PSMA Pet Scan results

[Simonapo]

My Dad has been on Abiraterone, Prednisone and Lupron for 2.5 years. He already had back in 2021 radiation to prostate, lymph nodes and 2 ribs. His PSA started going up and we just got the results from PSMA Pet Scan: “Highly PSMA positive tumor in the left prostate gland, increased in intensity and spatial extent of activity. A previous right sixth rib focus of uptake demonstrates focal, more intense activity compared to 6/20/2023 and there is suggestion of subtle sclerosis and cortical irregularity on the registration CT, consistent with metastasis.”

We are meeting with oncologist at City of Hope next week. I am devastated with these results. Please let me know if anyone had the same path and what treatment decided to continue with and if it was successful. I appreciate any help and suggestions. I am trying to be as informed as possible about next treatments available before meeting the oncologist to discuss. Thank you so much.

[Radtech40]

I'm sorry to hear this about your father. He can try Xtandi (Enzalutamide) with lupron to see if that would work, it works for alot of people, dad has been on it for 3 years now and his psa is still super low with no new mets although he has other issues now. So Xtandi with lupron would probably be the next go to and if he fails that probably some form of chemo also I did read that they now suggest xtandi with another drug if xtandi alone fails and its shown to be promising. If, he has increased activity in old mets he can have those radiated, my dad did and it knocked them back to remission. It is always devastating getting these reports, he still has quite a bit of options to work with but we never want these reports its devastating, I can sympathize, I hope your dad gets to feeling better and the doc has a plan in place for him which I'm sure they do.

[Simonapo in reply to Radtech40]

Thank you so much Helen, I didn’t expect Abiraterone to stop working so soon, especially as he was oligometastatic, low volume disease . I feel like we started strong with Abiraterone and Lupron and worked for only 2.5 years. I forgot, has your Dad started with Abiraterone or he started straight with Xtandi? I am worried as I heard that Xtandi doesn’t work for very long after Abiraterone. We will see what the doctor says and if possible to do radiation to that one rib. I don’t think he can do again at the prostate. Thank you again.

[Radtech40 in reply to Simonapo]

Dad started with Xtandi and its 3 years and still working, there's some people on here that started with abiraterone and switched to xtandi and have been going strong for 4 plus years, xtandi is supposed to work longer. Doing radiation to the rib will help, it will flare and hurt at first after radiation but then get better. Keep us posted!

[Simonapo in reply to Radtech40]

Thank you so much Helen, your dad’s journey it’s such an inspiration to me, thank you for sharing his story and for helping others, much health to your sweet dad.

[GP24]

An RO could treat the two lesions with SBRT radiation. Sometimes Abiraterone will start working again after destroying the lesions. pubmed.ncbi.nlm.nih.gov/305...

[Simonapo in reply to GP24]

Thank you so much

[vintage42]

Unlike your Dad, I just recently started ADT with Abiraterone. But like your Dad, I had prostate radiation in 2021, then pelvic node radiation in 2023, with cancer still remaining in the prostate and growing, according the second PSMA scan. Radiation failure.

The Urologist says no salvage can be done for the prostate. A HIFU expert said it was not worth the risk, and that generally prostate salvage is not done if there is metastasis (two nodes in my case). I am told that I might do SBRT for the prostate after a few more years have passed, and that I can have SBRT any time for any node or bone mets.

I am told that for the moment, the ADT with Abiraterone is my best hope for suppressing the cancer in the prostate and in my present and future mets.

[Simonapo in reply to vintage42]

Thank you so much for your reply, I was afraid that radiation to prostate won’t be possible in his case either. We are meeting with oncologist and radiologist next week. Abiraterone worked great for him for 2.5 years, I am sure it will work for you too. Best wishes and much health your way🙏

[EdBar]

Seems like those couple of spots would be candidates for SBRT radiation. I’ve had to get a spot on two different ribs radiated over the past couple of years now that I’ve become resistant. Both times lead to a reduction in PSA and the area to be resolved, I’m hoping to get back to undetectable status. I’ll keep playing whack a mole as long as I can. SBRT is by far the easiest form of treatment I’ve undergone, and I’ve had many. I’m trying to hold off on things like Lutetium or BAT and keep those bullets in the holster.

Ed

[Simonapo in reply to EdBar]

Thank you Ed, I agree SBRT is the easiest treatment, we will have it done for sure for the spot in the rib. I am concerned that the other spot in the prostate won’t be able to radiate again since it was radiated in 2021. We will meet with radiologist next week to discuss. Best of luck with your treatments 🙏

[j-o-h-n]

Sorry if I asked this question before..... how old is your Dear Father? BTW apo in Tagalog means "Grandson"....... Hopefully his latest treatment(s) works.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Cactus297]

I am not sure about the radiation either. My son was radiated once in the pelvic node area… not sure if they can radiate the same area twice. He goes in at the end of the month for Lupron and numbers checked. Please keep us posted on your Dad.

[Simonapo in reply to Cactus297]

Thank you, we are meeting with two radiologists next week, one at City of Hope and one at UCLA. I am hoping they will find a solution🙏