SBRT left common iliac node

briang1958, even without experience I feel compelled to say-- go with Mayo. Kill it.

I had SBRT radiation to my spine last October. I had one metastasis, on L4, zapped. They did mine in three days because they didn’t want to put as much radiation on the L4 all at once since it was already a little weakened. After 15 years I have been undetectable for 14 months, since a month after that. I am on Darolutamide. Haven’t seen this much time undetectable since 2019.

I was on ADT for eight years. I just stopped it about six months ago, My oncologist agreed since I have been on it so long it’s unlikely my testosterone will come back. For me, ADT was not life-changing, I don’t have fatigue so I can do quite a bit.

My brother Had radiation on his prostate, five sessions of SBRT.

Don’t worry about Having SBRT radiation, It is widely used and is extremely common for what you are doing?

@briang1958 there are different types of radiation machines. You might want to consider one that has a built in MRI vs fused images as the amount of impacted healthy tissue is less than one that does not have a built in Mri that uses fused images. Two machines have built in MRI, the Mridian and the Elekta.

I'd agree with @gently! One shot? if it were me, I'd give it a go. I was on ADT for two years. No Bueno, but, we do what we have to do!

I'd say @briang1958 makes a good point as well.

Previous 18 months of ADT really sucked - I was only 55. They tell me at 66 I have less testosterone and maybe it won't be so bad.

I do appreciate the input - this is what he is recommending, would you suggest I look for a 3rd opinion?

@briang1958 I am a big believer in multiple opinions from centers of excellence, like a Mayo. My prostate cancer was contained to my prostate and so I still have my prostate, so yours is a different scenario but it can't hurt to print out the article from the attached link and talk to your doctor about margins and exposure of healthy tissue. The article talks about the randomized trial comparing built in mri radiation machines vs non-built in radiation machines and toxicity/side effects.:
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

You could have a somatic test on your tissue or blood to see if you’ve got any genetic issues that could be treated by current drugs.

At your stage, your best bet is to get your Lymph node zapped and then get on drugs That can prevent your cancer from coming back. Yes, you Probably need ADT followed by a second level drug like Zytiga or one of the lutamides.

With only one metastasis, you aren’t really a candidate for Pluvicto yet.

Chemotherapy is the other option, But you shouldn’t do that until you find out whether or not the drugs that you can take now keep your PSA down and stop your cancer from growing.

I was in your situation seven years ago, ADT and a second ARSI drug Can give you a lot more time,

Well, SBRT to the lymph node identified in the imaging is an option.

The medical community is mixed about that, some say it is palliative while others say it may be "curative."

I'm in the former camp. Imaging can only see so much, micro-metastatic PCa may be present.

The simplest option is to treat with SBRT, then actively monitor. You could also opt to add short term ADT, say six months, then monitor. If so, Orgovyx could be a good choice give. Its advantages over others such as Lupron.

I am not sure given the clinical data you present that additional treatment such as an ARI, chemotherapy or WPLN is necessary.

If you decide to do SBRT only to the lymph node, you are not wrong in that decision. It may very well delay a need for systemic therapy...

Neither would you be wrong in adding short term ADT.

You could review the NCCN guidelines but I think more revenant data to support your decision may be I recent clinical trials, a Google search should bring them up.

Clinical trials investigating the use of Stereotactic Body Radiotherapy (SBRT) for single lymph nodes in prostate cancer are primarily focused on evaluating its effectiveness in treating isolated lymph node metastases, often referred to as "oligometastatic" prostate cancer, where only a limited number of lymph nodes are involved; with the goal of delaying or avoiding the need for systemic therapies like androgen deprivation therapy (ADT) while achieving good local control.

Key points about these trials:
Treatment approach:

Researchers are exploring the use of SBRT to deliver high doses of radiation to the single positive lymph node, aiming to destroy the cancer cells while minimizing damage to surrounding tissues.

Patient selection:
Trials typically focus on patients with a single positive lymph node identified through imaging techniques like PSMA PET scans, following a radical prostatectomy.

Primary endpoints:
The primary endpoints in these trials often include biochemical recurrence-free survival (bRFS), overall survival, and assessment of treatment related side effects.

Examples of clinical trials investigating SBRT for single lymph node prostate cancer:

PACE-NODES trial:
This trial is studying the efficacy of SBRT delivered to both the prostate and pelvic lymph nodes in high-risk prostate cancer patients, comparing it to SBRT directed only at the prostate to see if adding lymph node treatment improves recurrence rates.

Studies on "oligometastatic" prostate cancer:

Many clinical trials are investigating SBRT for oligometastatic prostate cancer, where only a few metastatic sites (including single lymph nodes) are present, aiming to assess its efficacy in delaying or avoiding systemic therapy.

Attached is my clinical history. I chose to add 12 months of Orgovyx, but, mine is high risk, ergo, I take a more aggressive approach.

Kevin

I'm scheduled for SBRT at Mayo Clinic - we are still discussing short term ADT.
I appreciate all the feedback, input and support.
I'll report back!