Bone Metastasis: What treatment did you have?

Posted by florida11 @florida11, Mar 18 3:14pm

My last PET scan showed a "sclerotic lesion on my right acetabulum" measuring 1.5 x 1.5 cm (PSA was 0.18 and testosterone 37 at the time of the scan; I was coming off ADT from last year), which was an increase from my prior scan a few months earlier. Planning on 4 months of ADT and 1-day radiation treatment at Mayo. This is my 3rd reoccurrence (Gleason 4+3=7, surgery 12/17, radiation to prostate bed in 2018, radiation to lymph node area near abdomen in 2023). I had no pain until after receiving the PET scan results, then felt mild hip pain on the plane home in February and ever since.

I would welcome and appreciate if anyone has experience with hip bone treatment/radiation they can share (i.e., any noticeable pain, treatment, outcome, etc.)?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

northoftheborder | @northoftheborder | Mar 18 5:30pm

Sounds like a good plan.

I'm happy I had my spinal lesion radiated after debulking surgery. Some oncologists think that the primary cancer and big metastases provide support to help new, smaller metastases to develop, so treating them aggressively might help slow progression more generally (in his book, Dr Walsh calls that apprach "attacking the mother ship").

gently | @gently | Mar 18 9:05pm

Northoftheborder, did they advise zoledronate or Prolia.

northoftheborder | @northoftheborder | Mar 18 9:23pm

In reply to @gently "Northoftheborder, did they advise zoledronate or Prolia." + (show)

"Northoftheborder, did they advise zoledronate or Prolia."

Neither. A full-body bone scan* showed no other metastases, and things happened very fast for me: I was admitted to hospital on Monday with trouble balancing, was given a likely cancer diagnosis (unknown type) after an MRI on Wednesday, got a biopsy on Thursday, lost use of my legs on Friday from spinal-cord compression, and was on the operating table in the wee hours of Saturday morning for 10+ hours of emergency spinal debulking surgery to try to save me from permanent paraplegia (it succeeded, but it took a long time to get my legs back). I got post-op radiation to the surgery site 4 weeks later, and radiation to my prostate a few months after that. Otherwise, just ADT + Erleada (Apalutamide) have been managing my cancer.

No indications of other bone metastases since. I've lost a little bone density (not sure if it was before or after I started on ADT, because I didn't have a baseline), but nothing serious — regular weight training and calcium supplements help.

(* Note that a PSMA PET scan wasn't an option in Canada in 2021, because the maker of the imaging agent hadn't gotten final Health Canada approval yet; they always come to smaller markets like us a couple of years after the big markets like the U.S. and EU.)

gently | @gently | Mar 19 7:46am

Fascinating. Was the compression prostate spinal cord compression. And you were diagnosed with the cancer, had the biopsy and the loss of leg use and debulking surgery all in four days. Must have been insane. And it seems you have amazing doctors.
The US didn't get pylarify until May 2021. PSMA-11 was approved in 2020.
Do you dxa for bone loss yearly or at all.

zzotte | @zzotte | Apr 30 4:37pm

Hello everyone, I’m currently going through the diagnostics process and today I was told by my Doctor that my Pet Scan shows that my prostate cancer has spread to the bone and two lymph nodes, now I’m waiting for Oncologist appointment, without getting ahead of my self what procedure it’s the norm for cases like this PSA 7.5 and Gleason 9

Thanks
Zzotte

ezupcic | @ezupcic | Apr 30 5:19pm

In reply to @zzotte "Hello everyone, I’m currently going through the diagnostics process and today I was told by my..." + (show)

Your PSA number seems relatively low considering the Gleason 9 result. I wonder if that would impact treatment options. Did the doctor explain anything? Hope for the best.

northoftheborder | @northoftheborder | Apr 30 5:28pm

In reply to @zzotte "Hello everyone, I’m currently going through the diagnostics process and today I was told by my..." + (show)

There are a lot of variables, so we can just share some ideas and experiences.

If there are just a couple of bone metastases in addition to the lymph nodes, then your cancer is oligometastatic. If there are lots of bone metastases, then it's polymetastatic.

If your cancer response to hormone treatment (PSA goes down after a few months), then it's castrate-sensitive. If not, then it's castrate-resistant. Castrate-sensitive cancer often evolves into castrate-resistant after a few months or years, but new drugs can sometimes delay that process for much longer.

For polymetastatic cancer, treatment will often involve chemotherapy and/or Pluvicto (radiation administered internally). For oligometastatic cancer, they will often radiate each of the metastases, and maybe your prostate as well.

For hormone therapy, in addition to the traditional androgen-deprivation therapy (ADT), you will likely be put on ARSI like one of the -lutamides.

Personally, I've have oligometastatic, castrate-sensitive prostate cancer since 2021, and treatment has prevented any progression since then.

Best of luck.

zzotte | @zzotte | Apr 30 5:58pm

In reply to @ezupcic "Your PSA number seems relatively low considering the Gleason 9 result. I wonder if that would..." + (show)

No not really, he just said he is scheduling me with the Oncologist for best option for treatment

zzotte | @zzotte | Apr 30 6:04pm

In reply to @northoftheborder "There are a lot of variables, so we can just share some ideas and experiences. If..." + (show)

Thank you, I'm sure will know more about it when I see the oncologist, thank you so much for the information

Zzotte

jeff Marchi | @jeffmarc | Apr 30 9:01pm

In reply to @zzotte "Hello everyone, I’m currently going through the diagnostics process and today I was told by my..." + (show)

If you don’t have more than five metastasis, then you can have them zapped with SBRT and maybe at the same time zap your prostate. Question is what did the biopsy show? Was there any cribriform found? Other major issues in the biopsy?

If you have more than 5 metastases then they frequently do triple therapy ADT plus an ARSI (Zytiga or a lutamide) and chemotherapy.

They could do Pluvicto instead of chemo, not the standard but it is approved.