New to stage IV failed primary SBRT

Hello All , I had SBRT in 2016 , failure recently. i had the PSMA-Pet , pylarify at VA . I hot lymph node in pelvic area . Talked to my RO , Dr. Hirsch , she says 3 SBRT sessions to the hot node and 25 sessions to the pelvic region . I received 1 jab of Eligard last week at VA . VA does have the team approach. Just want a few.opinions going forward Im looking for a team approach which I have an appt . Jan 7 at the University of Chicago . So I ran across this team at Prostate Oncology Specialist on the internet , Dr. Schold and Dr.Lam . Anyone here can recommend them or another would be appreciated . Thanks All .JJ

Might I also suggest close to home, Northwestern University?
https://www.cancer.northwestern.edu/types-of-cancer/prostate/

Other than being in CA, I have heard that Prostate Oncology Specialists charges patients and does not rely on most insurances, not sure how that works with VA (like TriCare?) but you can check out the link below:
https://www.prostateoncology.com/services/medical-billing/

The key is finding the doctors and place you can trust your care with. There are lots of sub classifications within Stage IV even through it sounds so harsh and final, like the word "metastatic. My wife is Stage IV and will most probably live a long time given the specifics of her situation. The radiation plan may solve the problem, you never know...

I see nothing wrong with the plan that Dr Hirsch proposed.

With the ELIGARD injection, a new weapon has already been implemented from the armory ...

Right after the holidays, and NEW YEAR's DAY, your appointment on January 7th will be right around the corner.

I like the timeliness of it all ... getting that new course of action defined, determined, and IMPLEMENTED!

Great to hear that you already have doctors who believe in a coordinated "team approach" ---- I have that experience here, for my case, and I am so GRATEFUL for that coordinated care.

Be sure to write down your questions, in advance, to take with you on January 7th!

Keep us posted ... we're here to support you!

CYCLONE - # Iowa State University

My situation is somewhat a mirror image of yours. I get my primary cancer care through Dana-Farber in Boston. Now that my D-F oncologist wants me to start Zytiga. I've arranged an appointment with a VA oncologist to request the prescription through the VA. My D-F doc says they have coordinated care with the VA for other patients. I doubt there will be any problem for either of us using both VA and private doctors.

Regarding your hot nodes. I guess this might qualify as stage IV, but spread to local lymph nodes is a worrisome but lesser concern that distant mets. I had a hot node at the time of my SRT in 2010 that was treated with radiation, another one about 4 years ago that shrank back to normal size when I started intermittent ADT. I now have hot lilac nodes and nodes near the former prostate bed, which should respond to Zytiga. But scans do not yet show any distant mets.

With luck radiation to your hot nodes will prevent further spread, or at least postpone it for a long time.
Jim