Seeking Options for Treating An Extraprostatic Lesion

I am 7 years into managing my PCa. Currently, I am post-Salvage Cryo that didn't get the results I had hoped for and the subsequent MRI revealed an Extraprostatic Lesion.

Luckily, we've been able to achieve a PSA of <.01, thanks to Firmagon and Xtandi. I just want to make sure I am not overlooking viable treatment options.

Here is the background of what brought me here.

In 2010, PCP referred me to urologist for PSA of .95 and abnormal DRE. Subsequent biopsy revealed 3 cores were Gleason 7 (2x4+3 and 1x3+4). We treated this via Proton Therapy ending in 5/2011.

The PSA was rising again at the end of 2014 and eventually had full gland Salvage Cryoablation in 10/2015.

By 2/2016 it was obvious the cryo didn’t get it, PSA was on the rise. (4.3)

5/2016 MRI revealed a Gleason 8 lesion in the right lateral base and a Gleason 9 lesion in the extraprostatic region. Posttreatment changes within the right posterior peripheral zone at the level of mid gland with markedly increased extraprostatic T2 heterogeneous soft tissue with associated diffusion restriction coursing posteriorly along the rectum with associated broad-based abutment of the rectal wall concerning for recurrent disease. Cannot excluded rectal wall invasion.

6/2016: I begin ADT (Firmagon) with PSA 14.3

11/2016: PSA reached Firmagon-only nadir of .70 and began rising

2/2017: We added Xtandi in February 2017. PSA reached <.01 in May 2017 and has stayed there.

Which brings me to the purpose of this post: I have an Extraprostatic lesion which abuts the rectal wall.

I am very happy with the recent results of treatments and really like the folks at Duke Cancer Center.

However, I have this feeling that we are just kicking the can down the road (just like Congress) and waiting for the PSA to start rising again.

Have any of you had a similar situation or know of others who have successfully treated an extraprostatic lesion?

Thanks in advance for any ideas.

Tony

Thanks, Allen.

That is one of the options we considered after the first recurrence. We were concerned about too much radiation and those side effects.

However, I was thinking like you and may need to revisit this.

I have my regular quarterly round of Bone Scan/ CT Scans and MO visit coming up in a couple of weeks. I plan to revisit this topic during that visit.

While I have you, TA, have you ever heard of FLA or HIFU being used on extraprostatic lesions?

I was turned down by one FLA clinic in my first salvage go-round. They said only PCa contained within the prostate itself. I didn't pursue it any further.

Thanks for your help.

Tony