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Next steps for metastatic low volume
Prostate Cancer | Last Active: Sep 5, 2025 | Replies (10)Comment receiving replies
OP back again. Thanks for the comments. I asked about irradiating the bones at the same time and he said that would be strereotactic and later if necessary. If I recall correctly he said that this was consistent with NCCN guidance based on the STAMPEDE trial in Europe. But we didn't get into what would determine necessary.
Sorry I didn't mention the genetic testing but that has been done given the cancer in the family (sister also ovarian at age 58). Nothing there really other than I would be a good candidate for PARP inhibitors later if needed.
Thanks all for your comments. Keep them coming!
Replies to "OP back again. Thanks for the comments. I asked about irradiating the bones at the same..."
Yes, that sequencing of IMRT and then SBRT - if necessary - is accurate. They are looking to see if your PSA remains low over time. How much time I cannot answer.
However, if your PSA begins to rise within a few months of IMRT, then it’s pretty much a sure bet that those bone lesions were metastases.
I forgot the statistical details of the STAMPEDE trial, but my guess would be that the less radiation the better.
Phil
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The PARP Inhibitor is mainly usable if someone has BRCA. If they didn’t find that then telling you that the PARP inhibitor would help is questionable.. I know a couple of people that have tried it, that did not have BRCA, And it did not help at all. It was designed to help people with BRCA, though it has been found to help a little if you have Homologous Recombination Deficiency (HRD).
Now it is possible somebody’s hereditary DNA doesn’t have BRCA, But a somatic test could show that it is found as a result of the cancer. In those cases, the PARP inhibitor will work. The problem is that the BRCA in somatic tissue can also go away, Making the PARP ineffective in that situation.