ogliometastatic

[Jewelrylady]

my husband was diagnosed as low volume ogliometastatic (4 spots on bone) and he’s getting SBRT to the bones, and prostate. When he gets his next PSMA, if it showed a couple new spots, does that mean he’s no longer ogliometastatic?

[Tall_Allen]

You can keep playing "whack-a-mole" but there is no known benefit.

[kainasar in reply to Tall_Allen]

Do you mean he needs to begin ADT and systemic meds? Is he mHSPC? or CPRC?

[Grandpa4 in reply to kainasar]

to my way of thinking he should have been on it before the radiation. If makes the radiation more effective. When you have several lesions on PMSA scan you have many more that are not visible. You need systemic therapy. The good news is that with these meds he can have many years of a good quality life. The main thing is to start lifting weights immediately and to start aerobic exercise.

[Jewelrylady in reply to Grandpa4]

Thanks! He was started on Lupron, Zytiga and prednisone before radiation and he is going to gym and walking regularly. His PSA and testosterone are responding to meds and are low.

[Tall_Allen in reply to kainasar]

I mean the benefit of whack-a-mole is unknown. The benefit of systemic therapy is known.

[Seasid in reply to Tall_Allen]

I believe radiation if the metastasis is visible on the scans could get rid of the castrate resistant strains and hopefully that would mean no new metastasis from that site? I personally would probably only SBRT Mets which are castrate resistant and which are not stable (growing in size and painful and not responding to system treatment. Of course if I could avoid radiation I would but the best is to consult a radiation oncologist for example from Daba Farber cancer institute because you want to get this right.

[Tall_Allen in reply to Seasid]

Your beliefs have nothing to do with it. There is no such thing as a metastasis that is purely hormone sensitive- metastases are heterogeneous. It is unknown whether ablating oligomets have any net impact on survival. Given the lack of data, I can't think of any reason, other than safety, for not doing it. I just would not have great expectations, and would not pull back on systemic therapy.

[Seasid in reply to Tall_Allen]

This discussion seems to focus on treating metastatic castrate-resistant prostate cancer (mCRPC) using a combination of radiation and systemic therapies. Here’s a breakdown of the points being made:

1. Whack-a-Mole vs. Systemic Therapy: The "whack-a-mole" approach—using targeted radiation on individual metastases as they appear—is debated. Its benefit in terms of overall survival is uncertain compared to systemic therapies, which are generally better studied and have clearer efficacy.

2. Radiation for Castrate-Resistant Metastases: Radiation could theoretically help by targeting metastases that aren’t responding to hormone (castrate) therapy. Some patients might prefer radiation to address symptoms or pain from specific lesions, especially if they’re growing and resistant to systemic treatments.

3. Importance of Consulting Experts: Since metastatic lesions can vary greatly in their hormone sensitivity and response to treatment, consulting an oncologist, especially from a reputable cancer center, is critical to make informed decisions based on individual cases.

4. Expectation Management: Radiation might help with certain symptoms, but it may not necessarily improve survival. Patients are advised not to rely solely on local treatments and should continue systemic therapy.

This approach to treatment is complex and highly personalized.

ChatGPT said

[Seasid in reply to Tall_Allen]

You are correct that the system therapy should not be negotiated just because I had a local treatment. Actually my first oncologist professor Richard Epstein warned me against doing any local treatment.

[Seasid in reply to Seasid]

Ok, he also said that even xofigo is local treatment but was fine if I end up doing it after I run out of options.

[Tall_Allen in reply to Seasid]

Xofigo is not local, it is systemic, but it only treats bone metastases. It works best if used earlier and in conjunction with other systemic medications.

[Seasid in reply to Tall_Allen]

Thanks for the information.

[Seasid in reply to Tall_Allen]

My new oncologist also said that xofigo is not fighting prostate cancer only killing bone metastasis. I read the post here which said that why our member was undergoing xofigo treatment new bone metastasis popped up.

The only real reason for me to try xofigo is the hope that it will reduce the pain from bone metastasis. If you have lots of active and painful bone metastasis it makes sense to use xofigo for palliation but as you multiple times said chemotherapy could be also used for pain palliation. Maybe as you said multiple times combination of xofigo treatment with low dose docetaxel would be helpful. I said that to my oncologist but I had a feeling that he would rather put me on full dose docetaxel chemotherapy if needed. At the moment I don't have any bone pain and my PSA is still stable at 2.5 on degarelix and bicalutamide alone.

I believe that I don't have any visible bone metastasis. My alkaline phosphatase is very low 38. I don't really want to do psma pet CT scan with contrast until my PSA goes above 5.

I think tango65 said that he didn't have any on the psma pet CT scan visible metastasis until his PSA reached 7.

I know that MarkBC had regular bone scans even with very low PSA in order to catch if there is any radiological progression despite low PSA. At the start of his disease he was doing nuclear medicine bone scans every 4 months later switched to yearly nuclear medicine bone scans. He never had psma pet CT scans because it is not common in Canada.

[Tall_Allen in reply to Seasid]

Many men only have prostate cancer in their bones, so Xofigo is certainly fighting their prostate cancer everywherefor them. If you have prostate cancer elsewhere, combining it with a lower dose of docetaxel is equally effective and less toxic. But if you have no bone metastases, there is no reason to change therapy.

[Seasid in reply to Tall_Allen]

Why did the bone Mets popped up during xofigo treatment?

I am just wondering?

I understand that xofigo extends life. It makes sense because it kills bone cancer, but I personally would not rush to spend 60000 Australian dollars in order to get xofigo instead of docetaxel which is totally free. I would rather try to organise Provenge immunotherapy drug in communication with chemotherapy. Of course if I have bone pain the priority would change.

[j-o-h-n]

Give us more bio.......... on Mr. Jewelrylady.......... Age? Location? where treated? and etc. All Infor is Voluntary and if need be, added to his Bio page Thank you!!!

P.s. Looking for a bargain on a yellow 14k or 18k ring, size 5.5.......... Whatcha got?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/12/2023 12:46 PM DST

[Seasid in reply to j-o-h-n]

I like your time stamp.

[j-o-h-n in reply to Seasid]

Thank You! You're the first member who ever commented on it. It is an old habit/carry over from my old army days serving in a communications outfit.

I stopped date/time stamping my posts around a year ago since no one really cared..

God Bless all military veterans today and forever.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/11/2024 4:11 PM EST

[Seasid in reply to j-o-h-n]

I believe we all should have a date stamp. How are you generating the stamp?

[j-o-h-n in reply to Seasid]

I agree...... even though I am an old dinosaur IT guy (main frames - not pc based) I would manually enter the date/time stamp.. I am not a Java person.....Took a little work but I'm from the old school and can handle work.... Best wishes if you can convince management to upgrade their "system"....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/11/2024 4:24 PM EST