Results From Mayo

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compiler
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Date Joined Nov 2009
Total Posts : 7184
   Posted 10/7/2016 12:43 PM (GMT -7)   
Well, got results this morning:

Overall, VERY good news, in my opinion.

It is in two spots: that original lymph node, about twice the uptake as 2 years ago, but still considered a small amount. It is also in one femoral chain node, but actually a VERY slight uptake. In other words, extremely small amount.

Probably none of this would show up in a regular scan yet.

Dr Kwon is pushing surgery or radiation to remove all the lymph nodes. This is what I rejected 2 years ago (SE).

I will be consulting with Dr. Lam in one week.

Then look and see if SBRT is still a possibility.

Also, I wonder if chemo at this point is advisable. I'm thinking not. It seems the study cohort were those with mets and I think they were distant mets, but not sure. Tall -- I read the document you linked to and it seemed the big success was in those with large mets.

I also know that you are much less enthusiastic about SBRT, but it might be worth a shot.

Anyway: in 1 week, I have a consultation with Dr. Lam. I then intend to consult with Dr. King (who does SBRT).

Any comments/suggestions on how to proceed would be welcomed.

DID I SAY I HATE THIS STUFF!

Mel

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2537
   Posted 10/7/2016 1:21 PM (GMT -7)   
I'm not smart enough to comment. But I can say I'm happy you know where the enemy is and that you've got several tools to fight it. Good luck with the appointments next week...
Age 55, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
6/16: T = 162, PSA = 0.20

Time101
Regular Member


Date Joined Dec 2012
Total Posts : 184
   Posted 10/7/2016 1:38 PM (GMT -7)   
Hi Mel,

Actually that is good news....you know where the second one is. Where is the first one? Btw, can you add your profile again. Are you to see Dr. Lam in person or a phone consult?

I'm sure all you guys will make the right decision and you may now get a cure for sure!!

I am getting anxious about my PSA and may follow you at some point if it doesn't go back down.

Will look forward to hearing what you decide.

Robert
Current age: 70
1/28/13 PSA 5.3
Dx'd 2/27/13, 2 of 12 pos. GS6 (3+3) <1.0% and
GS7(4+3) 10% 5.5mm, DRE neg., 39cc,
2/13 - 12 months Lupron
6/13 IMRT 41 treatments 77gy
10/13 PSA 0.02
12/13 thru 6/14 PSA <.015
6/6/14 Metformin
9/14 PSA 0.085 (Lupron effects)
12/14 PSA 0.2
2/15 PSA 0.20
5/15 PSA 0.23
8/15 PSA 0.249
11/15 PSA 0.27
2/16 PSA 0.31
5/16 PSA 0.29
9/16 PSA 0.50

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7184
   Posted 10/7/2016 1:56 PM (GMT -7)   
Robert:

The first one is a abdominal external iliac node .
I've given up listing my profile -- just not enough space anymore.

But, in short:
G 4+3.
Failed surgery. Failed SRT. Guess I'm just a lousy student.
I have been on intermittant HT (Casodex + Lupron).
I'm just finishing my second HT vacation.
PSADT when off HT is very fast (usually 1 month -- but a bit longer now).

Hope this is helpful to you. I just turned 70 -- we are the same age!

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3139
   Posted 10/7/2016 2:42 PM (GMT -7)   
Mel,

It's good to hear that you know exactly what you're dealing with. As far as how to deal with it, I'll leave that to the experts....

Hang in there!
Age at Diagnosis: 56
Biopsy: 3 of 12, G3+3, all on LT side, 20%, 5%, 3%
Clinical Stage T2C
Bone Scan, CT scan negative for spread
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8940
   Posted 10/7/2016 6:36 PM (GMT -7)   
Mel,

I'm sorry I don't remember your situation in detail, and you didn't provide a signature. If all your mets have been PLN mets, then whole pelvic radiation may be beneficial. But if you have had bone or visceral mets, then it is already systemic, and there is no evidence that there is anything to be gained by undergoing potentially toxic radiation. As I said the last time you asked, CHAARTED only showed a survival benefit to early chemo among men who had 4 or more mets.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.2,no lasting urinary, rectal or sexual SEs
my PC blog

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7184
   Posted 10/7/2016 9:43 PM (GMT -7)   
Tall:

Total of 2 nodes as stated in my post.

Are you now against just doing SBRT???

Sounds like chemo off the table at this point as per the article

Mel

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8940
   Posted 10/8/2016 12:17 AM (GMT -7)   
What are you talking about?

