Is whack-a-mole for a vertebral tumor (that is responsible for recent PSA increases) wise, when the vertebra isn't causing pain?

[Skilover]

I am age 66. had whack-a-mole radiation about 2,5 yrs ago (yo my left acetabulum/hip) when PSA began to rise after 10 -11 yrs on ADT (Lupron for 12 and Abiraterone for most of that time).

This time, Pet/CT indicates 1 of my 2 vertebral tumors is the culprit for my PSA rise over the last 2 yrs. PSA measured .35 2 weeks ago and was .20 just 11 weeks earlier so the doubling time most recently was increasing to approx. 3 months. The culprit for the rise in PSA this time appears from the reports to be 1 of my 2 vertebral tumors.

In addition to adding a new treatment such as chemo or some other, would whack-a-mole make sense once again (this time for the vertebral tumor)? From what I have read, radiation of vertebrae is typically warranted when the vertebra(e) cause pain. But, I am not experiencing any pain, unless the intermittent neck pain I have in the mornings is a result of the vertebral tumor.

I appreciate your responses.

[NanoMRI]

(edited-did not like my tone). I have come to reject the often used broad brush whack-a-mole labeling (I have used it). I think in terms of removing tumor burden.

Coming on seven years since I had six cancerous pelvic lymph nodes removed in my third treatment, salvage ePLND. uPSA holding 0.03X, no ADT. IMO a lot goes into this treatment decision - one I consider very viable.

[Tall_Allen]

Given that there is no proven benefit, safety is paramount. If safe, why not? I find the data on systemic treatment (like hormone treatment, chemo, Xofigo) more convincing. Where there is some cancer that you can see, there is a lot more that you can't see.

[kiteND in reply to Tall_Allen]

What about with systemic treatments? I’m on ADT. Chemo discontinued due to allergic reactions. The approach I’m getting is whack a mole

[Rocketman1960]

Have used SBRT twice to lower tumor burden. I wouldn't hesitate to do it again if they allow it. Good Luck.

[j-o-h-n]

When we were young we used to "whack the bishop" now we whack a mole"....If you ask me whacking the bishop was a lot more fun.

Good Luck, Good Health and Good Humor.

j-o-h-n

[hansjd]

On advice from MO and RO I had SBRT to 4 mets about 8 months ago when my PSA started to rise (from about .45 to 1.0) over about 10 months and a PSMA PET scan showed some increased avidity in the mets. After SBRT my PSA started to drop straight away and returned to pre-rise level, which is my ‘normal’ as I still have prostate and it’s enlarged. One of the mets was in a lumbar vertebrae. Others were in pelvic region. No side effect from treatment which was ‘easy’ and I’ve been told I can have SBRT again if I need it for other mets. Hope this helps.

[Teacherdude72]

What exactly is whack-a-mole? First time hearing that. diagnosed in 2015