Another positive lymph node

[Abcsoup73]

Hi all,

Quick recap: My dad was diagnosed in 2002 at age 52 with 3+4 pca. Surgical removal at Mayo.

2003 (one year to the date of surgery) PSA was detectable and he had radiation at Mayo.

Fast forward 2015, psa detectable again, put on Lupron. C-11 choline scans every 3 months, appt. with Dr. Kwon afterwards, and monthly psa tests/Lupron injections.

Lupron kept his PSA undetectable until June 2022. 5 days of radiation to the prostate bed again (since it had been so long since his first round of radiation he was eligible to have radiation to that area again) and start Zytiga. Zytiga made liver enzymes climb so he was taken off of it after the first month.

PSA undetectable again until March 2023 when PSA was 0.11 and scan which showed uptake in one presacral node. April 2023 Radiation to that node for 3 days in a row.

May PSA- 0.12

Today's PSA- 0.14 and scan shows presacral node has resolved but a new 5 mm right obturator node appeared

We see Dr. Kwon in the morning and I just want to know what questions I should be asking regarding possible radiation to the new node? Trying a half dose of Zytiga? Is it time to start thinking about chemotherapy agents?

Thanks all, I just want to make sure I'm doing everything I can for my father.

[Tall_Allen]

It is definitely a mistake to irradiate one node at a time. Lymph is a fluid that carries cancer cells to the entire pelvic lymph node drainage area. You should be talking to a radiation oncologist who knows this, not Dr Kwon who has no expertise in this. You have to treat what you cannot see. Here are the dimensions of what must be treated:

redjournal.org/article/S036...

[Abcsoup73 in reply to Tall_Allen]

Tall_Allen,

Thanks for your response. Sorry, I should have clarified, we have our follow-up appt. to go over test results with Dr. Kwon tomorrow. We have always worked with Dr. Stish, a RO, at Mayo in radiation oncology. All of the providers we have had at Mayo have been wonderful and I'm so grateful for their care. I'll take a look at the journal article you posted. Thank you!

[Tall_Allen in reply to Abcsoup73]

They may be nice people, but the treatment you were given was a mistake, IMO. I hope you discuss all this and you make the decision.

[User14952]

My understanding of treating individual mets with radiation is that it’s an attempt to buy time to adding more systemic therapy. If you discuss radiation again, I would want clarification from your doctors about what the radiation goal is, and what you can hope to gain with that approach.

Radiating individual lymph nodes was the approach we took, but we were also getting PSMA scans at any small jump in PSA, and my husband knew the risks with pausing systemic therapy. It was a quality of life choice, not the choice that was the most aggressive for treatment.

[maley2711]

Just wondered.....do you recall if your Dad was given a postop pathology Gleason regrade?

[Abcsoup73 in reply to maley2711]

Yes, it was 7. 3+4.

[maley2711 in reply to Abcsoup73]

I thought perhaps he was upgraded to higher Gleason, as I just came across a study showing how often that occurs....OFTEN. Your Dad's final GS is in line with his relative success , though of course you would hope for a 20 yr cure and not deal with recurrences, etc as you have. Maximum whole pelvic might still be effective in giving some more years of avoiding lifetime ADT, IMHO....but I don't know if studies are out there re your Dad's specifics and second-line treatment success. Thereis a dilemma that men face when making such decisions.....risk earlier progression but avoid immediate treatment SEs and loss of QOL, or accept most aggressve treatment, almost certainly experience some rapid unwanted SEs, but no guarantee of treatment success and substantial delay of progression to distant metastasis......hopefully your top Docs at Mayo can help you /Dad make such decisions..hopefully with some relevant study data!!!! It is a blessing to have such a place to guide your Dad, IMHO. Wishing your Dad well!!

[Channelhomec]

Did your dad have any positive margins ..

[Abcsoup73 in reply to Channelhomec]

Yes, he had a positive margin at time of surgery back in 2002.

[ron_bucher]

There are several similarities with my history. On my second post-prostatectomy rise in PSA, prophylactic radiation of abdominal lymph nodes outside the local area plus Taxotere gave me 4+ years of undetectable PSA (and freedom from ADT).

[m1946]

An interesting response trail which I guess has caused me some concern. I received Brachytherapy treatment way back in 2012. PSA started to rise end of 2022. An MRI & two petscans later and a small tumour was detected by the prostate scan. Radiation treatment was recommended - not sure of the terminology but a strong beam from one of only 4 machines in the country over a period of 5 days "zapped" through tumour. My next blood test to take place July/August. What now concerns me is the question raised regarding the treayment to only one node?