Do Physicians only recommend radiation for non metastatic men?
and only recently in Oligo metastatic patients?
Do they use radiation as a tool to bring psa down in metastatic men?
and or radiation is only used as palliative for bones and pain?
My apologies, If I’m not processing this thoroughly
I am deeply troubled that men with bone and lymph node metastasis do not get offered radiation as a preventative measure against early bio chemical reoccurrence.
Than again “it may be offered” to some oligo metastatic patients or under 56 years of age ,
I do believe it is offered in metastatic breast cancer, seems odd.
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Shorehousejam
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1. "Do Physicians only recommend radiation for non metastatic men? and only recently in Oligo metastatic patients?"
Here's the current guidelines as of 2018: If there are 3 or fewer distant metastases on a bone scan/CT, one can benefit from irradiation of the prostate (called "debulking"). Debulking is not curative, but it can increase survival.:
The prostate is where metastases originally came from of course, and it can slow down early spread by eliminating it. Still, there is metastasis-to-metastasis spread, and most metastases are undetectable.
If there are 4 or more metastases, there is no benefit to debulking. It adds toxicity but not survival. The reason for this is that once there are more metastases, the cancer is already everywhere, significantly spreading from met-to-met, even if it can't be detected.
2. "Do they use radiation as a tool to bring psa down in metastatic men?"
Metastasis-directed radiation (MDT) does bring down PSA because most of the PSA comes from larger, more visible metastases. But PSA is not cancer, and MDT may be reducing PSA without slowing the cancer down. No one knows for sure yet. So, until we know more, they do MDT while the cancer is oligometastatic and when it is absolutely safe to do it.
3. "and or radiation is only used as palliative for bones and pain?"
Radiation is certainly used palliatively, and for debulking in men with low metastatic burden. It is also used as MDT in oligometastatic patients, if safe.
4. "I am deeply troubled that men with bone and lymph node metastasis do not get offered radiation as a preventative measure against early bio chemical reoccurrence."
You are confusing two terms. Biochemical recurrence (BCR) refers to PSA going up in spite of attempted curative therapy (prostatectomy, radiation or both). BCR is only used for men who do not have mets (Stage M0). if they have distant metastases (bone, non-pelvic lymph nodes, or visceral organs), they are metastatic (Stage M1), not recurrent.
4."Then again “it may be offered” to some oligo metastatic patients or under 56 years of age"
Age has nothing to do with it. 56 is a very specific number - where did you see it?
5."I do believe it is offered in metastatic breast cancer, seems odd."
For breast cancer, there is no benefit for debulking:
Thank you, I knew you would give a great response and an excellent explanative answer, to help clear up some confusion we are having as well as other readers on this site,
If there are 3 or less, why not? There is no advantage eliminating them before vs after pain. All metastases are "life threatening" whether you can image them or not.
Biochemical reoccurence means, I believe, that the only evidence of reoccurence is a a PSA level the is greater then undetectable after a RALP. When that happens, as it did for me, most men are offered radiation to the prostate bed and lymph nodes. If there is evidence of metastasis to the bones or soft tissues then radiation may be offered palliatively to reduce pain. Once there is metastasis to the bones or soft tissue then bio chemical reoccurrence is meaningless.
I'm metastatic (high volume) and have had RT both to bone mets for palliative pain reduction and to the prostate itself. I'm in the UK under NHS care though.
My husband is polymetastatic and also in the UK. He has received radiation to his hip (as the largest area of metastases), and also to his prostate for de-bulking.
The oncologist said the radiation to the prostate would help with local control of the cancer. He did vastly improve urinary function after it and was able to give up Flomax.
Three or less was the beginning working number of metastasis that was mentioned for oligometastatic PC. Once experience was obtained with three, that number was lifted to five, five is no longer though to be the high limit, then it thought could go much higher.
I have a article from early this year saved (somewhere) that the study proved it had life extending capability and it was believed that it could be used to keep cancer down with the goal of making it a manageable disease.
The prostate will continue to seed your body with cancer if not treated. Removing or radiation to the prostate will shut down that seeding
Progress on cancer is undergoing a radical evolution with a speed and volume of advances never seen before. There will be ways to cure or make PC a manageable disease in the near future.
Your need to the things that get you to that point whether it's as far off as 10 years, or more likely 5 or less years.
My son age 50 was given IMRT radiation along with Lupron, generic Zytiga and prednisone. His prostatectomy was October 24th and at his 2 mo follow up his PSA actually jumped to 20 instead of going down! A PSMA pet showed spread to nearby pelvic lymph nodes. My son said they showed him the pictures and they were about the size of diamonds. No other spread was found so he underwent six weeks of radiation and his PSA dropped to .07 from 20 now we’re waiting for the next PSA to be performed and hoping that the PSA has not gone up. He’s also tertiary five which is the more diffuse pattern of PC so he will always have to be monitored closely. I don’t know about radiation if it’s spread to the bones because we haven’t dealt with that yet.🤞 but there are no reassurances because his cancer is quite aggressive. I did ask if Surgery could be performed instead of radiation and his doctor said no surgery would not have worked in his situation. I hope this helps. He’s also quite young and was diagnosed just before his 50th birthday last August so I think they probably factor agent to it too. Best of luck. We are all in this together.
His robotic RP was October 24th 2022. He started Lupron, generic Zytiga and prednisone in the December after it was discovered the PSA was 20.
He rang the 6 week radiation finish bell approximately March 13 so 6 weeks Monday through Friday back from that would have been his radiation start date. After the radiation, his PSA dropped to .07 from 20. He’s going to have another PSA taken, not sure when but probably pretty soon as he’s finished radiation mid-March.
He’s my son not my husband and he never mentioned it. Since I am a mom not a wife or SO I try to practice good boundaries and never asked either! So I’m sorry I don’t have an answer to that one!
I hope so I think he will be getting another PSA test soon so am hoping it’s still down to .07 from 20. There is so much waiting from test to test with PC. It’s so difficult for I think all of us.
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