PSMA Pet Scan results are in

[avenasse]

Today we had a consult with the oncologist to review the results of the PSMA pet scan.

“Heterogeneous PSMA avidity throughout the prostate gland consistent with foci of prostatic malignancy, combined with foci of acute and chronic inflammation as diagnosed on prostate biopsies. There is no evidence of PSMA avid nodal metastasis in abdomen or pelvis. Mild increased activity of a celiac node is most likely physiological. There is relatively high PSMA avidity (more than liver activity) involving the sacrum and both sacral ala and corresponding to heterogeneous sclerotic appearance on CT. This finding would be consistent with metastatic prostate cancer. There is no PSMA avidity of the small lytic lesion involving the anterior right 10th rib and the lesion involving the spinous process of T5 for which a metastatic disease from prostate cancer cannot be confirmed. There is no other evidence of distant PSMA avid metastasis elsewhere.”

While we were waiting for the results of this scan I was already working in the background to get his tentative medication plan organized in terms of paper work and approvals with the mind set of prepare for worst but expect the best. He starts casodex tommorrow until the approval of Erleada comes through, followed by zolodex injection in the next week or two.

Treatment plan: Local radiotherapy to prostate + SBRT radiotherapy to sacrum is the tentative plan, along with lifelong ADT and Apalutamide (erleada).

This is the treatment plan in the medical note in mychart however the doctor did confirm for me on our call that he meets the criteria for oligometastatic. I read that treatments for this can be curative as an opposed to management. I guess it’s a wait and see how he responds to treatment kind of thing. Perhaps ADT could be intermittent or stopped all together if he responds favorably?

Next step is mapping for radiation. I am happy it’s not more widespread but still worried as this disease can be unpredictable. Is there anyone out there that can share a similar experience ? Hearing stories helps put things into perspective . Any advice and guidance is greatly appreciated.

[Tall_Allen]

Triplet therapy (ADT+docetaxel +darolutamide/abiraterone) is SOC for newly-diagnosed metastatic PCa. Arguably, his bone metastases were only found on a PET scan but not conventional imaging, so it is a small leap applying the triplet clinical trials (ARASENS and PEACE1).

prostatecancer.news/2021/05...

Radiation treatment of the prostate may slow progression for oligometastatic PCa. Again, that is based on conventional imaging.

prostatecancer.news/2018/09...

" I read that treatments for this can be curative as an opposed to management." Sadly, there is no good clinical evidence for that. There is a difference if all the metastases are in pelvic lymph nodes (N1), but his metastases are in bone (M1b).

[bandit119 in reply to Tall_Allen]

Tall_Allen, does the abiraterone need to start at the same time as the docetaxel as part of triplet therapy? How long after starting the ADT can you wait before adding the other two ?

[Tall_Allen in reply to bandit119]

In PEACE1, all patients started abiraterone within 6 weeks of beginning ADT, and docetaxel began 6 weeks after starting ADT.

[EdBar]

I think your initial treatment plan sounds good, very similar to the one I did over 10 years ago when dx stage 4, Gleason 9. Having the prostate radiated in addition to the SBRT at the very least will help avoid spread into difficult to treat areas of the urinary tract. You can read my profile to see what treatments I’ve done over the years.

Ed

[j-o-h-n]

Greetings avenasse,

It's a good idea to copy and paste pertinent data from your first post (3 months ago) and to put it in his Bio. You should add any more relevant data you feel that will help you and help us.

Regards to you all and have a Happy Christmas.

Good Luck, Good Health and Good Humor.

j-o-h-n