Please help us decide on next treatment

[Simonapo]

Hi, my Dad was diagnosed back in 2021 with stage IV, Gleason 9, oligometastatic. He had 6 weeks of radiation at the time of diagnosis and has been for the past 2.5 years on Abiraterone, Prednisone and Lupron. As I mentioned in my prior post my Dad’s PSA started going up. He had a PSMA Pet scan and it shows activity in the left side of prostate gland and in one rib. We met today with radiologist and oncologist and we were given 3 options: SBRT to the active parts of the prostate and the rib, HDR Brachytherapy to prostate and SBRT to rib or Prostatectomy surgery of prostate and SBRT to the rib. Please, please help us decide what treatment is best. Any success stories with any of these treatments after initial RT failed and ADT + Abiraterone failed? Thank you SO MUCH!

[WisdomSeeking]

Because he's 85 years old, I wouldn't recommend prostatectomy at all.

Why don't you ask about switching to Xtandi instead of Zytiga? See post "Xtandi (enzalutamide) +ADT slows metastases in recurrent men" on Tall_Allen's blog prostatecancer.news/2023/05...

I don't know about SBRT to the prostate after failed RT. But given that you dad had dose of 55 Gy to the prostate then maybe it can be a possibility.

It's strange that your dad's PSA is extremely low (0.03) and that the PSMA scan shows any result. I thought that PSMA scan is mainly for PSA over 0.2. See [1] below.

Please update your bio: that your dad is 85 years old, his PSA levels, health issues, ... Is he still very active and has he still no other health issues? I read in a previous post that he had high blood pressure due to Zytiga.

Links:

[1] PET scans for prostate cancer on Tall_Allen's blog prostatecancer.news/2016/12...

[Simonapo in reply to WisdomSeeking]

Thank you so much for all this information, I really appreciate it. My Dad is very active, no other health issues, no pain at all, he had high blood pressure due to ADT which is now controlled. Thank you again.

[Tall_Allen]

Not prostatectomy!

Abi is still working pretty well.

Focal HDR brachy to the prostate and SBRT to the rib, if safe.

[Simonapo in reply to Tall_Allen]

Thank you so much Allen, should Abi be continued after HDR brachy and SBRT to the rib?

[Tall_Allen in reply to Simonapo]

For as long as it works.

[Simonapo in reply to Tall_Allen]

Ok thank you very much

[Derf4223]

Ain't it great how we are given several tough choices...

[Simonapo in reply to Derf4223]

I know