Stage 4 prostate cancer in my bones

Normally, they will do radiation or chemo if there are too many metastasis or they are in dangerous places that could be affected by the radiation.

Keytruda is sort of new being used for prostate cancer. As you were finding, it isn’t working well.

What have your doctors recommended?

Have you had a PSMA pet scan? As long as your PSA is above .7 a PET scan can find out where the cancer is in your body and make a decision as to what further treatment is needed. Can they just use radiation to treat the prostate and any metastasis or do they need to use chemo because there’s too many?

I had prostate cancer six years ago and it was radiated internally and externally
My PSA went up a year and a half ago. I had a PET scan and it showed five different locations my sternum two runner and a rib and somewhere around my tailbone
I recently had CT scan, which showed some increase in the cancer
Thanks for your input

I'm sorry to hear that your cancer has become castrate-resistant, and Keytruda isn't helping. I notice that Keutruda's makers don't list prostate cancer on their web page; are you getting it as part of a research trial? If so, then extra thanks for your participation.
https://www.keytruda.com/how-does-keytruda-work/
With 5 metastases detectable, you're right on the borderline: from my reading, some oncologists will still consider that "oligometastatic" and radiate each metastasis separately (assuming they're far enough apart), while others will consider it "polymetastatic" (high burden) and use a system-wide therapy like chemo or Pluvicto.

I hope the next step goes well for you.

Thanks

@northoftheborder
Reports say Keytruda not effective for PC
Spot radiation after PSMA PET or get approved for Pluvicto which I am getting second injection Nov 19 after Enz, Abiraterone, Chemo 4 sessions Radium 223 over 8 years since radiated out

I don't know who you have for caretakers and it doesn't matter, but have you had at least one second opinion? Your doctors shouldn't be insulted by you doing what you can to do to save your life. Try to visit a center of excellence somewhere in the country. I got two, one from Mayo and the other MD Anderson. My doctors were pleased I did.
Never quit!
Dave

Thanks Dave

I assume that you have the mutations for which Keytruda has been shown to be potentially effective. Before using Keytruda for PCa treatment, patients are supposed to be tested for germline and somatic mutation profiles. Keytruda has only been demonstrated to be effective for PCa with a specific set of MMR related mutations.

My recommendation would be to connect with a person who has had success with Keytruda, if only to understand their experience. For example, the amount of time before there was any PSA reduction and any other associated therapies they were undergoing at the same time. One of the PCa patients that had a successful outcome with Keytruda and speaks publicly is John W. White III - you can contact him via the PCF - Metastatic Prostate Cancer Support Group (FB?).

There are also online forums for PCa patients who are presently undergoing or have completed other immunotherapies and Pluvicto.

My situation was and is similar to yours. Had brachytherapy, and external beam Radiation little over seven years ago. My PSA started to rise several years ago in very small increments. Had psma pet scan twice . Almost 12 months apart. Showed PC had metastasized to the sternum in the first one and the second one a year later when my PSA was 2.8. The sternum , thoracic region t7, and 2 lymph nodes. To make a long story short, I had a biopsy done in the first one on the sternum showed negative for prostate cancer. On the second one we didn’t do any biopsies. The second PSMA pet scan and two CT scans, I had completed for other reasons confirmed the sternum lesion was stable and there were no more lesions attribute to growth confirming a negative biopsy.Assumption was this has been a reoccurrence, and I just completed SBRT on 4 spots. Of which I feel only two to be possibly cancerous. on the second PSA pet scan the pathologist didn’t list SUV numbers, but did say there mild uptake in the T7 and one of the lymph nodes. The other one just said there was uptake. If your using an F 18 tracer, it has a significantly higher false positive in the bones then the 68 tracer. Also,for prostate cancer to metastasize to the sternum is very very rare.so if it was me. I would do a biopsy to confirm especially in the bones. Since you’ve already had prostate cancer, and a few of these spots are shown up on a PSA pet scan your physician is going to assume recurrent anyway so do your homework as many questions and best of luck and may God bless you in your journey.