Just got this report from PSMA scan. Increased size of a few mildly tracer avid aorto-caval lymphnodes. The largest of these nodes measures 0.5 cm in short axis (image
204), previously measured 0.2 cm.
Meet with MO tomorrow. I am 10 years in. Prostatectomy, bed radiation, and two years ago, whole bed. Taking six months Lupron. PSA never dropped below .1 this last time. PSA was .14 in April. .21 today.
Any thoughts?
Looks like you'll get a 2ng gen ADT added to lower your
testosterone
It might be worth some radiation to the para-aortic lymph nodes, if safe.
A series of radiation treatments the same as whole pelvis, just a little higher up? Or targeted spot treatment?
You already had radiation up to the common iliacs, right? This would cover the para-aortics, if safe.
You already had radiation up to the common iliacs, right? This would cover the para-aortics, if safe.
Yes. So I'm maybe looking at multiple, daily treatment for several weeks?
My friend had his done in 3 treatments. But your personal anatomy will dictate safety.
My impression is there is a small cluster of slightly avid nodes with one node that has actually grown from .2 cm to .5 cm over the past two years despite radiation and Lipron treatment. I asked for ADT+ two years ago. The MO thought the additional treatment was too aggressive. Not a point now. It is in the past. I'm simply wondering if any new radiation treatment would mean a short round of a week or a long term commitment to months long daily treatment. I'm not sure returning to my local RO center would be wise and the trip to Duke is a three hour drive.By the way, I published my first novel this month, not nearly as sophisticated as your work, but still it is a milestone for me at 71. Another x on my bucket list.
The only way to know is to talk to an RO. Congratulations on your novel!
I guess the smoking gun in the room is why didn't two years of lupron and 40 sessions of radiation not kill cells in an avid node?
Your MO should be having your RO determine if this area can be radiated, likely stereotactic radiation probably 5 sessions. If not able to radiate, you might need a meeting with surgeon who removes cancer like this all the time.
So why does any prior radiation plan ( such as whole pelvic) need to be checked. To see where radiation was targeted. My plan showed prior radiation hadn't targeted that area, so I can. Your's is higher so likely yours can be radiated as well, only your RO with prior radiation plan knows for sure. You can have any RO request that plan from whoever did radiation previously.
What hospital do you go to. It should be a major cancer hospital and surgeon needs to be experienced to the point they can do this in their sleep. But they will need to be fully awake and on their toes.
I go to MAYO Rochester, Urologist Dr Kwon, Dr Stish RO. Forget who the surgeon is.
My MO is at different hospital nearer me. This cancer hospital offered to do the same for me but I will be verifying PSMA scan with second one before proceeding with treatment.
For me Ureter was passing in same area (right common illiac in my case which is below the split, yours is above the split if I understand this correct), and created doubt due to ureter passing urine to bladder and urine is how the radioisotope is excreated from your system.
I had PSMA scan read twice and both agreed there was some doubt, requiring rescan and MRI in my case.
My MO wants me to schedule an appointment with my RO before further treatment. He is thinking stereotactic radiation. If it is safe, have it done and wait to see if PSA drops. If it is not safe, begin Nubreq.
rising psa but scans are clear
PSA DECLINING WHILE IT WAS RISING
Apalutamide and rising PSA 
Rising PSA after Prostatectomy
PSA Rising After Chemo
