Prostate cancer of the right common iliac medial artery lymph nodes

Hi, I have also a recurrence in the right common illiac lymph node after RP in 2019.
My doctor says this is oligometastasis, beyond local recurrence but not distant mets.
How are they proposing to treat you? They are suggesting to me I might benefit from surgery, removal of the lymph nodes and this may delay the start of radiotherapy and hormone treatment, although I'm not convinced this is the best option.
I would appreciate hearing what your team are suggesting for you.
Best regards

Thanks for replying,
I was diagnosed with stage 3 prostate cancer back in late 2017. PSA 30 and Gleason scores of 7s, 8s and one 9. My treatment was hormone, RT, and high dose Brachytherapy.

The reoccurrance was detected 2 months ago via PSA. My doubling time was 1.6 months. 7 months ago nothing then bang here I am. They did a PSMA/Pet and found two of the Iliac common artery nodes had an SUV of 80 and 88.

So my urologist started me on hormone treatment 2 weeks ago, and I am scheduled scheduled with my radiation oncologist to go in for my RT simulation Thursday.

Only thing that might get in the way of the RT treatment is what was the amount and exact location the the previous RT I received. He was waiting the the data to be sent to him from my previous oncologist. Hopefully I didn't get to many rads before.

I would be cautious of the surgery recommendation. My medical team, urologist, oncologist and radiologist have not recommended it either time I've had reoccurrence in the PLNs based on imaging.

The first time my radiologist treated the entire PLN system, 25 IMRT, 45 Gya. The 2nd time she is using SBRT, five treatments.

With the first reoccurrence we added taxotere and ADT, Lupron. This time we're adding Orgovyx and Zytiga to deal with micro metastatic disease, too small to be seen by imaging.

Here's a link to an article about PLN radiation treatment - https://www.prostatecancer.news/2021/05/new-guidelines-for-salvage-radiation.html

Kevin

Hi Kevin,
Thanks so much for your reply, your answer to my dilemma has been very helpful, I will not go ahead with the surgery as there are to many unknowns.
I have the possibility to enter into a clinical trial (Primordium) RT with ADT and apalutamide.
It is has the benefits of being in a very good private hospital ,close monitoring,all following pet/psma scans also included (my insurance doesn't have the required cover) I may get the trial drug or maybe not, 66/34 possibility in favour, even if I don't get the additional drug I will get RT,ADT in a top private hospital. They suggested 20 sessions 53-60 gy for pet positive node and prostate bed, and 20 sessions to pelvis 48 gy.
with 6 months decapeptyl preceded by 10-14 days casodex.
The alternative is to have the treatment on the social welfare.
They recommend
RT pelvis 50gy at 2.00gy/fr
+SIB prostate bed 62.5 gy at 2.5 Gy/fr sequentially SBRT on the infected pet+ node at 33 gy in 3 fractions.
6 months eligard but with no additional meds to stop testosterone flare.
I Will have to make a choice soon
Again thanks for your input,I realise everyone's journey is different but it's very insightful to see how the medical recommendations and treatments in different countries compare to my own.
Stay well
Best regards Andrew

Andrew. I am on this Jansen clinical trial with ADT & Apalutimide ( Erleada ) 6 months meds, then RP, then 6 months meds. It was manageable for me and I got good results. The Erleada has a side effect of increase blood pressure which is not a side effect of the ADT and I was delighted to get this side effect as it indicated that I got the Erleada. As I recall, men in this trial who got the Erleada averaged 41 months before the cancer progressed while men who got just ADT averaged 17 months. I am glad that I took my surgeon’s urging and accepted the clinical trial. Good Luck to all.