Go-forward Treatment Plan

[sixmongoos]

First of all, I've been an avid reader of this forum over the past 2 years, and wanted to express my gratitude towards the amount of knowledge everyone has been sharing on this site.

My father (62 y.o., very healthy) was diagnosed with aggressive PCa (Gleason 9, PSA 58) in Sep 2021, and underwent RALP + PLND in Spring 2022. Post-op pathology was T3B N1. For reference, we are in BC, Canada.

His PSA started to rise in June 2023 (0.04 -> 0.09), and spiked (0.09 -> 0.45) by Sept 2023. He just had a re-test few days ago and the PSA has remained at 0.48 over the month . With the rapid PSA rise, we had a PSMA PET scan done, and got the results today that there was uptake in the pelvic lymph node but nowhere else.

Currently, the urologist has recommended ADT + Radiation, and has referred us to a radiation oncologist. I wanted to better prepare myself for the upcoming meeting, and had a couple questions:

1. In this case, would Whole Pelvic Salvage Radiation w/ ADT be the optimal course of action?

2. If so, what is the optimal site coverage and recommended dosage for Whole Pelvic Salvage Radiation? I recall reading TA's blog post from 2017 before, but was wondering if there were any updates since (prostatecancer.news/2017/12...

3. Are there any other questions worth asking the radiation oncologist?

Thank you!

[Tall_Allen]

1. Yes+3 yrs of ADT+2 yrs of abiraterone. Should have begun immediately with that path report - but better late than never.

2. prostatecancer.news/2021/05...

[sixmongoos in reply to Tall_Allen]

Thanks TA.

Is 3 yrs ADT + 2 yrs Abi (Zytiga, if I'm not mistaken?) while doing WPRT considered SoC?

Or if it's a recent research/clinical trial result, could you please direct me to the source?

I'm in BC, Canada and sometimes feel like the treatment plans here can deviate from the US, and would like to be ready just in case.

[Tall_Allen in reply to sixmongoos]

It is SOC (I think in Canada too) because of the STAMPEDE trial result.

ncbi.nlm.nih.gov/pmc/articl...

[sixmongoos in reply to Tall_Allen]

Amazing. Thank you!

[Cancer2x]

I think it’s a bit patient directed, as each of our histories is unique. I am about to start SBRT (on an ETHOS machine, as Meridian Viewray went belly up) to two recently detected lymph nodes.

The RO and my MO BOTH felt that based on MY history, age, time to detectable, comorbid disease and personal wishes to delay hormones or ADT as long as it seems prudent, that treating just these two nodes then watching the PSA for effect and rescanning was conservative and appropriate at this time.

Damn that was a long sentence!

I start next week.

PAX luck to us all!

[sixmongoos in reply to Cancer2x]

Thanks for sharing! Hoping all the best for your treatment as well.

[j-o-h-n]

Here's an old dated post of mine regarding the frying of my pee pee area.

Greetings: Radiation - I've posted this before so to those people who have already seen this please forgive me.

I had 8 weeks of salvage radiation to "the bed". 5 days a week (not weekends) for 8 weeks minus 1 day for a total of 39 sessions at MSKcc. The actual radiation was like getting an x-ray by my dentist. I never had any side effects during the whole 39 sessions. However, 2 years later my left urinary tract was "fried" as per my urologist (or from passing prior kidney stones he was not sure). So, I had to have a urinary stent placed up my urinary tract (through my willy which is really nothing - sounds terrible but it's nothing) to aid in passing my urine (which was never a problem anyway). So I had stents in and out every three months for many years and now I'm stent free, However today 15% of urine from left kidney and 85% from right kidney, but not a problem. So make sure you get a good radiologist. Also, I don't know if this would apply to you but guys here recommend SPACEOAR HYDROGEL to be inserted for protection of parts of your body. Make sure you ask your R.O. about the space oar and make sure you ask here on this forum before getting fried.

If I'm off base with this post, then what do you expect from an old snake like me fighting off sixmongoos (give me a break)....(BTW where is your dear Dad you located?)

p.s. Maybe look into getting a Medical Oncologist for your Dad.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/14/2023 3:43 PM DST

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

Hey j-o-h-n, appreciate you sharing your journey and experience with salvage radiation. I'll definitely ask them about the spaceoar hydrogel - from a quick research, it sounds like it's a must!