George_
Regular Member


Date Joined Apr 2016
Total Posts : 423
   Posted 10/8/2016 3:39 AM (GMT -7)   
Allen prefers systemic therapy while I am on Dr. Kwon's side and think radiating mets is helpful.

I think Dr. Kwon told you either to remove all lymph nodes with surgery or radiate just the affected ones with CyberKnife. CyberKnife would have very low side effects which would not be the case with surgery.

Dr. Kwon made a presentation at PCRI 2014 demonstrating many case studies radiating metastases and bringing down the PSA value to undetectable that way.

I also described how you can combine the radiation of metastases with an intermittent ADT.

George

Bobby Mac
Veteran Member


Date Joined Mar 2016
Total Posts : 670
   Posted 10/8/2016 7:06 AM (GMT -7)   
Hi Mel-

What was your PSA when before you had the scan?

How long had you been off HT before the scan?

Bobby Mac
Age: 69, 69 at PC dx, PSA 6.7 Biopsy: 2/16 13 of 14 Positive, 2-99%, GL 7 (4+3) - RALP 4/20/16 Pathology:Non-Focal EPE, 2 positive margins, Gleason 4+3=7, involving 50% of gland, prostate weight 31.5 g, Stage pT3a N1, nodes 2/10, right side positive, Casodex 7/27/16, Lupron 8/17/16, uPSA 6/1/16, 2.41, PSA 6/16/2016, 2.6, 7/12/16, 2.2, 8/11/16 .6

81GyGuy
Veteran Member


Date Joined Oct 2012
Total Posts : 2082
   Posted 10/8/2016 7:31 AM (GMT -7)   
"Overall, VERY good news, in my opinion."

Great to hear that, Mel!

This reminds me of something I remember posting here on the forum a while back. Actually, I seem to remember posting it a couple of times or so in different threads, which is arguably evidence of my elderly mental slippage, present in the form of my repeating oneself, but here it is anyway.

I noted in those earlier posts that I had once heard a certain image presented on a Muscular Dystrophy Telephon years ago by a medical researcher to describe an important discovery about one of the MD diseases.

He described it as a boxer fighting against an opponent in a pitch-black dark room. The boxer could not see his opponent but his opponent could see him. So, while his opponent could see to land blow after blow on the boxer, the boxer was swinging widely in the dark, generally missing, and only occasionally landing a blow on his opponent.

But then, the researcher said, making this discovery was like someone suddenly turning on the light in the room. Now the boxer could see his opponent clearly, and land every blow right on target.

Maybe comparable to your situation now, Mel. Whatever blows your doctors decide to start throwing now, they will have the target clearly in sight.
Age: 70
Chronic prostatitis (age 60 on)
BPH w/ urinary obstruction, 6/2011
TURP, 7/2011
Ongoing high PSA, 7/2011-12/2011
Biopsy, 12/2011: positive 3/12 (90%, 70%, 5%)
Gleason 6(3+3), T1c
No mets, PCa likely still organ contained
IMRT w/ HT (Lupron), 4/2012-6/2012
PSAs (since post-IMRT): 0.1 or lower

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7184
   Posted 10/8/2016 8:19 AM (GMT -7)   
Some responses:

Tall, my ONLY mets are the two pelvic nodes. One is barely showing up on the C11 scan. I can look up the exact uptake figures if that will be helpful. That is the new one found, in the left femoral node chain. The other original one found 2 years ago as a very small uptake has now double the uptake, but is still considered small, I think. That one is an external iliaac node.

My PSA taken on 8/1 was 1.28. Then taken on Thursday just before the scans, it was 3.1. My PSADT historically when off HT was less than a month, so this was actually somewhat "better." Meaningfully better? I doubt it!

Dr. Kwon did not mention cyberknife. He mentioned either surgery or doing the full IMRT on a large number of nodes (maybe all of them). He suggested this could effect a cure.

Tall, I am going to see what Dr. Lam thinks. I am strongly leaning against chemo Dr. Kwon didn't mention it but I asked him just before he was leaving and he did say that was a possibility along with HT and surgery or radiation if I really wanted to "swing for the fences." As I get older, QOL becomes increasingly important.
Frankly, I would not opt for chemo in my current situation. If I had distant/many mets., then I would possibly go that way. I am also very much afraid of doing surgery or such a wide amount of radiation (my SRT, incidentally, was to the prostate bed only).

Tall -- I am thinking of going with Chris King and doing the SBRT to the impacted nodes. I know you used to be very positive about that, but subsequent results made you less enthusiastic. If King thinks there is a reasonable chance of extending an HT-less remission with close to zero SE (he said zero when I only had the one node), it may be worth a shot. I know King said the SE profile could go way up if there were many more nodes, especially on opposite sides. This was one more node, near the first on the same side. I do feel King is honest, a straight shooter. But, then again, radiation is his thing!

