Radiation

[Barnacle124]

My husband has been on Zytiga/Eligarde since January 2022 after a diagnosis of Stage 4 Metastatic Prostate Cancer. He was 79 at the time of diagnosis, and there was a met in his sternum and activity detected by a psma scan in lungs, liver etc. He has be doing quite well despite some dizziness and fatigue ( given a clean bill of health from a cardiologist after numerous tests), and his latest psma cat scan was very clean except for the right part of his prostate. The MO is referring my husband to a radiation oncologist for a three week course of radiation, five minutes every day. I have a lot of questions and concerns: why do this now and not before? What will the side effects be? He is 80 and responding well to the ADT, with a psa of .08 ( not undetectable but showing good results). Should we rock this boat? Any thoughts and/or insights from this wonderful group would be most appreciated

[Gearhead]

Good questions, IMO.

[GP24]

The ADT will not work that well forever. The cancer will start growing again and if the prostate is not radiated, it will cause urethal obstruction, pain and bleeding. Therefore I would do it. It may also extend the duration of the effectiveness of the current ADT therapy.

[Barnacle124 in reply to GP24]

Thank you! Do you know why his doctors recommend the radiation now and not 18 months ago, when he was first diagnosed?

[GP24 in reply to Barnacle124]

While ADT works fine, this radiation is done to be on the safe side to avoid these side effects in the future. After 18 months the effectiveness of ADT may continue or cease, so you may want to get this radiation in time.

[GP24 in reply to GP24]

The objective of this radiation is not debulking. I refer to Prof. Fizazi who recommends it to avoid obstruction: urotoday.com/video-lectures...

[Barnacle124 in reply to GP24]

Thank you!! This article is very interesting, and upbeat!!

[Tall_Allen]

It is called "debulking." Two large randomized clinical trials have proven that there is no oncological benefit to debulking the prostate after more than 3 metastases have been initially detected (which he has exceeded):

prostatecancer.news/2018/09...

Radiation may cause problems peeing, so why do it?

[Barnacle124 in reply to Tall_Allen]

I believe, but don't know, that my husband's metastatic disease is low volume at this point, which is a factor that would make this treatment more effective (according to the 2022 study mentioned in the article). In any case, these comments give me more ideas about what we don't know, so we can ask questions to help us make better choices.

[Tall_Allen in reply to Barnacle124]

To clarify... What I wrote was, "3 metastases have been initially detected (which he has exceeded)" It does not matter what is detected "at this point."

There is a tendency among patients and some doctors to think of detected metastases as all there is. It is not like weeds sprouting in a lawn. It is more like the mycelium of a mushroom that extends all throughout the soil. The mushrooms you see have nothing to do with the true extent of the plant. Even the most sensitive PET scans can only detect tumors larger than 5 mm. There are hundreds of millions of cancer cells that have to be active for tumors to get that large. Mean while there are thousands of tumors smaller than that size that are undetectable, and may put out little or no PSA.

[Barnacle124]

Thank you, TA! That is precisely what I am wondering about...

[Barnacle124 in reply to Barnacle124]

And thank you again, TA.

[Barnacle124]

Well, a Dean of Harvard Medical School once told me, going to a doctor is like going to a mechanic who knows .001% of the parts. I will read both these articles and discuss with my husband and the MO before making any decision. The radiation they are proposing is much less than that mentioned in the article btw...which might make a difference. 15 five minute sessions.

[NanoMRI]

I am not recommending for nor against debulking - simply sharing my experience because you asked for any thoughts and/or insights.

I was 61, post RP and salvage RT when imaging identified five (5) suspicious pelvic lymph nodes (no bone or other other organ mets identified). After many consultations, considerable patient research and thought, I chose debulking by extended pelvic lymph node surgery. Six pelvic nodes were confirmed cancerous including common iliac and para-aortic. That was over six years ago and there is no doubt I realized viable oncological benefit.

To your question as to why not do this before, it seems logical many/most of us would like do-overs. IMO the key now is to think broadly and make better informed decisions.

As for rocking the boat, how stable is your husbands boat now? I felt mine was not stable so I took less common significant actions.

[Mgtd in reply to NanoMRI]

Great point about do overs. Why spend energy reflecting on something you can not change. It is done so time to move on and look to the future.

[Barnacle124]

Thank you. Good point about stability.

[SpencerBoy11]

I tell this as often as I can. Radiation and chemo can result in myloidisplastic syndrome (MDS). It is rare and the symptoms are similar to a lot of of other things. If red blood cells. hemoglobin and other bloods symptoms are not right, see if this could be the problem.