I’ve had SBRT in the past to oligometastatic bone Mets with great results ( no recurrence).
I now have a couple new bone Mets discovered by CTPET PSMA. My RO is not concerned about them as they are not painful although my psa has climbed from .9 to 4.2 to 6.2 since around August. Instead he has recommended XOFIGO which frankly sounds dreadful. I’d rather use SBRT on the two bone Mets since there are no ugly side effects. I turn 81 on January 3rd. Any thoughts/advice?
Bob
I think at this point you need systemic treatment vs the spot treatment. I wonder if could combine SBRT with XOFIGO
I am getting systemic tx with estradiol and Xtandi.
If you're on hormone therapy and you have new Mets I would be inclined to believe your are on your way to mcrpc. You probably should look at the Oxofigo as a treatment option since it will hit micro metastasis. Otherwise you'll be getting new scans every 6 months and finding new Mets. Chemo is another option. Have you biopsied any of these Mets? If not, might was to consider that and send it out for genetic testing.Of course, being 80ish, you may just want to be conservative. You have options.
Hey Bro, if the SBRT works for you with minimum side effects of day gi for it, especially since the procedure is highly accurate and you've been through it before.Trust what your spirit is telling you and since you have confidence in your clinicians get er done. Other options create too much chaos in your system when your bouncing back. I haven't had to do this but know a few bros that have, and they're bayou with the results. Hope that helps. Cheers my Friend.
Don't mind my type os fingers a Lil lazy sometime
That's what your little willie complains about....
Good Luck, Good Health and Good Humor.
j-o-h-n
Verrrrrryyyyy funny Dr. J.🤣🤣
good morning, Break
From my perspective considering your age as well as your good experience with SBRT I would suggest talking with your physician about staying on SBRT and commending both of yourselves for the successful past treatment.
I hope things fall quietly into place for you.
if you listen to your soul, you’ll hear the echoes of truth
💜
There is no known survival benefit of SBRT to metastases (whack-a-mole). There is a known survival benefit to Xofigo. SEs are usually mild - what is dreadful?
TA
I doubt that XOFIGO was compared to SBRT for survival benefit.If such a trial was done point me to it. As I understand it, XOFIGO provides five months survival benefit vs. doing nothing . To me five months of survival is not worth the side effects of XOFIGO or DOCETAXL. I’ve had YEARS of survival from SBRT to bones in 2017 and 18. If Mets are few ( oligo) as are mine, I may be playing whack a mole but infrequently.
Bob
Perrhaps I was unclear. There is NO KNOWN survival benefit to SBRT of metastases. You cannot know that you had "YEARS of survival from SBRT to bones in 2017 and 18." How long would you have survived if you hadn't had SBRT?
What side effects of Xofigo are you afraid of, and what is their probability?
TA
SBRT had no side effects for me whereasXOFIGO publishes a long list of known SEs. Indeed I don’t know where I’d be today had I not had SBRT to only 3 bone Mets. If I had had Mets all over my skeleton I obviously wouldn’t have opted for or even been a candidate for SBRT.
Meanwhile I’m still alive five years after SBRT ( 11 years after dx) notwithstanding I’m a Gleason 9 Pca survivor.
Your survival is what one would expect with or without SBRT to metastases for oligometastatic PCa. You would probably be in the same situation.
The "long list" of known SEs for Xofigo rarely occur. Just like SBRT, it is radiation to bone mets. However, Xofigo irradiates the metastases you can't see, while SBRT only irradiates the larger metastases.
It seems your logic about known survival from drugs is different than your logic about known survival from radiation. I assume you mean there is no study showing better survival rates with SBRT? How can there be any studies to convince you when PSMA has only been available widely for a few years?
What does PSMA have to do with it? TA was citing statistics that show there is no additional survival due to treatment with SBRT. Those who have been treated (in large samples) have not lived longer. This is a simple statistical fact.
I am receiving wack a mole only to improve my quality of life. I have vertebrae that are impinging on nerves causing inability to walk and in one case risk of serious paralysis if the broken vertebra breaks more.
To me it is worth treating these critical spots only to improve the quality of the time I have left. However long that is is yet to be known. Treating a much greater percentage of my known disease could possibly reduce the total tumor load and to a very minor degree slow down spread but this is not done because I would spend my whole life dealing with one set of locations after another and the cumulative effect of all that radiation could make things worse.
"I am receiving wack a mole only to improve my quality of life. I have vertebrae that are impinging on nerves causing inability to walk and in one case risk of serious paralysis if the broken vertebra breaks more."
