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Recurrance and metastatic to bone

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Posted 6/7/2017 5:43 PM (GMT 0)
Hello to all. Have not written in a long time, everything good until last 6 months. G9 .0 psa for 9 years then jump in numbers. Now 1.8 count could not fine the cause until last week. Not in the prostate bed but seems it's in the L4 lower back. Planning on using sbrt end of month. Did have 30 mg of lupron and will continue with that therapy. Tumor is 1.5 cm. Health is excellent and Dr seems wii do well. Do any of you more experienced guys have suggestions or info you could pass along.
Anything will be helpful
Thx
Posted 6/7/2017 6:02 PM (GMT 0)
This is Savinjames's signature from the first post, back in Nov 2015:

DOB 11/13/51. Dx 5/2008 Adenocarcinoma age 56. PSA 7.6
11 cores taken, 10 positive. Gleason 5+4=9.
Bone and cat scan negative.
Surgery 8/29/2008.
Stage pT3b. Margins and nodes (13) clean.
No radiation or HT.
PSA every 3 months

Link to that post: Newbie pT3b with rising PSA after 7 years. Need advise.

The G9 cases, as we discussed back then, are aggressive and tenacious. Radiation certainly seems like a good first try, especially if that first discovered met is causing issues.

When was the Lupron administered? Is the 1.8 happening after being on Lupron for a while (over 4-5 weeks)? Has the testosterone been measured, to see if it's "castrate" level or not? It's important since a rising PSA after, vs. before, hormone therapy has a very different meaning.

Those more experienced in this situation should be along shortly.
Posted 6/7/2017 6:02 PM (GMT 0)
Sorry you have to come back to this problem.

The advanced guys will be along soon with better info, but sounds to me like a great plan that should work just fine.

The lupron isn't fun, but it works.
Andrew
Posted 6/7/2017 7:18 PM (GMT 0)
Thanks for answering so fast. The lupron injection was given on May 25 as soon as psa jumped from .8 to 1.8 within 2 weeks. Testosterone has not been tested as yet I kno there are a lot of testing coming up. I'll see to it that the testosterone is measured. I guess my case is going infront of the tumor board tomorrow and all the doctors will voice there opinions,but they want to wait until the lupron has been in my body for 6 weeks
Posted 6/7/2017 7:36 PM (GMT 0)
Welcome back. Sorry you are having to come here again. It is a real Shock and a very Scary thing to get any metastatic diagnosis. (Lots of metastatic guys here know. You are not alone.)

With this new info, I would assume you are expanding your team to include a Radiation Oncologist and a Medical Oncologist (hopefully with lots of experience in Genitourinary cancers, and especially prostate cancer. Here are a few other thoughts, in no particular order.

With bone mets, you can ask/learn about either periodic Zometa (zoledronic acid ) IVs, or Xgeva (denosumab) injections.

Scanning technology has changed in recent years. This could be a good time to learn/ask about improved CT machines, multi-parametric MRIs, C-11 (Choline) PET Scans, and possibly other types of scans, such as Ga 68 PSMA PET/MR, Axumin F-18 PET scans, in addition to the older NM Bone Scan.

Start thinking about asking your local doctor to whom he would refer you for advanced Prostate Cancer consultations and treatments, if/when the time might come. Research those names and places.

Consider emailing or writing ahead to your doctor and requesting a conversation with you about the CHAARTED, STAMPEDE, and LATITUDE Clinical Trial results, and how they might apply to your Individual Options at this point in your disease treatment.

Start learning more about the basics of some treatment options, such as Zytiga, Docetaxel, and Xtandi.

And, of course, check into the many good resources on-line and in books for "advanced prostate cancer".

Also, keep your spouse/partner or others in the loop, too. Have them in the room during those doctor discussions as your second set of eyes and ears. It can help.

Charles
Posted 6/7/2017 7:41 PM (GMT 0)
Sorry you have to deal with this. You might want to talk to your Dr. about xgeva for bone health and potential PC benefit. Keep us posted.

