Treatment update-is SBRT missing the lesions ?

[alperk]

PET scan 8/21 following PSA 54.5 showed numerous bone lesions. Zytiga, prednisone, Eligard knocked PSA to <.064 until 1/23 PET showed new small lesion in left hip. Radiation 35 Gray 5/5 completed 3/15/23 with PSA drop then bounce from 0.24 to 5.9 triggered another PET on 9/6/23 which showed a new metastasis in same area. Same radiation again on 10/25/23 didn't get it with PET showing larger area in hip. Radiation upped to 35 GY 14/22 and switch from Zytiga to Xtandi. PSA went from 6.6 to 3.46 but then 5.8 to 8.08 on 6/3/24.

It appears the radiation is missing the cancer and Xtandi did no good at all. My MO kind of expected this and is OK with waiting until my wife's kidney transplant on Tuesday and 4 week recovery in Tampa. I am thinking I should get a PET in Tampa and go from there. Radiation seemed to be ineffective but I keep that up? Maybe Docetaxel when kidney recovery is stabilized after 4 weeks.

A lot going on at my house, Any advise on "Why is radiation missing?" " Why did Xtandi not help ?"

Anything else...

[Tall_Allen]

It probably isn't missing. If the met was painful, the radiation might resolve the pain. Otherwise, what do you hope to achieve?

[alperk in reply to Tall_Allen]

A assume a PET scan would identify any active mets. I thought radiation therapy would target and destroy cancer cells in the affected areas preventing spreading of the cancer if not only for a limited time. I generally feel fine and have no bone pain but am reacting to PSA which I believe shows disease progression. I am running out of SOC systemic therapies

[alperk in reply to alperk]

Dexa scan shows bone density still normal with slight loss in spine and femoral neck and increase in hip.

[Tall_Allen in reply to alperk]

PSMA PET reveals PSMA-avid metastases that are bigger than about 5 mm (it has nothing to do with activity). Most metastases are smaller, and there is no data that confirms that a man diagnosed with multiple metastases receives any oncological benefit from playing whack-a-mole.

[alperk in reply to Tall_Allen]

OK then. It seems Xtandi did little and Docetaxel is my next step. Do you see any urgency i.e. waiting a month or 2 until my wife's condition is stabilized.

[Tall_Allen in reply to alperk]

Docetaxel works best when PSADT is less than 6 months.

[alperk in reply to Tall_Allen]

Thanks

[Leader4077 in reply to alperk]

Agree that Docetaxel should be tried. I would mention to docs that you would like information if Pluvicto might be in your future treatment.

[EchoII]

ask your oncologist about trying Apalutimide and Orhovyx. These are newer and possibly more effective than what you have been taking.