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Prostate Cancer now spread in 3 lymph nodes

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Posted 11/15/2022 7:32 AM (GMT 0)
Hi
After brachytherapy in Mar / 2019 my PSA steadily dropped to 0.7. Over the last year it rose to 2.2 in June /22 and then dropped to 1.9 in Sept / 22

However I just saw my oncologist(s) last week who gave me the results of an MRI (Sept / 22) that showed:

"MRI of the prostate on September 29 revealed no focal lesions within the prostate. The prostate
itself measured 27 mL. There was, however, a 1.5 cm left internal iliac lymph node visualized,
which is somewhat abnormal and a suspected lymph node higher up."

A subsequent CT scan showed: "The patient underwent CT scans of the chest, abdomen/pelvis on October 31st, which showed the following findings; redemonstration of left internal iliac lymphadenopathy measuring 1.5 cm; and more superiorly, another internal iliac lymphadenopathy is also appreciated, measuring 1.3 cm. The
CT scan was also significant for an enlarged aortocaval lymphadenopathy, just superior to the aortic
bifurcation, which measured 1.2 cm. These findings are consistent with a lymph node metastasis from
the prostate cancer."

The oncologists "recommended different management options for this metastatic prostate cancer,
which largely include intermittent ADT, and also discussed a clinical trial (PR.20) to assesses the role of SBRT in the metastatic prostate cancer setting where patients are randomized to continuous ADT with versus without SBRT to all of the metastatic sites"

I'd like to know the pros and cons of ADT (zoladex) they are offering. I've been told by others this is generation one hormone therapy. Is it best if I ask to combine zoladex with abiraterone in combination with prednisone?

I'd also like to know if SBRT is effective to treat the lymph nodes (2 in pelvis, 1 in kidney)

How quickly can the prostate cancer spread? Should I try to get treated with hormone therapy as soon as possible?

Many thanks for any help
TWF
Posted 11/15/2022 3:06 PM (GMT 0)
After surgery, ADT and salvage radiation failed I was put back on Eligard + Xtandi. I sought out and received spot radiation to my 3 pelvic (approximately 1.5 cm diameter) lymph gland mets + area radiation to my internal pelvic lymph nodes. I then quit the chemicals due to many serious side effects. It has now been 19 months, my PSA is less than 0.003 ng/dL.

I opted for the spot radiation and it has apparently been successful. Your mileage my vary, of course. smile
Posted 11/15/2022 6:34 PM (GMT 0)
Hi Trailguy
Thanks very much for sharing your experience and I'm glad to hear radiation is working and your PSA is so low. Did you just have one radiation treatment or several?

In addition to PSA tests after your treatment, do you also have ongoing tests such as CT scans, bone scans, PSMA or other tests to measure any further metastasis in the lymph nodes or other places in the body?

Thanks for your advice:>)
TWF
Posted 11/16/2022 2:58 PM (GMT 0)
Hi TWF,

After initial treatment had failed I was put back on Eligard. My PSA only went down to 1.5 from 3.3 (should have been less than 0.1), so the doc wanted to add Xtandi. To get that script OKed he had to show I had metastases so he had me get an Axumin F-18 PET scan. They were there so I got put on Xtandi + Eligard. I got bad side effects from both.

When I got the Axumin F18 PET scan I demanded to see the pictures and to have a Radiation Oncologist explain them to me. In those pictures I saw the 3 metastatic lymph nodes shining like stars in my pelvic area.

The RO suggested 56 Grey of radiation to those mets and 50 Grey to my internal pelvic nodes. I received those 106 Gy in 30 sessions over a 1 & 1/2 month period. The treatments were based on the ORIOLE study.

None of this hurt more than getting any needle poke. After that I quit taking the Eligard and Xtandi. The Side effects from the radiation are quite minimal this time around. The fatigue was the most notable, but that has faded.

Other than 6 month PSA tests, no scans or anything else. If my PSA goes up, my RO says I'll need to get a PSMA scan. I have already told him I will want any treatable recurrence spot treated with radiation.
Posted 11/16/2022 7:44 PM (GMT 0)
After biochemical failure of proton therapy and a couple followup clinical trials, I had SBRT radiation to lymph nodes after a DCFPyl PET scan identified spread (June 2017). Also a part of the ORIOLE trial at Johns Hopkins. I'm currently "hanging in there" with a 0.28 PSA with no meds (i.e. Lupron) at all. Details are in the clickable link below.

Good luck in your treatment whatever you decide.

...Jerry
Posted 11/16/2022 10:18 PM (GMT 0)
Thanks very much Jerry for your helpful reply.

I'll be doing more research before I decide.
All the best
TWF
Posted 11/17/2022 1:57 AM (GMT 0)
It seems to me that hormone therapy plus radiation is the way to go because you really want to prevent metastatic spread via the lymphatic system.
Posted 11/23/2022 10:07 AM (GMT 0)
Hi Trailguy, I have been on intermittent Zoladex treatment since 2007, when my PSA goes beyond 11.5 my Oncologist starts me back on the HT, after 3 months this time , I am already back from 11.8 to 0.80, works for me, and should work for you, good luck.

Regards Mal.
Posted 11/23/2022 3:18 PM (GMT 0)
Thanks Mal, but I do not need any further therapy or treatment at this time. My PSA is less than 0.003 ng/dL now. I have been off of Eligard + Xtandi chemicals for 1 and 1/2 years.

The ORIOLE - style radiation therapy I received almost 2 years ago seems to have killed the 3 metastatic pelvic area lymph nodes. The inner pelvic area radiation appears to have discouraged other lymph nodes from becoming cancerous as well.

If my PSA goes up I will get a PSMA PET scan and go for more spot radiation to kill any more mets, if necessary.
Posted 11/23/2022 3:57 PM (GMT 0)
If you are not being treated at a major cancer center, I would be changing that.
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