Next step after PSMApet shows one metastatic cite

Posted by edward72 @edward72, 8 hours ago

76 year old man treated 22 years ago with radiation by seed implants and 7 weeks of EBRT. Undetectable and very low level PSA for years. Gleason was 3+4 and tc1 . PSA rose from 1.7 to 2.7 in last 18 months. Scan was done and no bone or organ cited as spread. What was detected is nodule in soft tissue between rectum and pelvis that is 1.7 cm and had SUV of 4.5. Urologist suggesting ADT or surveilance. Seen podcasts suggesting delay of ADT and another suggesting targeted additional radiation. Any thoughts ?

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xahnegrey40 | @xahnegrey40 | 7 hours ago

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..

Jeff Marchi | @jeffmarc | 6 hours ago

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.