Rouge clone radiation on 10/31/23 has PSA continuing to drop to 0.85. MO plans to monitor PSA before requesting PSMA scan (insurance) unless it is increasing.
Considering switch from Eligard to Orgovyx if PSA looks good in early Feb since Orgovyx apparently has less severe SE and doesn't tie me to clinic for shots.
Bone density down considerably( thanks ADT ) but still normal for age 83. Starting Calcium, vitamin D, and increasing resitance training. Prefer not to take bone strengthening agents since bad SE with Zometa and MO not positive they will do that much good.
I look forward to your comments.
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alperk
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MO says "It is an oligo progression and the few lesions that might show growth may be what I call Rogue clones and usually what I do is not stop or change the current treatment and just add stereotactic radiation to the areas that showed progression usually 3 lesions or less." My RO explained that the "rouge clone" is a small group of cancer cells that did not respond to Eligard/Zytiga. The rest remain dormant. Thankfully I did not the advice of my now replaced MO who wanted to replace Zytiga with Xtandi. Yes, that would have acted on all the cells and probably worked but it is the last good arrow in my quiver. Now, I have bought a year for the development of another treatment. Hopefully I can identify new PSA rises with PSMA scan and radiate those cells.
My husband was first on Lupeon, 1-month shot, then Orgovyx 2 months, then Eligard. Of all, Eligard has been the absolute worst, and O the best. I have had him taking Vit D3 with K-2 and Cal/Mag/Zinc supplements from day one.
He just finished 28 days radiation, and it has really gone a number on him with fatigue and poor attitude, anemia. But that's another post.
Tell him to hang in there. Now six months post radiation and fatigue and anemia are totally gone BUT ….
more important then supplements he needs to do resistance training and walking/aerobics. Even he needs to it when he does not feel like it. Start slow. Tell him no wimps allowed and war is hell.
I started exercising when I was diagnosed with osteopenia. Nordic Walking, stationary bike, working out with 13 lb. dumbbells. Taking calcium citrate w/ D and K. K is also important.
"The Role of Vitamin K
Vitamin K regulates calcium in your body in at least two ways: Promotes calcification of bone: Vitamin K activates osteocalcin, a protein that promotes the accumulation of calcium in your bones and teeth."
you can’t identify oligo mets without a PSMA scan. Don’t let the PSA drive the bus unless you want the cancer to just take its own course. SBRT is of no value if there are more than 5 sites of metastasis on PSMA scan. So it would be valuable to know to select best treatment. Waiting and watching PSA is unwise. And you should be on an ARSI med in addition to ADT.
Thanks for your reply. Here is my response to Don_1213 which details my current plan
"MO says "It is an oligo progression and the few lesions that might show growth may be what I call Rogue clones and usually what I do is not stop or change the current treatment and just add stereotactic radiation to the areas that showed progression usually 3 lesions or less." My RO explained that the "rouge clone" is a small group of cancer cells that did not respond to Eligard/Zytiga. The rest remain dormant. Thankfully I did not the advice of my now replaced MO who wanted to replace Zytiga with Xtandi. Yes, that would have acted on all the cells and probably worked but it is the last good arrow in my quiver. Now, I have bought a year for the development of another treatment. Hopefully I can identify new PSA rises with PSMA scan and radiate those cells."
So my hope that PSA in Feb comes in at <0.2. If it is significantly higher that can justify PSMA scan to insurance. What do you think?
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Xtandi vs Orgovyx
PSA seems stuck around 1.0 while on Orgovyx and Nubequ
how soon after starting orgovyx can one test PSA levels. 
Post radiation psa
Orgovyx & Xtandi
