Have any of you guys had any luck targeting distant metastases with SBRT after your mets remained small or dormant while on ADT but after PSMA scans had showed more in number than olago (more than five mets)?
My PSMA scan in January 2022 showed 10 scattered small mets so our area SBRT (Cyberknife) radiation expert told me he couldn’t target them all, but if some became undetectable, he could go after the remaining ones. But does that make any sense, since the PSMA scan doesn’t show anything at undetectable psa levels? I’ve been on Orgovyx and Erleada ever since the scan ( and one more year sometime prior to it). Now I remain psa undetectable, castrate sensitive, and eager to stay that way if possible!
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SeattleDan
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No one thinks there is any value to playing whack-a-mole when there are more than 5 metastases. There may or may not be any value even when there are fewer than 5 metastases. And PSA becomes a useless biomarker when you play that game:
I can't find links to actual studies comparing radiation vs no radiation for cases with few mets. And I suspect there are no such studies with PSAM scans.
You are right that there are none with PSMA PET scans. But there are several links to 3 small trials of SBRT to oligomets vs no radiation. They are discussed in: III. SBRT of oligometastases 3. Danger of Withholding Early ADT. Or I can link to articles about the main three:
Thanks. This is what I find exciting and aligns with my discussions with my oncologists: "Complete metastatic ablation of oligometastatic prostate cancer may provide an alternative to early initiation of androgen deprivation therapy (ADT)."
ORIOLE was deeply flawed, and provides no evidence of anything useful, as described.
Of course, with only 6 months of follow-up, most of the detected progression was PSA progression. Progression-free survival when most of the progression is PSA progression is not the endpoint we need to evaluate this therapy. SABR "treats" PSA. "Treating PSA" would occur if the radiation only provides excellent local control, while not necessarily delaying progression elsewhere. PSA is secreted in proportion to the size of the tumors, so treating only the tumors will do nothing to stop the micrometastases that are elsewhere. However, the strong T-cell response found by this study suggests that there may be a true delay in progression and not only a delay in PSA. Also, the fact that distant metastases were delayed by almost 2 years among those who had all of their PSMA-detected metastases irradiated, suggests a true response.
Yep..The links provided here are 4, 5 and years old. That is an eternity in Pca research and treatment. Old news....is....old news. If you aren't satisfied with your RO recommendations get a 2nd and 3rd opinion. Lupron IS/WAS standard of care 4 years ago. Gleason score..grade..positive cores certainly define the risk profile. Current research points out that even G 8-9 bone Mets can be radiated and sometimes eliminate need for systemic therapy. Your body...your choice....AND your Qql. Research....research...research. Oligometastices....read up...on current info.
Oh....and a possible "cure" my RO says average time to a PSA rise is 3 years. Consult your RO and ask the tough questions....Good luck guys. Inform yourselves!
In case you, or anyone, was wondering about the arbitrariness of 5 mets as the limit for radiation, I asked that question of my radiation oncologist as he prepared for my single spinal met plus one much smaller faint location that could not be clearly diagnosed. The difficulty of planning the treatment for each additional met requires beams that will not overlap or meet which will add higher toxicity of the dose to areas that are not within the target zone. Sometimes this problem appears with fewer than 5 mets but experience has shown that 5 is the greatest number that can be addressed within the safety parameter. The RT energy goes through the body and to ground and the location(s) where the beams coincide has the killing power. Multiple beams are necessary for each metastasis. With 5 metastases the multiplicity of beams creates a treatment field that is greater than the safe therapeutic range.
This is my paraphrase of his explanation.
If this treatment is beneficial over time is another question.
The following site has several helpful recent short videos for everyone from those just beginning our voyage to us old-timers. There was a recent mentions of SBRT and several other topics I've found useful. I started my journey 24 years ago and I've been stage 4 for nearly ten years now and I'm still here!! I wish YouTube and sites similar to this one were available many years ago! Doctor Mark Scholz is located in SoCal. This videos may prove very helpful helpful and informative for many, regardless of stage! youtube.com/@ThePCRI/videos
I showed one met at T 10 after a PSMA Pet scan. My RO did 5 rounds of SBRT and my PSA dropped. After a high of 2.77 my PSA is now 0.16 after three months. I and my RO are encouraged with the results.
Thinking and praying for you on this Journey. This site / people have been so helpful for me!To Max00, first time I have seen a posting from you, fascinating!
Looked at your bio, nothing much there? You are so amazing, being on this journey for that amount of time, I would love to read about your complete journey, if you would feel inclined to post it.
Could be very inspirational / encouraging to some of us to know more about your 24 year journey.
