ORIOLE trial at Johns Hopkins using 18F DCFPyL CT Pet to select for SBRT

In attempting to qualify for clinical trial for subject scan at JH , I was informed that another trial (ORIOLE) was in process , led by Dr. Tran , to use the subject scan to determine if only a few mets (oligometastatic) were present which could be treated with SBRT , obviating the need for " onerous" HT. I assume (maybe incorrectly) that SBRT would only be used if mets were in locations not previously radiated.
Any thoughts on use of SBRT for stage pt3b gl9 PCa particularly after I've had so many previous IMRT treatments ( see signature)?
Bob

TA
Turns out I don't qualify for ORIOLE due to having had too much ADT.
Why do you think SBRT is risky if used to get mets not previously radiated? Dr Dattoli said he would not use in certain areas like spine. I don't know Dr Tran's prohibitions. He says JH has another scan (PSMA gamma?) which would be used. I've also applied for another trial for 18F DCFPyL at Yale, Dana Farber etc.

In general don't you think it's worth getting scanned to find mets? I gather you think just going back on HT is the course for me to take? My RO is thinking Lupron plus Zytiga or Xtandi. Is that a good combo?
Finally do you know of any good MOs near Hilton Head SC?
Thanks
Bob

TA

DCFPyL is not available to me due to ADT as I said. It's available elsewhere if I have lesion(s) of certain size based on other scans and am willing to have it biopsied. The trial at JH is an attempt to see if guys can avoid HT by using SBRT to zap mets.

My last Lupron injection was 7/21/16 and my last casodex tablet was 10/15 so I've theoretically been off HT since then notwithstanding the half life of HT. On 1/23/17 my T had increased to 59 so not sure I'm castrate resistant. I still get hot flashes.

How is one demonstrably metastatic unless a scan finds mets? The CT scans I got on 12/8/16 found nothing but PSA was only .028 then. That's why I'm seeking the best scans available as PSA increases.

As I said, JH I believe ( if I understood Dr Tran correctly ) has PSMA gallium 68 CT Pet which purportedly can find mets with low PSA although it's not foolproof. Nothing is.

I could also wait for PSA to rise and get more conventional MRI with contrast.

What do you think?

Bob

Hey Break60, I agree with Allen here.

I've had something like this going on, with numbers that are so far a little ambiguous. I had RT as primary therapy, so my residual PSA levels would be higher than one who's had surgery.

My HT ended 3/16. Since then, something like this (might be off on the T numbers a little):
May 2016 T=132, PSA <0.1
Sep 2016 T=250, PSA=0.2
Dec 2016 T=390, PSA=0.5
Mar 2017 T=TBD, PSA=TBD

So for me, either my PSA has tracked up with T, or if the T saturation theory is right, then something's developing. Saturation says as long as there's a certain level of T, the cells have enough to operate and they'll do what they do.

Kind of like as long as the water's deep enough to float the boat, it doesn't matter how much deeper it gets. That saturation T level is supposedly somewhere near castrate, so even at the May level of 132 the PSA should already have bumped up. Maybe there's a time factor in there somehow too. I don't know.

Point is, your PSA may go up with the T level to some level. Kwon's office told me their scan wouldn't likely find anything unless the PSA was 2 or more.

Just sharing my numbers for general interest, though not directly comparable to yours.

TA, Redwing, LSil:

Very interesting! Thank you.

TA : I find it odd to think that rising T is causing rising PSA! Isn't that the same as saying that PCa has resurfaced after T increased due to stopping HT?! If I had no PCa , increasing T with T replacement therapy presumably would not increase my PSA correct? Chicken or egg conundrum? I am laboring under the premise that if one has no prostate and no PCa one would have 0 PSA. Is that false?

LSil: Dr Strack who coordinates the trials for DCFPyL under license from JH at Yale etc. has told me that I would qualify IF traditional scans find lesions amenable to bx. Basically they're looking to see if DCFPYL can corroborate/ improve upon traditional scans. So I need scans to be scanned!!! Dr Tran at JH told me I did not qualify for OSPREY or ORIOLE due to prior ADT but could get another "super sensitive" scan he can administers ( PSMA 68 gallium)?
Strack thinks I should go with Tran and not wait until PSA rises to a level where traditional scans would be effective.
You think waiting for PSA to rise to >1.0 or 2.0 is dangerous? At my current PSADT I'll likely be there in a couple months !
Bob

TA
Sorry man! My bad!
Bob

Turns out that PSMA gallium is NOT available at JH. I'm now looking into AXUMIN scan which is FDA approved and becoming more widely available and which Medicare pays for.
Bob

@GoBucks,

I just posted my update as an ORIOLE participant over on the Australian study on radiation to mets thread.

I don't know that it directly relates to you as I was not on ADT with I got zapped and I didn't have bone mets.

...Jerry