palliative radiation treatment questions

[running_kiwi]

In my prior (first) post, I shared about my 82 year old father’s condition. Thanks for all the helpful and thoughtful responses from this community.

He has gone off Goserelin (ADT) injection and now just on bicalutamide pills. As his testosterone seems to have returned, he’s now having more energy and sleeping less. His PSA has also dropped from 115 to 76 in the last month. He has metastases in his pelvis and pelvic lymph notes (CT scan a month ago). 2 weeks ago, he was having bone pain.

At the first consult, the radiation oncologist had recommended ”palliative radiation treatment in a single fraction to the pelvis, 8Gy, for palliation of bone pain”. Yesterday, he also said he can wait, since the bone pain has currently gone away (I don’t understand why is bone pain has diminished).

He also said the radiation would not change the outcome or progression of the disease. As he’s not on the Goserelin ADT treatment, it would seem that metastasis will continue.

1- I don’t understand why the radiation treatment would not change the trajectory of the disease. Is it because once PCa has metastasized, it’s in the blood stream and will continue without more aggressive treatments, etc?

2- If he’s not having bone pain now, it is better to delay palliative radiation treatment until there is bone pain or is there value in the radiation treatment, even with minimal pain?

I’d appreciate any feedback on this 2 topics.

Prior post:

healthunlocked.com/advanced...

[Tall_Allen]

1- Yes. The cancer is in his blood and in tissue reservoirs throughout his body.

2- Yes. There is no advantage to palliative radiation when there is no pain.

[running_kiwi in reply to Tall_Allen]

Thanks for the quick reply Tall_Allen. I'm going to contact the radiation oncologist. He had a lot of pain 2 weeks ago. Actually went to the ER 6 weeks ago for pain, and the bone mets showed up in a CT.

Seems like the ADT he was on (started in March), has had some impact, as his PSA went down. Unfortunately, life was just miserable for him when he was on the ADT.

I don't understand why the pain has diminished. Do you know if metastases shrink when PSA goes down? The only other change is that he's started the bicalutamide.

[Tall_Allen in reply to running_kiwi]

The pain diminished because the ADT is working. That's what it does. This is not a mystery -- it is expected.

[running_kiwi in reply to Tall_Allen]

Thanks Tall_Allen. Does that mean the mets have shrunk due to the Goserelin?

Now he's only on the bicalutamide pills, which the rad oncol says will be of some help, but not as beneficial as the Goserelin.

I assume at some point, once the Goserelin has completely cleared out of his system, the cancer may grow and mets grow also.