My History to date

[Sisyphus]

Diagnosed 09/2019

PSA 12.8

T2C Grade Group 5 - (4+5) Cores right posterior @15mm length, cores right mid and left posterior Grade Group 4

MRI showing Pi-Rads 5 lesion right side successfully targeted N0

Pet PSMA showing avidity right side of prostate and two avid lymph nodes common iliac and external iliac right side of prostate

Consulted Prof Declan Murphy and Prof Scott Williams at Peter MacCallum Centre Melbourne on referral by urologist

Prescribed ADT Zoladex with Casodex (30 days) for PSA flare + whole pelvis radiotherapy 78 Gy in 39 fractions. No Brachytherapy after consideration

Fiducial seeds and SpaceOar inserted 03/2020

Radiation commenced 04/2020

Severe acute side effects from ADT - hot flashes, fatigue. Severe acute effects from radiation - urinary urgency/frequency and severe faecal incontinence mid program resulting in two week suspension to investigate faecal issue. No respite despite break in radiation so decided to press on and complete radiation.

Decided to stop ADT after 06/2020 injection in consultation with urologist who said that my treatment side effects were the worst he had seen

Regular 6 monthly PSA tests thereafter showing scores in range 0.01 -0.9 until rise from 0.96 12/23 to 4.3 6/24

PET PSMA reveals avid three lymph nodes in para-aortic/para-caval area. Nothing in prostate or in pelvic area, no osseous or visceral metastases.

So recurrent disease after 4 year ADT holiday seems limited to (predictable?) lymphatic pathway and most happily with no bone or organ metastases.

[Tall_Allen]

You might benefit from irradiation of the para-aortic and para-caval lymph nodes and 3 years of ADT and 2 years of abiraterone.

It's too late for you but the PROSTOX test may determine those patients who are particularly radiosensitive:

miradx.com/prostox