Spine metastasis

[Telegraph2022]

My father in law is 78 year old male with PCA with what appears to be a single spine metastasis. Gleason 7 ( 4+3) We have an appointment coming up with the radiation oncologist . Is this something they would get a PSMA TEST for to confirm and also would he just receive ADT with radiation to primary site or are there also new combination therapy we should look into. Thanks in advance to everyone willing to share their well earned wisdom .

[Tall_Allen]

There's nothing in his profile. You didn't say how the single spinal met was discovered -bone scan? CT? MRI? pain? Did he have high PSA? anything felt on DRE? extraprostatic extension on MRI? how many cores?

[Telegraph2022 in reply to Tall_Allen]

spinal met was discovered on bone scan at T2 , all cores positive, PSA WAS 4.7 , retest after biopsy his PSA was 3.7 ( actually went down but I know it can fluctuate) and it was discovered on abnormal DRE with suspected extraprostatic extension on MRI. Not sure if PSMA scan would yield anything if the PSA was low ? I also forgot to ask if he would be a candidate for focused radiation on that spot if he did turn out to be ogliometaststic. Thanks Tall _Allen . I know browsing through the chats you are on top of newest treatments and protocols

[Tall_Allen in reply to Telegraph2022]

He is classified (so far) as "high risk" because of the extraprostatic extension. That means Medicare will cover his PSMA PET scan. Bone scans have a lot of false positives due to arthritis, stenosis, or other spinal degeneration that happens with age. If he can get it, a NaF18 PET scan is 2x more sensitive than a PSMA PET scan.

If confirmed, the best therapy is "triplet therapy":

prostatecancer.news/2021/05...

He can also get "debulking" prostate radiation, and why not get the spinal met irradiated at the same time.

prostatecancer.news/2018/09...

[Telegraph2022]

Thanks for the info. I had one final question ? Triplet is ADT + docetaxel + androgen receptor inhibitor like darolutamide ? Also for low volume is it true that ADT + AR inhibitor has equal success or does adding docetaxel always improve survival. Father in Law is currently 78

[dhccpa in reply to Telegraph2022]

If you want TA to answer, you have hit Reply to him.

[maley2711]

Perhaps this review will help in discussions of any future imaging studies for your father-in-law ......

sciencedirect.com/science/a...

Overall, pylarify PET seems a good option for both bone and node PCa detection.

Apparently we have to wait for longer term studies of the actual improvement in survival that we hope will be associated with more precise imaging.

Best of luck for your family and father-in-law!

[NecessarilySo]

I have had a spine Metastasis at T7 for many years which I have tried to control for many years using heat and lycopene. I have pain and manage to control the growth of the met when it feels inflamed. I don't know how far the condition has progressed in your father-in-law, but he might try the same. Read my bio for further details.

[VCinTx]

I have a spot on T 10 and I received SBRT radiation. My PSA is again going down.