next steps for asymptomatic oligometastatic Mcrpc

[Break60]

so I had an mri in area of pain ( lower back) and no Pca found. So given I have only 3 bone mets per CTPETPSMA , my next step should be imrt to those Mets, correct?

[ragnar2020]

Break60,

It depends. Have you requested an evaluation of your back ache by a orthopedic doc? From my own experience, when my back began causing me pain issues, I assumed, incorrectly as I’ve since learned, that my PCa had not probably spread into my spine. Instead, my back pain was caused by osteoporosis and low bone mineral density causing painful compression fractures. I have nine now. My poor bone mineral density was not caused as a side-effect of HT ADT because I have not had any HT yet. My osteoporosis and low bone mineral density is probably just hereditary bad luck. I suggest that you see an orthopedic doc who specializes in spinal care.

[Break60 in reply to ragnar2020]

Back in 1965 in The Marines I had a fall which caused compression fractures at L1, L2 and T12. So I’ve seen orthopedic docs many times and had cortisone shots. So the fact that MRI sees a non Pca problem here is no surprise.

[Break60 in reply to ragnar2020]

I switched to estradiol patches as ADT five years ago because they are less of a factor for osteoporosis and cardiac issues .

[Tall_Allen]

Why not, if safe? Docetaxel is next.

[EdBar]

Yes, I’ve done that for a couple of mets on my ribs over the past couple of years and each time my PSA has fallen back to nearly undetectable. My oncologist, Dr. Sartor said that I could continue to do that indefinitely depending on location and number of mets.

Ed

[Break60 in reply to EdBar]

Sartor is a great source from what I’ve read. I had a met to right femur done in 18 and one to Aron and scapula in 2019. I was also on ADT by estradiol. In 21 I added Xtandi which worked until now. My RO recommended Xofigo which sounds terrible to me.

[EdBar in reply to Break60]

I’m still on Xtandi, Lupron and Dutasteride per Snuffy Myers. Just gonna keep playing whack a mole as long as I can, after that possibly BAT.

[GP24]

I would get SBRT radiation. This radiates smaller areas with higher doses and destroys the mets. It will be three or five sessions only.

[Break60 in reply to GP24]

That’s exactly what I got last time I had bone Mets and what I want this time. I need to know why my RO is pushing Xofigo .

[Mgtd in reply to Break60]

Why not ask your RO directly?

[GP24]

Xofigo will address all mets but SBRT will destroy them for sure. I would get the three bone mets radiated with SBRT and then get Xofigo for the micromets.

I think the RO is afraid new mets will appear after he has radiated the three mets.