How do you make decisions?

Hi Craig, welcome to the forum.   Are you in the Atlanta area?   I am, and hopefully can help.

As to the decision in your case, who has the experience?   Datolli is well known for pushing the envelope and using the very cutting edge technology.   Emory is going to stay more evidence based and probably more conservative.   I suggest you ask Datolli how many he has treated like you and his success rates and then ask the same of Emory.   As I understand, Datolli has done a lot with advanced stage and high risk cases with a lot of success.   One of the leading Prostate Cancer oncologists, Dr. Charles "Snuffy" Myers used Datolli for his own radiation 15 years ago and sends continues to send patients there.

There are also a series of scans that may be useful for you in finding the source of the PSA.   Tall Allen is the most knowledgeable and will hopefully chime in.   If you know where the cancer is, it is easier to treat.

I went through SRT almost immediately following my surgery.

After watching my PSA rise for a few years, scans finally found two lymph nodes. I talked to my Oncologist about radiating them and he was against it. His fear was the potential side effects from additional radiation.

After communicating with the Vice Chair of Radiology at UCLA and sending all of my records and scans. He invited me to come out have the two nodes radiated with pinpoint accuracy. I discussed this at length with Tall Allen. He lives there and knows all of the best of the best in this field.

When I arrived, I suggested that I have one more scan, (C11 Acetate) to get a really good picture of what we were dealing with.

The scan found 3 additional nodes.

At that point the doctor said that radiation was off the table. The field would have to be too wide and the risk of QoL affecting side effects was too great.

I did not have them radiated. But instead went on 1 year of Lupron. I recently started a HT break after 1 year. My PSA dropped from a high of 92.5 to 5.24. And all of the nodes have either resolved or regressed.

Just giving you something to think about. I know that there is newer and better cutting edge radiology taking place, (as Tall Allen points out) but I chose to put my faith in the guy that is head of one of the biggest Radiology units in the country.

Sonny

Post Edited (Sonny3) : 3/18/2015 6:44:41 PM (GMT-6)

I was wondering why Dattoli didn't recommend feraheme MRI - you left that part out. And you've already had a choline PET scan - you left that part out too. So ignore my last post.

When you say L2, do you mean a lymph node near L2, or are you talking about a spinal met? How many positive nodes did they find? You're making it sound like a lot - is there an exact number you can share? It makes a difference. If there are a lot, I can see why Dattoli is proposing irradiating the entire area from the pelvic nodes all the way up to L2 - or is that what he's proposing? It would help if you could clarify all this.

- Allen

Now I'm beginning to understand...

There is a phenomenon that sometimes (not often) occurs called "oligometastatic cancer," which means there are 5 or fewer detected mets (lymph node, bone or visceral). Sometimes those mets can be irradiated and that may stop the cancer. The reason the limit is 5 mets is because beyond that the cancer is almost certainly systemic, and treating all the visible mets isn't likely to achieve anything but add to side effects of radiation. Sadly, with 30 infected nodes, you are well beyond that limit. This is what Sonny is talking about - he too had too many mets to treat as oligometastatic cancer.

Lymph travels very freely throughout the lymphatic system that goes everywhere in one's body. When there are that many infected nodes, it's likely that it has already carried the cancer cells with it everywhere. Those cells, called micrometastases are too small to be seen by our best imaging. If you want to go to additional expense, there is a blood test called CellSearch that detects the load of circulating tumor cells (CTCs) in the blood. Certainly, if there is a significant CTC load, there is no point in incurring radiation. Since you have good insurance, maybe they cover it. Here's the website:

/www.cellsearchctc.com/

You can, of course, go with the Dattoli plan to irradiate the wide area. (They would not irradiate individual nodes when there are that many because the lymph has obviously been moving throughout). Perhaps it might reduce the tumor burden somewhat. I would ask, as JNF suggested, how many men they've treated with those characteristics and what the oncological and toxic effects were. This is far from standard of care.

You can alternatively hit it hard right now with a combination of Taxotere and ADT. A recent study (CHAARTED) showed that early use had a particularly good effect in men like you who were recently diagnosed with multiple mets. (You might consider starting Xgeva or Zometa against bone loss at the same time.) If this is the route you choose, you should hook up with a good medical oncologist.

- Allen