PSMA PET scan found cancer in rib and #3 vertebrae. Any experience?

I'm not good with making the choices, It's great they give you options, do your research and then decide. I'm a maintenance tech with a high school degree, no way I'm qualified to decide my own treatment plan. My doc said this is what we are doing and I'm all in. As for chemo and working, I took the day of treatment off but otherwise worked a full week. It's not great but you can get by. I wish you the best on your decision and your journey. Best to all.

If your cancer is hormone sensitive, then ADT is an option that should be pursued and it sucks to suggest to do this long term, but the other option is ??? If the cancer is hormone resistant, there is a suite of other drugs to explore. Because you have been on this road for a while, whether or not to explore couplet/triplet therapy that includes chemotherapy is definitely a conversation to have with the medical team.

In terms of the "10 isn't many", my team talks to me in the same manner, they just won't talk beyond 10 years, so in that regard, feel good that you are part of this "maximum outlook"!

Your PSA levels are low, surprised the PSMA PET found a couple spots, unfortunate in that regard, but good to know where it is, because it is somewhere (remember, PSMA PET is 85%/90% capable of finding cancer, some variants of PCA don't work with PSMA).

My laymen thoughts, go with ADT, and check PSA every six weeks. If you can manage ADT and PSA remains less than 0.1, then you are good to go. Just keep biking, that is terrific to clock those miles per week!

If only in bones get Xofigio or Radium 223 prescribed

Option go on Xtandi for a year

LU177 trials then chemo

@natem, what did you decide? What helped you make the treatment decision?

You still have plenty of options and likely time with those.

Since the PSMA scan showed those two locations, ask your radiologist about SBRT to them. SBRT has been found in lab studies to elicit a strong immune response. It releases cancer antigens into the bloodstream that are detected by T-cells, which become activated to find more cancer. That T cell response to radiation is thought to contribute to its effectiveness (called "the abscopal effect").

Likely there is micro-metastatic PCa elsewhere, -micrometastasis is a small collection of cancer cells that has been shed from the original tumor and spread to another part of the body through the lymphovascular system. Micrometastases are too few in size and quantity to be picked up in a screening or diagnostic test, and therefore cannot be seen with imaging tests such as a mammogram, MRI, ultrasound, PET, or CT scans. These migrant cancer cells may group together to form a second tumor, which is so small that it can only be seen under a microscope. So systemic therapy may be what your medical oncologist suggests in coordination with your radiation oncologist. If so, question is what...?

The recent EMBARK trial showed promising results combining ADT with an ARI. For those who responded exceptionally well, there was a break from treatment.

There is also the the recently published EXTEND trial evaluated the utility of adding MDT to IADT. This phase II trial randomized patients with oligometastatic hormone-sensitive or resistant prostate cancer (0-5 lesions) to six months of hormonal therapy followed by intermittent hormonal therapy with or without MDT.

You can search for articles on those two trails, perhaps discuss them with your medical team.

As to taxane therapy, that is an option too. Because of the cyclic nature with an infusion every three weeks, fusion day to 24-48 hours later and the steroids they put in to avoid nausea (don't want to throw up) you feel great, then crash for a few days and then feel "better." So one week out of three typically you feel off. Yeah, you likely lose your hair.

Attached is my clinical history, fortunate that no bone or organ involvement but unfortunate in that RP, SRT, Triplet Therapy have all not achieved that elusive "cure." However, 10+ years, only three on treatment, the other seven, well, enjoyable! We'll see how long my current off treatment is after SBRT and 12months of Orgovyx.

Kevin

Waiting to meet with Medical Oncologist. I'll likely do at minimum having the spots radiated and take orgovyx for two years. I hope to be able to add treatment from the Medical Oncologist to the two other treatments. The 1st option of hormone treatment alone leaves live cancer sitting, possibly dormant until it becomes resistive. I suppose I would then be depending on how long the adt works, which probably varies from person to person unless there's a standard of time it works.
Thank you,
Nate

My PSMA SCAN INDICATED WIDESPREAD BONE metastasis. Prior to this scan I was on aberaterone & Xtandi. I am currently having chemo docetaxel every 3 weeks.I have had 2 treatments. Side effects not too bad. A little fatigue & mouth sores. I now keep ice in my mouth during treatment to prevent sores. Take anti nausea if needed.
If this treatment is not successful the next step will probably be Pluvicto. I will have PSMA scan after treatment 3. Good luck.

I would like to add that Aberaterone and Xtandiwere prescribed to lower my PSA. They are basically adt. Aberaterone kept PSA low for a while but not XTANDI. My oncologist ordered PSMA WHEN PSA stayed high, around 75.I had no reason to suspect wide spread bone Metastasis as there was no pain. I suggest you may want your oncologist to order PSMA sooner rather than later. Frankly, I was shocked. Scary.