Had Davinci RP w/ LNR 8 Reoccurrence in Bed, PSA Rising 0.77 CANNOT Do Radiation active Crohn Disease / Colitis, What about Cryotherapy?

[Shorehousejam]

Please Help Me Out, What Can I Do?

After resolving incontinence after RP w/ PLNR (8) on 03/14/2033

Had Davinci Radical Prostatectomy with Lymph Node Removal on 03/14/2023

Only 8 Lymph Nodes Removed, according to operating urologist surgeon that is what he saw to remove

I brought onto my team a second Medical Oncologist from Cancer Only Hospital

Please Read MRI test below:

11/14/2023 MRI of abdomen and pelvis

CLINICAL STATEMENT: Oligo Metastatic Gleason 8/9 prostate cancer.

Status post ADT, abiraterone and chemotherapy.

ABDOMINOPELVIC NODES:

Decreased now predominantly resolved necrotic left pelvic adenopathy for example measuring 4.3 x 3.4 cm, previously 6.0 x 4.9 cm in the left external iliac region.

Multiple additional subcentimeter pelvic nodes. For example:

* Right internal iliac, 1.2 x 0.8 cm * Left mesorectal, 0.8 x 0.6 cm

* Left external iliac, 1.1 x 1.0 cm * Sigmoid mesenteric, 0.7 x 0.7 cm

Left renal cysts. Resolved left

metastases, for example in the right iliac bone. Resolved

OTHER: Circumferential wall

thickening of the partially imaged proximal sigmoid colon, possibly colitis.

IMPRESSION:

1. Since July 10, 2022, interval prostatectomy with residual/recurrent mass in left prostatectomy bed with decreased seminal vesicle, rectal wall and left posterior bladder wall invasion.

2. Decreased pelvic adenopathy.

3. Decreased osseous metastases.

4. Resolved left hydroureteronephrosis.

5. Partially imaged proximal sigmoid colon wall thickening, possibly colitis.

What can I Do, Other than Radiation to Prostate Bed Fossa.

I’m fuming listen to first MO and waited, I didn’t follow my gut instinct before chronic disease / colitis started and Now I can’t radiate

[mperloe]

Have you seen an RO? Might Lu177 with compassionate use be something to consider?

[Shorehousejam in reply to mperloe]

That’s what my first MO wants from the beginning, I’m not doing Lu-177, not enough known or studied about with men with mutations like myself. It seems there is a lot debate on how good or bad it actually is. Many are disappointed with the results and many have hypo progression to death.

Not doing it, why I found a second MO

[Shorehousejam in reply to mperloe]

Do you know anything about cryotherapy?

[mperloe]

Cryo and IRE seem to be limited to prostate. There appear to be more failures and side effects and I would not think they are appropriate for lymph nodes.

[Shorehousejam in reply to mperloe]

Thank you

[Tall_Allen]

I doubt spot radiation would help . There were osseous metastases in addition to lymph node metastases. You have systemic disease and need systemic treatment. Pluvicto, Jevtana, and Provenge are good options.

[Shorehousejam in reply to Tall_Allen]

Is there anything I can do? besides systemic?

Anything direct? As the prostate bed tumour is growing as is my psa

[Tall_Allen in reply to Shorehousejam]

You have systemic disease and need systemic treatment.

[Shorehousejam in reply to Tall_Allen]

ok

Chemotherapy cabitaxel with Provenge?

[Tall_Allen in reply to Shorehousejam]

I'm confused by what you wrote above. You wrote: "Status post ADT, abiraterone and chemotherapy." Does that mean you've stopped taking ADT and abiraterone? If so, no wonder your PSA is increasing.

Hold off on chemo until there is evidence that metastases have become active.

[Shorehousejam in reply to Tall_Allen]

No

I had triplicate therapy with docetaxel chemotherapy back when diagnosed in July 2022

I’m still on

Firmagon very 28 days

Zytiga with prednisone daily

Plus Skyrizi for plaque psoriasis and colitis

Colitis was brough on my Taltz a med for plaque Psoriasis