IMRT do or not do on undetectable PSA

I'm sorry — it must be discouraging to hear that.

For metastatic prostate cancer, as I understand, the current research supports what your medical team told you: prostate-directed radiation therapy (PDRT) and metastasis-directed therapy (MDT) show benefits only if there are a~5 or fewer metastases (aka "oligometastatic"), but not if there are many metastases (aka "polymetastatic" or "high burden").

In the latter case, as they mentioned, systemic approaches like chemotherapy and Pluvicto are more effective, on top of ADT and an ARSI.

p.s. Layperson writing; keep talking with your medical team, because prostate-cancer treatment is evolving fast these days.

@northoftheborder

Yeah, dude, after your words / true, I definitely want to pick up a gun and just shoot myself. There's no chance anyway. Eat grass like a goat or not, lift weights, or run like crazy, it's all for nothing. For us, with the tall Gleason, all we can do is $hit bricks!

I won the race against millions of little tailed sperm heads, but life hit me in the face with a huge brick! "Mom, please, rollback my birth back! I dont won't any race anymore!" Only now have I begun to understand that this is the end for me!

They detected the cancer too late; only those guys who don't have metastases survive...

So sorry for your situation and totally understand the hopelessness you feel.
But the ADT/Erledea is keeping in under control for now so that’s good.
Your ATM mutation is similar to BRCA so PARP inhibitors will help in the future.
In the meantime, a search of clinical trials might be something you want to explore - you never know what’s out there, right? Best,
Phil

Somebody with your condition almost always gets triplet therapy. ADT, ARPI and chemotherapy. Because you have multiple metastasis in different places, that is the only thing that is successful in giving a long-term overall survival. You would definitely be given the same treatment in the United States.

I do know one guy that had SBRT to zap all of his metastasis and he had 15 of them so they had to do it in multiple sessions. This is very unusual they would normally not do this for people. Long-term survival would be questionable because of the possibility of micro metastasis other places.

@denis76 I don't want to minimise what we're facing, but even metastatic prostate cancer is often manageable now. It either is already or is on the verge of becoming a chronic disease that you live with, like Parkinson's or HIV (they can't know for sure until they're looking back at 2026 from 5–10 years in the future).

This article is two years old, and there's been even more progress since then:
https://www.scientificamerican.com/article/treating-prostate-cancer-at-any-stage/

@heavyphil ghjjgfc

The short answer is no, IMRT or surgery will not help you. People do not die from prostate cancer that is contained within the prostate, but prostate cancer that has escaped from the prostate and is growing elsewhere in the body. Once it has escaped it is also spread by the metastasis creating further metastasis. I have the ATM defect and would probably be in the same boat with you if my cancer started before my annual PSA tests (50+). Prostate cancer that is contained rarely produces symptoms. Without PSA tests it is usually detected through metastasis to bone which creates pain. If all 6 of your metastases were to bone you probably could have found someone to zap all 6 with SBRT. The lymphatic system is interconnected so the 3 node metastases found are probably just the type of the iceberg. That is why you were immediately put on systemic therapy including chemo. Surgery would not be dangerous as in life threatening; however, it could leave you incontinent and would do nothing to improve survival. It is the same with IMRT. It will not improve survival, but you could have painful side effects from the treatment. My PET scan came back negative, so I did get IMRT treatment with ADT. I hope it was caught while it was still contained, but you never can tell with this disease. I hope the drugs keep your disease suppressed for a long time.
The AMT defect doubles the probability of prostate (male) and breast (female) cancer to a little over 25% for each. It also triples the probability of pancreatic cancer to about 4%.

@heavyphil
That’s easy for you to say!!!

@denis76
@denis76
Awweee Denis 💗 : ((( , I know, it sucks big time and no matter what stage. I do not even have cancer (my husband has it) and just the other day I told my friend that I wish I was never born, it pains me soooo much to know that my husband has to deal with PC and I am emotionally in the worse state than he is.

But than I tell myself that newer and newer drugs and methods are becoming available and they come out of research pipelines faster and faster ! It is only matter of time until they find true cure and in the meantime we have so many different ways to control cancer until that cure happens.

I would not call your treatment palliative - I think that it is very active treatment and will keep your cancer under control for many, many years and with immunotherapy trials already happening and the use of the AI there is no way that they will not have big breakthroughs in the next couple of years.

Just yesterday I read that AI helped with discovery of possibility for utilization of some old asthma medication in treating aggressive breast cancer ! I also know for a fact that AI is used as we speak here in the Bay Area for development of new drugs for PC !

Here - listen to this also :