Cryoablation to previously irradiated rib met

[V10fanatic]

My latest FDG-PET picked up 4 new mets including one to a previously irradiated rib. My RO stated that the risks associated with retreating it with radiation was high, so he recommended I consider cryoablation. I didn't even know that was possible on mets. Has this option been around for long? Is it usually successful? Is there much pain associated with it? My appt. with the interventional radiologist is next Monday.

[Tall_Allen]

I'm not sure that cryo to the rib met will have any benefit. Did you have Neulasta (or similar) when you had docetaxel?

[V10fanatic in reply to Tall_Allen]

Only after the fact while I was hospitalized. In respect to the cryo, I was told that they might be able to perform a biopsy on the rib while they're in there to find out if it's still just adenocarcinoma or switched over to neuroendocrine.

[Tall_Allen in reply to V10fanatic]

Neuroendocrine is rare. Non-PSMA expressing cells are much more common.

[hansjd in reply to Tall_Allen]

Hi TA. When you say non PSMA expressing cells (that are not neuroendocrine) what are they? And how are they best treated? Thanks

[Tall_Allen in reply to hansjd]

They are prostate cancer cells that do not express PSMA. Chemo should kill them. In fact, anything that doesn’t specifically target PSMA

[God_Loves_Me in reply to Tall_Allen]

Learning questions - As patients, Many times doctor focus on PSMA PET SCAN and monitors all tumor that are PSMA Express. Does it mean non-PSMA tumor are not high important in compare to PSMA Express tumors ?

[dhccpa in reply to God_Loves_Me]

He'll answer, but I believe that many doctors that use PSMA scans tend to ignore that idea that those scans won't detect other cells that need treatment.

[Tall_Allen in reply to God_Loves_Me]

It has long been known that PSMA is a moving target. The advent of PSMA PET scans has enabled us to track PSMA expression. Cancers that express a lot of PSMA (called PSMA-avid tumors) can be distinguished from cancers that express very little. Radiologists determine avidity by comparing the uptake of the tracer in cells that express PSMA to the uptake of the tracer in cells known to not express PSMA. Early low-grade prostate cancer does not express PSMA at all. Higher grade prostate cancer may express some PSMA. PSMA expression really starts to take off when the cancer metastasizes, although it is highly variable between patients. About 90-95% of metastatic men express at least some PSMA on their prostate cancer cells. At some point, however, as genomic breakdown continues, PSMA is no longer expressed by metastases. Treating when PSMA is not adequately expressed can cause a lot of toxicity to healthy tissues (especially kidneys and salivary glands) and little therapy. Thus, there is an optimal point for treating each patient with PSMA-targeted therapy. Treatment too early or too late, may exert selective pressure on the predominant non-PSMA-types, allowing them to take over.

[V10fanatic in reply to Tall_Allen]

I'm visualizing what sounds like a PSMA avidity bell curve. Unfortunately, I'm at the far right side with my FDG positive mets.

[Tall_Allen in reply to V10fanatic]

It's more like an upside down U-shaped curve -- very little PSMA expressed at the start, and very little PSMA expressed in the most progressed. That's why other proteins (STEAP1, hK2, FAP, FGFR) may be better targets.

[addicted2cycling in reply to V10fanatic]

V10fanatic -- is that a Dodge Viper V10? 😁

As to CRYO, Dr. Gary Onik, Ft. Lauderdale, FL. has been performing Cryo and Salvage for decades. BOTH Cryo and IRE can also be used on Bone Mets.

[V10fanatic in reply to addicted2cycling]

A Viper indeed. It was my lightly modified 2006 which put out 700HP and 700lbs of torque. There's no way I could handle all that juice with my ADT brain fog. Glad I got to enjoy it when I could🐍

[j-o-h-n in reply to addicted2cycling]

Close but no cigar.😁

It's a 1988 two door Yugo with 4 rubber wheels and 1 for steering right or steering left.....

google.com/search?q=yugo+ca...

Good Luck, Good Health and Good Humor.

j-o-h-n

[Wife32]

My husband had cryoablation on a pelvic bone that was in the previously treated radiation field. They did biopsy it while they were doing the ablation. It was an outpatient procedure with no incisions requiring sutures, just a few holes that had bandaids on post procedure. It took care of the met and remains clear for the past 4 years.

Only downside was it shot an entire day as an outpatient procedure. He had no pain afterwards, just a bit of tenderness.

Hope this helps.

[RoseDoc]

Cryo is not a new procedure. It can successfully treat metastatic lesions. It is usually an outpatient procedure with no to minimal discomfort.