I see stories about RT as a treatment after RP with BCR, but don't see much when RT has been sole treatment. (See Bio-not even any ADT). PSMA-PET is clear currently, so no target for radiation. PSA has been rising, but not officially nadir plus 2, but the old 3 rises in a row has been reached.
If there is nothing curative to be done, do you just wait until nadir plus 2 is reached or something shows up on a scan? is there some way to be proactive? Tall_Allen didn't you have initial RT? What have you seen as SOC in this situation? Just curious as I realize this is a lucky 'problem' at this point. Thanks!
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mpMRI-targeted biopsy may confirm a local recurrence. NaF18 PET/CT is the most sensitive kind of imaging for finding a recurrence in bone. If both are negative, it may be in pelvic lymph nodes, too small to show up on PSMA PET/CT.
Had read this in your blog before, but thank you for reposting! Ok, stupid question. If nothing is showing up on any kind of imaging, but PSA is still rising beyond nadir plus 2, what do you target without a target? Or do you just assume it is in pelvic lymph nodes and radiate?
In the SPPORT trial in men who were BCR after prostatectomy, they got good results from irradiating the pelvic lymph nodes. They didn't have PET scans. Take it one step at a time.
I had radiation and after my 2 years of ADT stopped it. T came back in 3 months and by 6 I was pretty confident I had BCR. Insurance made me get CT and Bone scans and a PSA of 2 before they approved Pylarify (PSMA Pet). CT and bone scans clear, Pylarify showed mets in spine and LNs near base of skull. I went back on ADT and thats where I am now. New CT and bone scans this month. Waiting to see something on this imaging (no more PSMA pets) or becoming CRPC which would be actionable changes in my disease. In the meantime getting more active and lost a little bit of weight. I feel pretty damn good on Lupron and Zytiga and just waiting for mentioned axe to fall.Not sure if that answered your question but hope it helped.
For my G9, 5+4, stage 3 (at diagnosis by MRI), I had whole pelvic RT to 54 Gy, then prostate to 79.2 Gy. ADT for 3 years. After that primary treatment plan 10 years ago, there would be little else to do if the PSA began rising.
Recurrence within the prostate was unlikely, and surgery would be possible but difficult - not interested. Cryo, HIFU, and other localized treatments didn't seem attractive either, since a G9 radiated like that is far more likely to recur as mets, not local. My next-steps plan was always going to be resuming ADT, and eventually adding secondary ADT measures if/when it became castrate-resistant.
I did end up going back on ADT for the duration, about 4 years ago (PSA was indeed rising at the 5-6 year mark). My PSA is undetectable still, and I'm hoping for a good long run that way.
I think the "what's next" depends a bit upon the original diagnosis. Higher Gleason scores are less likely to recur locally. Talk to your doctors.
In 2017 RO PCa specialist considered an initial plan like yours with pelvic and prostate RT along with ADT, to be too aggressive for G7 3+4. In retrospect that might have gotten rid of the little devil once and for all! That's no longer a topic, but waiting now for new MO and new discussions.
Yes it’s tough to tell but can’t cry over spilled milk. If you want to hold off on ADT which I did, ivermectin was a very viable source for me n thus far has worked quite effectively. Good luck on whichever route you choose as there are a few to choose from…
Yes it’s remarkable how effective it’s been in killing all types of cancers n the pub med article really breaks down how it targets cancers pathways n causes the apoptosis (killing of the cell)
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