Axumin Results

[btl258]

I had an Axumin scan on Friday (PSA rose from 0.03 to 0.24 in the past 3 months - RP in July 2018). There were 3 suspicious areas: right external iliac chain lymph node (was enlarged since my pre-surgery PET and there was significant radiotracer uptake); increased uptake in the area of the RP; increased uptake involving L5 and C1 vertebrae.

My sent me an email asking to setup an appt this week, he wants to start radiation very soon. Previously, he suggested that it would be best to be on ADT for a couple months before radiation. I will meet with him but am also going to meet a couple more doctors. I will contact MD Anderson tomorrow as it is only a 2-3 hour drive for me (does anyone have a recommendation there)? Also looking to meet with someone at UT Health here in town (this is where I was originally diagnosed). I have Decipher results on the tumor and a Myriad cancer panel should be completed in the next week.

I'm now 47 (diagnosed at 46 - Feb 2018) with T2C N1 M0 PCa. Original PSA was 32, went on Firmagon for 2 months prior to surgery and PSA fell to 5. My testosterone just started returning 2 months ago, which is when the PSA jumped.

Any suggested next steps other than my plan to see someone at MD Anderson and someone else locally?

Thanks.

[Tall_Allen]

MD Anderson has lots of good clinical trials - Eleni Efstathiou is lead investigator on many of them. With likely mets in your spine and your pelvic lymph nodes, there is no evidence that salvage radiation will increase survival. There's also no evidence that it won't. The most recent STAMPEDE trial of initial prostate radiation in men with only a few distant mets suggested there was a benefit, so it's certainly possible that whole pelvic salvage radiation with some spot radiation to the spine may confer a benefit. So you have to weigh the side effects of salvage radiation against that uncertain benefit. The standard of care would be to start you on ADT only.

[btl258 in reply to Tall_Allen]

Thanks. I have an appt at MD Anderson June 10th, was referred by Charles Ryan (head of oncology at U of Minn, formerly of SCSF, where he focused on the roles of androgens and the androgen receptor in castration-resistant PCa) - he is a family acquaintance.

I am hopeful (but I know it is not guaranteed) that the L5 and C1 spots are due to disk degeneration (I have had surgery at both spots, both have <5% of the disks remaining). Of course the Axumin should have had PSA specific pickup. I have been dealing with these locations since my early 20s. The activity in the pelvis and iliac lymph nodes is no doubt real.

[tallguy2]

I had a similar result from my first PET/Axumin. Same chain of lymph nodes and the site of two back surgeries: the L5 vertebrae. So we are both what is called oligometastatic.

I chose radiation, although as Tall_Allen states there is no evidence of any benefit. I choose to hit it hard. There were no obvious side effects to doing the 26 treatments.

I would also suggest that you start or continue ADT.

[btl258 in reply to tallguy2]

I plan to be aggressive. Since I'm only 47 yrs old and other than PCa, very healthy and fit, I'm OK with dealing with side-effects. I have an appt at MD Anderson in early June, and will meet with local oncologists over the next few weeks. I have a feeling that ADT + radiation will be the way I go.

[tallguy2 in reply to btl258]

My urologic MO is also at MDA. Standing by for when I "progress" with this disease.

[btl258 in reply to tallguy2]

How long ago did you complete radiation? Still on ADT?

[tallguy2 in reply to btl258]

I had salvage radiation the the prostatic bed and lymph nodes in 2012. After mets were discovered last year I had chemo and 26 rounds of radiation Dec 2018-Jan 2019. Yes, I resumed ADT after a 1.5 year "holiday" 2017-early 2018. I am told I will be using Eligard every 3 months "for life." I have not yet been prescribed Casodex.

[btl258 in reply to tallguy2]

Have you been on ADT since 2012 (other than the 1.5 year holiday)? The only reason I'm not on ADT right now is I was at 0.02 until my last PSA check 1 month ago and I've been told that I shouldn't go back on until all scanning is done. Assume that will be in early June.

[tallguy2 in reply to btl258]

Yes I was on ADT immediately in 2012 after my RP due to measurable PSA after RP.

Good luck and keep posting!