That would be the one exception to the general rule that site specific radiation doesn't work on metastatic cancer.
You should also explore proton radiation as an option. It has better depth control than sbrt. Depending on where you are targeting that may be an advantage to sbrt.
The oriole MDT study used PSMA scans and I believe that was completed in 2020. Most of the studies weren't set up for OS because it takes a long time to find that out. SBRT in the Oligometastatic setting is promising only to the extent that it allows the patient time off of systemic ADT treatment if successful.
I never stopped systemic tx even after SBRT. Maybe I should give it a try this time around? I’ll see what my MO thinks. I thought hormon therapy was necessary to keep the micromets from growing. My T has consistently been around 3.0. Though I’m Gleason 9 I have low volume ergo oligometastatic which thankfully lends itself to precision to like SBRT.
Bob
I'm now in the same boat as you. I recently had a PSMA scan performed after dealing with a PSA that refused to drop below 0.3 while on ADT + Xtandi. My first PSMA scan after BCR was negative for Mets. This recent PSMA scan showed met on my ischial tuberosity which I had biopsied 2 Mondays ago. The pathology was positive for prostate cancer. The remaining biopsy samples have been sent out for genetic testing. My previous genetic testing was done on the prostate after my RP and Reoccurrence.
Now that I am informed of the source of my PSA, I'm starting SBRT treatment today for 5 treatments in total. Hopefully this will knock it down to < 0.1 and the possibility of ADT vacation can be realized.
There are a few more SBRT trials that may interest you. First is STOMP. This is similar to ORIOLE but specifically for Oligometastatic Recurrent prostate cancer. There are two follow on trials underway right now which may provide answers to the OS question and they are STOMP-3 and STOMP-6. The former is for (1-3) Mets and the latter (4-6) Mets.
These are phase 3 trials so are better suited to answer the OS question.
If you haven't done so, I recommend discussing a bone biopsy on one of the METs.
Knowing the genetics of your cancer is helpful to the extent that you know of any actionable mutations now and if things start to go south you are ready for immunology treatments vs waiting.
I have done genetic testing with negative results thank goodness.
Every patient situation is different, so what is promising depends on each patient situation.
Personally, avoiding the numerous unhealthy side effects of ADT is extremely valuable to me. So I'm thrilled that all three of my oncologists have seen a lot of patient successes with radiation of tumors that appear on PSMA scans. Within 6 weeks of completing SBRT without ADT, my PSA dropped from 1.05 to 0.14 and is now approaching undetectable. But that's just me.
Any experience on this forum with MONOTHERAPY SBRT for a single leison with a Gleason 3+3 = 6 score or Gleason 3 + 4 = 7 ?
My insistence (if that's what you mean by "logic") on clinical trials is the same for all therapies.
Please don't confuse "lack of evidence of benefit" for "evidence of no benefit." We currently lack evidence of benefit. My attitude is if safe, why not do it. But do it in addition to proven therapies, not instead of.
For a list of all ongoing oligometastasis-directed-therapy trials (most use PSMA PET scans), see Section 3:
prostatecancer.news/2020/07...
Thanks
With regard to treatment alternatives for yourself, I think you're better off getting more opinions from experienced oncologists than from a forum like this.
With all due respect, this forum has been a lifsaver for us. Questions and issues I'd never have known to ask. Some his doctor's did agree with, others didnt apply to my husband. No one is expected to decide treatment based on input here, but a good MO, RO will be willing to discuss options brought up here. My husband is treated by UCSF, and they've never had an issue with me asking about what I've heard here.If a person doesn't want input from other's experience, why ask? If someone only wants to hear that their preferred treatment path is the right one, why ask?
I will be forever grateful for a "forum like this ".
Amen. When you look around (in my case) the USA, but even Europe or India or Australia (curiously, little from Japan), and see patients being treated in at least several different ways in different timing and sequences by top docs at large medical centers, and then ask yourself if my local doc has that kind of wide knowledge, you want to explore that issue with the local doc--early and very often. I'd never have done Provenge if I had left it to local MOs and not read this forum. Same with radiation I'm doing now, particularly the sequencing. And I live in a county of 500K in the state with the largest number of aging prostates in the nation.
Curious, what was the outcome of the Provenge treatment? Successful, Unsuccessful or Indeterminate.
Unfortunately, there's no way to tell without the passage of years, if then, because Provenge supposedly neither affects PSA nor stop radiographic progression of your existing cancer. It is supposed to extend life, though.
