Next step after PSMApet shows one metastatic cite

I would think a short ( 6 mos) round of ADT followed by a short ( 5-10 sessions) round of radiation..nip it in the bud...it is active...why not eradicate it immediately..save you some worry- you could be finished with everything by late September..

What is frequently done is they will zap the metastasis with SBRT radiation. Usually only takes one or two visits. I had a metastasis wrapped around the L4 in my spine And they decided to do it in three sessions so they didn’t have to use as much radiation each time.

You want to see a radiation oncologist about what could be done to zap it. In some cases the growth is in a spot that could injure tissue that they don’t want to affect, So they won’t do radiation in that situation. At this point a urologist is not the only person you should be seeing. It’s possible they could zap it then you would not need to go on ADT as long as your PSA went back down.

Contact the radiation oncologist that did your initial treatments, They are the experts in this kind of treatment.

Going on ADT for six months to a year may be sufficient. The problem is it could come back right after you stop the ADT If you don’t trade it.

As above posters have said, referral to radiation oncologist is in order. They may or may not be able to zap it in its tracks, but it definitely should be evaluated by RO. Best wishes.

@xahnegrey40
Thanks. My initial RO is reviewing it and is located a good distance away. I was given an appointment with an RO who is closer and will see what options are given.

@jeffmarc Thanks. Sent scan info to original RO and also have appointment more locally with another RO

@edward72 good luck...I hope it is resolved quickly with little stress for you !

@edward72 I agree - zap it now if you can…but hold off on ADT to see if your PSA drops after treatment.
That’s the only way you’ll know if the PSA was only from that suspected lesion.
The change (or not) will then dictate next steps and you may 🤞wind up needing no ADT at all. Just my two cents…
Phil

You don't want to be on ADT forever. Use radiation to kill it off.

It seems the consensus is to either use MDT which can push back the need for systemic therapy or...use short term systemic therapy in combination with MDT.

What is "short term...?" That can be anywhere from 6-36 months though six seems a reasonable choice in this case.

If you and your medical team choose the MDT + systemic therapy then you'll need to decide which drug, Lupron, Orgovyx...the latter has advantages over the former:
No flare
Faster castration
Higher sustained castration while on it
Faster T recovery when stopping
Lower CV side effect profile

Same side effects though, hot flashes, fatigue, muscle and joint stiffness, genitalia shrinkage...

There is some literature that says those SEs may be "less severe..."

Having done both I'm going to say I don't notice a difference.

There is a third option,, do nothing...this presentation, length, discusses an intriguing point...with advances in imaging, are we treating sooner just because we can see earlier? Does it change the eventual outcome, OS or just PFS and RPFS while subjecting us to the toxicities of treatment.

That answer may lie in one's clinical data, high risk, intermediate, low, age and life expectancy ...? I'm pretty high risk so I treat sooner rather than later. Still, over time I've seen people and their medical teams wait to treat until PSA hit 2, 8, 10...

I can see the logic in the discussion being a 12 year member of this club and back in the day, a CT was useless under a PSA of 20 or so, thus treatment was based mainly on PSA.
https://ancan.us14.list-manage.com/track/click
Still, doing nothing is hard to do in the face of clinical data that says something is going on.

When my PCa came back after a five year vacation from triplet therapy, there was a single lymph node identified in a PSMA scan.

MDT was an option but given my clinical history, high risk, I knew there was micro metastatic disease too small to be seen so opted to include 12 months systemic therapy, Orgovyx.

I am two years out from completing that, PSA stable at .03, next labs in July.

Would the outcome have been different if I had done MDT, or as my oncologist wanted, 24 months + an ARI...well never know, we made a decision, no take backs as they say!

My point is you have multiple choices, any of which is likely a good decision

Kevin

Thanks . I had seen the video you cited on the long game. I now know my urologist wants me to use Orgovxx if any ADT is chosen. I think this will come down to what RO says about further radiation possibility and collateral damage if any. If denied targeted radiation I plan to seek second opinion from Anderson or Mayo. One respondent says if I do radiation with the ADT and PSA goes down I will not know if it got zapped because of radiation. I agree that may be a way to tell if radiation worked but if I did both and it never came back that would also seem to indicate radiation worked as ADT is temporary relief.