In the beginning (just a few years ago really) no doctors knew anything about oligometeastatic PC. Dr Kwon at the Mayo clinic Rochester MN, was able to get Choline PET scan FDA approved for detecting PC in the body in 2012.
It actually was Dr Kwon who choined the term oligometeastatic PC disease. MAYO was the only place to get this Choline scan so other doctors and hospitals poo pooed the idea of detecting and treating.
With the availability of PSMA scans everywhere now, the other doctors are coming onboard and catching up in thought, and just starting to get experience with it.
The number of metastases is actually arbitrary. So in the beginning they thought maybe we can go after one, then thought up to three, then five. Notice the number keeps increasing as experience is gained. It is thought now by some doctors that more, maybe ten, maybe even more will be considered treatable.
So we are all the patients that will help define that limit, or perhaps we should think of that just a guide not a limit. As to what's possible today, then tomorrow and so on.
So I had five detected, and all five were killed by pelvic floor & whole pelvic IMRT in 2019 and Two years of ADT.
I been off ADT since July 2021. My PSA climbed back slowly and a PSMA scan found one lymph node with PC. So that was in a delicate area still in the Pelvic. It wasn't targeted with whole pelvic because the area is sensitive.
So I had 3 rounds of SBRT in November 2024 on that single lymph node. My PSA is sinking and my doctors say it is normal for it to sink for up to a year, so I don't have a complete answer at this time.
I'm living a near normal life as one can live with advanced PC, but with a very low PSA this entire time (since 2017) with only an original 4 months of ADT, and then two years of ADT from 2019 to 2021.
Don't let people tell you this won't work, or your cancer is everywhere, etc. That was the mindset before the tools to find it became available. We are all different in our PC how extensive it is, where it is. For some it might be too little too late (at this time), for others it might be what enables you to live a normal life, a full life, a life until the newest technology like CRISPR are able to control and kill cancer.
The tools now exist and are being created to create the care to manage and beat cancer, never has the advancement of this ability advanced so quickly.
This work is literally advancing around the world with the new advancement occuring daily, even hourly. There has never been a time like this in the history of man or medicine.
Change is coming, coming very very fast. Be part of that change.
Finding your cancer is step one, treating it is another. There are many available treatments to spot kill cancer besides radiation (SBRT), and withing radiation this can be done with Proton or photon, actually there is even a better radiation currently available only at limited sites in Japan, China, Korea, and Germany.
So that's another thing other countries might have better options available than you will find in the US.
My RO was going to hit the 4 turned out to be 5 mets that showed up on my Pylarify PET Scan. I got fitted for my mask to hold my head steady and at the last minute he said no. One of the mets was too close to the espophagus and the planning software determined it would not get the correct gy/dose of RT. It was an all or nothing deal so back on ADT. I was on the fence the whole time so I took the news without issue. I'll never know if the RT would have kept me off ADT for a while, cured me, or destroyed my QOL.
I will share again, post RP and post salvage RT to prostate bed, at usPSA 0.10, no ADT, I had salvage extended pelvic lymph node dissection surgery after Ferrotran nanoparticle MRI identified suspicious pelvic lymph nodes - no other locations identified. The Ga68 PSMA and other scans were clear. That ePLND surgery confirmed cancer in five nodes including common illiac and paraaortic nodes and yielded a nadir of <0.010. That was six years ago. After two years lost < and very slow steady four year usPSA rise began; been in 0.03X range last two years, again no ADT. As I choose to delay ADT as long as possible I remain grateful that I had ePLND and I consider the further reduction in tumor burden very valuable. All the best to all of us with the paths we take.
PSMA-PET just found 3 Mets. L 7 rib..R..8 rib and retro pubis. RO is doing 20gy to each lesion. He says NO systemic therapy. Had radiation on prostate and all pelvic nodes 17 months ago. PSA went from 9.8 down to 0.57...then rose to 4.7 6 months later. Lupron may suppress any micrometastises....it will "mask" any other sites from another PSMA. Qql suffers greatly with systemic therapy. Me? I will roll the dice on "possible" new met and push it down the line. My RO says he wants to be the Dr. who completely eliminates the need for lupron. It has its place for sure....but is quickly being replaced with new therapies and PSMA-PET. Personal experience varies....but my decision is...."if ya can't SEE it...you can't KILL it. No lupron for me.
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My Intermittent Bicalutamide mono therapy - continued
Crossroads - ADT or wait for psma pet/LU 177? Meeting with oncologist to discuss tomorrow 
False Hope?
Have to make a decision next week 
