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Treatment Options for Pelvic Lymph Node Metastasis

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Posted 11/1/2018 11:37 AM (GMT 0)
A 18F-DCFPyL PET/CT scan has found about ten pelvic lymph light up with abnormal intense and intense signals. A T3 MRI didn't find anything significant. The prostate is completely clear of malignancy. PSA (3.26 on 10/22/18) is rising rapidly with a doubling time around 2 months. A biopsy of one of the lymph nodes (peri rectal) will be performed on November 9 under the NIH clinical study.

Sooner or later I will have to decide on a treatment option. The decision will probably depend on the result of the biopsy. In an appointment with my URO following possibilities came up

1. Removing suspicious lymph nodes combined with ADT

2. Radiating pelvic lymph nodes combined with ADT

3. Combining chemotherapy and ADT

4. Intermittent ADT only

I have an appointment with a MO on November 16. Let us see what he says.

I had brachytherapy of my prostate in 2011 and cyber knife for a extra-capsular nodule in 2017. Is radiating the lymph nodes a good idea? Does my age (78) rule out some of the possibilities? Should I go on intermittent ADT alone?
Posted 11/1/2018 2:27 PM (GMT 0)
Sorry you're needing more treatments.

as to your questions: Radiation would do it. You likely could tolerate a shot at the nodes, but you'll need the RO to agree to that. The more general wisdom is that you should avoid surgery the older you get, and while age is a factor, I think factors like your general health levels are a bigger factor. ADT alone would be palliative not curative, but between ADT and chemo, you could get a long time.

Tough choice.

Tell us what your MO thinks.
Andrew
Posted 11/1/2018 2:41 PM (GMT 0)
Based on what you know at this moment, RT/ADT would be the most attractive to me.

I feel that the MO, and an RO, are more suited to advise you than the Uro at this point.
Posted 11/1/2018 3:34 PM (GMT 0)
If that many nodes have cancer...your cancer is systemic...I realize that I am not up on all the so called curative possibilities of systemic cancer in all its many forms...my opinion is if it ain't quacking like a duck...there is \is more quack..than duck...bottomline imo...you will not die of Pca...and you should well...enjoy every moment of your life...storing up many treasures as you slip into who you are...I consider that a life sentence...not...a death sentence...again words are a sticky wicket...whot?
Posted 11/1/2018 6:40 PM (GMT 0)
I notice that all four of your options include ADT so there's not much decision to make there. I'd think you can eliminate surgery as an options at your age so that narrows things further. The conventional wisdom is that it's probably a bit early to think about chemo for you. That conventional wisdom is being challenged for guys who are at really high risk but since your cancer doesn't seem to be exactly off to the races you are probably not in the group that has shown benefits in recent tests of early chemo. But I dunno.

So, unless I am wrong about chemo your only choice is radiation or not. I'd be tempted by the radiation since the side-effects will probably not be particularly dire and it might help slow or stop the progression of your disease.
Posted 11/4/2018 9:11 PM (GMT 0)

Peter said...
I'd be tempted by the radiation since the side-effects will probably not be particularly dire and it might help slow or stop the progression of your disease.


I agree with Peter. ADT should be the basis of the treatment and you can combine that with radiation to possibly slow the progression. After 18 months of ADT you could make a holiday and start intermittent ADT.

The combination of Chemo and ADT showed a benefit if the patients had four or more bone mets detected with a bone scan. This is the result of the CHAARTED trial and the re-evaluated GETUG 12 trial.

George_
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