1. < Prostate Cancer

Numbers After SRT/ADT

Posted by heavyphil @heavyphil, Apr 24 12:55am

I just received my post treatment results after SRT with 6 months of Orgovyx.

PSA < 0.05. Had been 0.18
before treatment.
T = 688. Was 610 before ADT

The 25 sessions of IGRT ended on 12/09/24 and ADT ended 2/07/25.
I am shocked at the recovery of T since it was only a whopping 3 after one month of Orgovyx. From all I read and from comments of others who had taken it, I thought it would only be about half this number.
While I am glad of its recovery, I must admit a bit of trepidation at its strong presence; I’m hoping it will not fuel any dying embers and get the ball rolling once again. As usual I have difficulty taking the “W” and going home…
Meeting with PA in 2 weeks to discuss the results. Best,
Phil

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brianjarvis | @brianjarvis | May 4 7:01pm
In reply to @heavyphil "See Chip, this is where I get very confused. My rational brain tells me that if..." + (show)
@heavyphil

See Chip, this is where I get very confused. My rational brain tells me that if my PSA goes up after the SRT/ADT I just completed, the PSA must be coming from somewhere OUTSIDE the treated area - ie, prostate bed and pelvic nodes….but WHERE??
According to Jeff, recent comments by leaders in the RO field say you might not be able to see a lesion less that 5 mm with PSMA PET scan - do you know how freakin BIG that is??
So what if your PSA hits 2.0 and your PSMA shows nada….wait til 3 or 4? After having G9?? I don’t know, I have no answers but Dr Scholtz seems to think this is the way to go as well, so your RO may be following his lead. But this approach scares me, to be honest. Sounds like the PSA version of Russian Roulette.
If my PSA starts going up after all this treatment I might say screw it, take out another mortgage and spend the $100K on Provenge…it won’t bring the PSA down but it might be better than playing whack a mole for the rest of my life.
I hope neither one of us has to find out!! Best,
Phil

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If your “PSA hits 2.0 and your PSMA shows nada…” then request a non-PSMA PET scan like Axumin (aka, F18-Fluciclovine PET/CT).

Under normal circumstances, a PSMA PET scan far surpasses the older non-PSMA PET scans. However, in those situations where a PSMA PET scan doesn’t show anything, yet you know something is wrong due to a rising PSA, then is the time to fall back to one of the older scans.

Axumin (FDA-approved in 2016) doesn’t rely on PSMA. Axumin works by exploiting the fact that prostate cancers absorb amino acids at a much more rapid pace than normal cells. Axumin is made up of a radioactive tracer linked to an amino acid. Cancer cells absorb the amino acids more avidly than normal cells, so when Axumin is used, the radioactive tracer concentrates inside the tumor cells. When the patient is imaged, the areas that have a high concentration of the imaging agent signal the location of the cancer in the patient’s body.

(In these circumstances, the Mayo Clinic falls back to the even older C11 Choline PET CT that was FDA-approved in 2012.)

Good luck.

REPLY
jeff Marchi | @jeffmarc | May 4 7:09pm
In reply to @chippydoo "I thought current psma scan ability was 2.7mm. Yeah I know how big that is. At..." + (show)
@chippydoo

I thought current psma scan ability was 2.7mm. Yeah I know how big that is. At this point I am operating on they got it until I know different. He was clear on waiting until 2 as I specifically questioned him on that if I have another occurrence. My thought is they can find it rather than guessing where it is if I hit 2. I do have a bad margin slide in my bed that 2 out of 3 doctors can see which got radiated this winter. My surgeon can't seem to see it lol. I'm just another bozo on the PC bus trying to live my best life.

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At the UCSF conference last Saturday radiation specialist was saying that they really can’t see Metastasis if it’s less than 5 mm. At PCRI they said 2.7 mm.

I’ve read in other places that there is actually a range and that there are issues up to 5 mm

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jkoop | @jkoop | May 17 6:51pm

So I’d like to hear your thoughts I my next steps. Went for a second opinion at UCLA. Was told to get a MRI with/without dye. Get another PSMA -PET scan. If those don’t show any spots. Get salvage radiation, the 5 day one they offer plus ADT and Enzalutimied for 6 months, sounds better than 6 weeks treatment. My PSA as of April 4 was .45. Prior PSMA did not show anything other than 3rd and 4th rib, those were hit with SBRT with no change in uptake, probably a false positive. I’m sure hoping that something shows on these scans. Other radio oncologist did not offer MRI or the 5 day treatment.

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jkoop | @jkoop | May 17 7:38pm

I take that as you approve of my treatment plan? LOL

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jeff Marchi | @jeffmarc | May 17 8:34pm

Those recommendations sound pretty good to me. They give a lot of options to find metastasis, which they can zap.

5 day salvage radiation, sounds like a gift. Definitely something new. Ask more about comparison with IMRT or equivalent with 30 treatments. Safety, coverage.

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1 reply
heavyphil | @heavyphil | May 18 7:27am
In reply to @jeffmarc "Those recommendations sound pretty good to me. They give a lot of options to find metastasis,..." + (show)
@jeffmarc

Those recommendations sound pretty good to me. They give a lot of options to find metastasis, which they can zap.

5 day salvage radiation, sounds like a gift. Definitely something new. Ask more about comparison with IMRT or equivalent with 30 treatments. Safety, coverage.

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I’ve never heard of salvage radiation done in 5 days - thats the equivalent of FIVE standard IMRTs in every visit. How is this possible ?
My 25 treatments - down from 39 - is the newest protocol offered at Sloan Kettering. Six month SE’s show no significant difference between those getting 39 or 25 treatments but I think a 5 treatment protocol sure would…
Phil

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1 reply
jkoop | @jkoop | May 19 5:26pm
In reply to @heavyphil "I’ve never heard of salvage radiation done in 5 days - thats the equivalent of FIVE..." + (show)
@heavyphil

I’ve never heard of salvage radiation done in 5 days - thats the equivalent of FIVE standard IMRTs in every visit. How is this possible ?
My 25 treatments - down from 39 - is the newest protocol offered at Sloan Kettering. Six month SE’s show no significant difference between those getting 39 or 25 treatments but I think a 5 treatment protocol sure would…
Phil

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This is a trial that has been going on for several years. You can look it up http://www.uclahealth.org. Sounds promising to me especially with no extra side effects.

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1 reply
heavyphil | @heavyphil | May 19 9:04pm
In reply to @jkoop "This is a trial that has been going on for several years. You can look it..." + (show)
@jkoop

This is a trial that has been going on for several years. You can look it up http://www.uclahealth.org. Sounds promising to me especially with no extra side effects.

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Thanks for the website! It seems that it is SBRT post -prostatectomy. They talk about delivering high dose radiation to ‘tumors’.
All well and good if you have one on a scan. This is what Dr Scholtz is talking about in the YouTube video. But again I come back to the question: what if there is no discrete tumor? Just rising PSA? Where do you aim these very high dose beams and not cause severe damage? Your scans did not show any activity (other than the ribs).
They can’t be using a gel spacer - no place to put it….
Well, we’ll have to see what the study shows, I guess. Are you enrolled in this one?
Phil

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