pretty well.
I am on the same path. My MO took this approach and spoke of a cure. Just went off the drugs and hope that this works. Good luck but seems that you are being well advised
You have a Gleason 3+4. Conventional CT/bone scan will not detect the affected lymph node so this should not put you into high risk. Therefore I would just get six months of ADT plus Abi+Pred.
PSMA scan could/would detect affected nodes.
CT did not detect lymph node.
Bone scan clean.
PSMA found lymph node, yes.
All of the existing guidelines and studies are based on CT/bone scan, not on PSMA. You and your doctor should keep this in mind when planning the therapy. One affected lymph node on a PSMA scan does not put you into the high risk category. US cancer statistics show that you live just as long with or without affected lymph nodes in the pelvis, detected with a CT. Avoid overtreatment .
All of those studied are not based on PSMA, as PSMA is still young.
I may well be misinformed but my understanding is that the use of a CT scan with a PSMA-PET scan is to definitely locate which lymph nodes (or organs or parts of organs) the cancer is located. The PSMA scan only shows a glob of radiation that is very undefined but shows where to look anatomically.
Yes, the CT scan is done first, without moving the PSMA PET follows, the PSMA is overlaid on the CT image.
I'm not sure what procedures others might have had but mine involved a PSMA-PET scan in a specialized scanner at Seattle Cancer Care Association (now Fred Hutchinson Cancer) followed by a CT scan just before I left the building. I had to drink a solution for the hour before the CT scan.
You might have had 2 different scans.
The CT scan is done the moment before the PSMA scan is done in the same machine, that CT scan is not diagnostic, its only to be used as an overlay to the PSMA scan.
The CT scan with tracer (the drink) was for diagnostic, did you get an injection also, the moment the CT started?
I might have remembered wrong. I did get an injection as I recall. I could ask the clinic if it's important here.
Sorry I can't answer that Term......cause I'm Not A Lawyer....
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 05/22/2023 6:32 PM DST
practiceupdate.com/journals...
Not sure if this has any relevance to yourself but perhaps it does .....
Zytiga for high-risk non-metastatic PCa? 
ADT forever once you start ? 
Order of brachyboost
Why did they let me off the ADT hook so easily?