Jerry l.
Posted 6/7/2017 7:51 PM (GMT 0)
If you have SBRT to the met I suggest to apply 3 fractions of 10 Gy or 1 fraction of 20 Gy. See this study:

Safety and feasibility of image-guided robotic radiosurgery for patients with limited bone metastases of prostate cancer

George
Posted 6/7/2017 8:14 PM (GMT 0)

Savinjames said...
Thanks for answering so fast. The lupron injection was given on May 25 as soon as psa jumped from .8 to 1.8 within 2 weeks. Testosterone has not been tested as yet I kno there are a lot of testing coming up. I'll see to it that the testosterone is measured. I guess my case is going infront of the tumor board tomorrow and all the doctors will voice there opinions,but they want to wait until the lupron has been in my body for 6 weeks

Ok, cool. This is a better situation, since you have a really good chance of hormone therapy doing a lot of good. Lupron has an induction phase that takes a few weeks to knock your T down. We'll hope for a much lower PSA reading after it has taken effect.

And I have to say you've had a really good outcome from the 2008 surgery, with no further treatments needed for some 9 years! For a pT3b, 5+4 that is most impressive.
Posted 6/7/2017 10:39 PM (GMT 0)
After my PSA went up to 2.3 after stopping ADT3, I had axumin scan which found my first bone met in upper RT. Femur. I went back on ADT3, had SBRT in 3 fractions total 27 grays and start xgeva tomorrow.
We have quite similar case. Good luck.
Bob
Posted 6/8/2017 12:40 AM (GMT 0)
Wow, SavinJames you sure have done well for many years. You must have had a great surgeon.

A general question about SBRT for bone mets: What is the difference between RT for palliative purposes vs RT (SBRT) to hopefully eradicate the tumor on the bone?
Posted 6/11/2017 2:23 PM (GMT 0)
I don't really know the answer to Annie's question, but wish I did, so I'm bumping.

Dave's had several sets of (palliative) RT and here's my impression. Few are willing to say that eradicating the tumor on the bone is the purpose of the RT, because there is not good evidence that getting rid of that particular tumor (when there are presumably circulating cancer cells and many other sites too small to have been detected) has any benefit in slowing disease progression. You can look up the discussions of oligometastatic disease which are really about your question. Even George's SBRT reference says "palliative ".

On the other hand if someone is having pain from bone mets RT is definitely effective in stopping the pain. Everyone (even the insurance companies!) agrees with that.

When Dave was having urinary symptoms last year from growing tumor in prostate again, he happened to have urologist appt and of course talked to him about it. Urologist put him on some useless drug and never mentioned radiation as an option. (Urologists!)

Next MO appt suggested radiation right away, and RO was happy to treat. Note that when Dave had asked her about radiation to intact prostate previously while having palliative RT to bone mets, she had been doubtful. We asked her this time around about dose to pelvic area, and she said it would be "definitive". And the RT did provide Dave relief of urinary symptoms (at least so far, treatment ended last December). Might it also have been good treatment for his overall disease? Should he have gotten RT or prostatectomy initially? Maybe....but I think there is no evidence.

Even though you asked about bone mets I think the principle is the same here.
Posted 6/11/2017 5:24 PM (GMT 0)

Redwing57 said...
And I have to say you've had a really good outcome from the 2008 surgery, with no further treatments needed for some 9 years! For a pT3b, 5+4 that is most impressive.

Indeed... in fact, I find myself wondering, in light of the SVI, why there was no adjuvant or salvage RT...... or did I miss something here?
Posted 6/12/2017 3:43 AM (GMT 0)
My first detectable met was a bone metastasis to T-10..My Onco said radiation was a waste of time..But my RO disagreed, since there was only one met, lets kill it before it causes trouble. 5 shots of SBRT and the met was gone..To date, no more bone mets...You can't stop this monster forever but you can sure slow him down...
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