I looked at it this way: I'm at the perfect point to use it, it's covered by Medicare, it's relatively easy, has few and mild temporary side effects, and does not keep me from doing any other treatment going forward.
The single problem was finding a provider in my area. But I did, and I haven't let me MO forget it, because he was of no help.
Got hubs on low dose estrogen patches to eliminate hot flashes thanks to this forum. No MO ever brought it up and would not have known about it or PATCH as a possible avenue in future if not for this. Do I like starting the day every day reading about cancer? No but it’s too important not to!
Sorry, I didn't intend to say the forum is not of any value. I also find it valuable, along with live support groups I attend, to gain information and learn about personal experiences from other guys in the fight.
My suggestion to the original poster was intended to encourage him to get more opinions from other oncologists when deciding what treatments might be best for his personal situation.
Thank you for that. Appreciate the clarification. I apologize for taking offense quickly.
I get a little over sensitive, this forum has been amazing. Has given me so much information to digest and run by my husband's doctors. Has personally gotten me off a few ledges during this ordeal.
Like the others who replied, I find the experiences of other members informative. The treatments that are discussed by members are helpful to the extent they form the basis of my inquiries when I meet with my MO.
Actually the experiences of folks on this forum are the result of recs from their health providers. So I am getting various professional opinions . Plus doctors tend to understate the downsides of treatments they recommend !
I had SBRT to a few mets earlier this year at the advice of 2 MOs and an RO (top specialists in Sydney Australia). It was very successful. PSA declined after treatment to pre SBRT levels (from 1.0 back to ~ 0.4 to 0.5) and has remained there. It involved two short treatments a few days apart. No side effects (same as you). I was advised that if my PSA started to increase again that I should again have a PSMA PET scan and if it showed increased avidity in the few mets that weren't treated the first time that SBRT could and should be repeated on them and any new avid ones. What you are considering is what I would do. All the best.
I finished SBRT on 2 new tumours ( left hip & 8th rib) a week ago. I have had SBRT twice before on separate tumours each time. Unfortunately the radiation on my T10 3 years ago caused a compression fracture on my T10/11, which lead to fusion of my vertebrae (T7-T12 and S1) in May this year. Not a great experience, but I have generally recovered from that now. In both cases my psa went down to almost 0 ( my Nadir). I am hoping my psa of 1.61 will come down after my recent SBRT. Exercise has helped me each time.
my PSA is around 2500, I doubt that any amount of SBRT will decrease it much.Maybe the next round of chemo will.
I’d go with the SBRT, I’ve been playing wack a mole with it the last couple of years with good results and virtually no SE’s. My MO, Dr. Sartor says I can continue to use it indefinitely depending on number and location of mets.
Ed
My dad (Gleason 8) had SBRT on 2 bone mets on his spine a little over a month ago. So far so good; neck is a little sore which comes and goes. Could be radiation fibrosis or his psoriatic arthritis. He's staying on Eligard and Nubeqa for now but may get a holiday after next year. PSA is below 0.1 for the last couple months as well.
If your RO will do it, I would go the SBRT route. If nothing else it lowers the tumor burden on the body. Have done it twice and if allowed, I'd do it again. Please know "You are NOT a statistic ".
Everyone here is dearly loved by someone who wants to keep them around and feeling as good as possible!!
Lot of great food for thought here. I think it depends on your personal outlook and what you hope to achieve. SBRT is a good patch and may buy you time on holiday or overall with excellent QOL, but perhaps adding Xofiga will help kill micromets and extend your progression free and overall survival with only a slight change risk of more SEs. Definitely a detailed discussion should be had with your MO on this. I've not been in this exact position (yet), but I also had Ogligo Metastatic and went after it with triplet therapy from the get-go. My theory is use the big guns first and leave as little cancer behind to mutate as possible if the quality of life is manageable. Of course, my age and fitness were favorable you should factor these items in as well. Good luck and keep us updated!
With just two new mets I would also go with SBRT again (now) and see what happens to PSA. Could still follow with Xofigo.
Decisions, Decisions Decisions...Do you pick what's behind curtain number 1 or curtain number 2?
Good Luck, Good Health and Good Humor.
j-o-h-n
A friend of mine who was "cured" of prostate cancer had a sudden jump in PSA to 4ish. PSmA imaging located the issue on his pelvis. He took SBRT for 5 fractions. He reported no pain and PSA fell back down to near 0
talk with your oncologist with your concerns and your preferences
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