I always welcome your thoughts, TA!



Mel

PDL17
Regular Member


Date Joined Oct 2011
Total Posts : 464
   Posted 10/8/2016 8:19 AM (GMT -7)   
Mel,

I would radiate and continue intermittent ADT per Dr. Kwon. I realize that Dr. Lam stated a 20% cure chance before. I would be interested in what he will say now.

Paul
Gleason 3+4; 5/16 positive cores; average volume 30%; PSA prior to tx 4.8
TX-IMRT + brachytherapy; IMRT Nov. 2011; Brachytherapy Feb. 2012
PSA April 2012--3.6
PSA May 2012--2.5
PSA Aug 2012--2.2
PSA Nov 2012--2.9
PSA Feb 2013--2.8
PSA May 2013--2.1
PSA Aug 2013--2.3
PSA Nov 2013--2.5
PSA May 2014--1.1
PSA Dec 2014--0.8
PSA Jun 2015--0.5
PSA Jan. 2016--0.4
PSA Aug. 2016--0.4

Bobby Mac
Veteran Member


Date Joined Mar 2016
Total Posts : 670
   Posted 10/8/2016 8:49 AM (GMT -7)   
Mel -



Mel said...
Dr. Kwon did not mention cyberknife. He mentioned either surgery or doing the full IMRT on a large number of nodes (maybe all of them). He suggested this could effect a cure.


I would imagine, given a node was cancerous two years ago, that more than one additional node is positive and Choline is not picking up uptake. Even though you may have been on HT for much of that time castrate resistant cells are always working.

If it were my call, I probably would choose IMRT to radiate all the Nodes and base radiation coverage on the study TA mentioned. I don't have the link, but the conclusion was:

Conclusions:
"Pelvic LN failures frequently occur superior to the commonly used L5/S1 landmark for PRT coverage, and use of ADT may be protective of more superior LN failures. The current RTOG 0924 trial is evaluating the benefit of PRT with extended superior coverage to L4/5 when possible, which, according to our data, should significantly improve the coverage of potential sites of failure."

Bobby Mac

Cyclone-ISU
Veteran Member


Date Joined Oct 2014
Total Posts : 972
   Posted 10/8/2016 9:39 AM (GMT -7)   
Hello Mel,

I'm thankful that you are pursuing top-notch consultations for your case --- we all deserve the best medical help we can find ---

Keep forging ahead --- your treatment plan will emerge --- I have great faith in that.

A line of encouragement and ongoing support,
"Cyclone Fan" ~ Iowa State University
PSA At Diagnosis In Year 2013 : 138
Initial Diagnosis: Advanced Prostate Cancer, With Metastases In Both Lungs
Age At Diagnosis: 48 years
ADT Treatments: LUPRON, FIRMAGON, and currently ZOLADEX
Subsequent Treatments: Chemotherapy Treatments (TAXOTERE) & now ZYTIGA
Additional Medical Consultant - Dr. Eugene KWON - Mayo Clinic
PSA Level: Currently < 0.10, With Treatments Ongoing

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8940
   Posted 10/8/2016 11:22 AM (GMT -7)   
Mel,

You are right that I do not see any value in treating individual lymph nodes. But I do think there's value in treating the entire pelvic LN area. The reason is that lymph is a fluid, fortunately a slow moving one, so if cancer is present in the LNs you can see, it is undoubtedly present in those you can't see as well.

Surgically, what Kwon is proposing to you is called an "extended pelvic lymph node dissection" or ePLND. What they do at Mayo is they use a fluorescent dye to help find all the LNs. This is very difficult. Unlike blood vessels, which branch predictably, lymph vessels network haphazardly. They try to get 20+ LNs out of the area, but they can't know if they got them all. As you know the dangers are lymphocele or lymphedema.

Using radiation, they can target the whole area and possibly get more of them. But there are toxicity dangers as well. The problem is that the small bowel comes into that area and the radiation can get pretty high for some of it. Bowel (enteric) tissue often has a late response to radiation that may not show up for years. A lot depends on your individual anatomy and visceral fat. This should be decided by an RO after a very careful look at your pelvic CT.

Neither surgery nor radiation will be useful if the cancer is already systemic because they provide local control only. But, so far, your evidence from the PET scans is that it is still locoregional.

There is no evidence that spot radiation of individual LNs is a good idea; it may accomplish nothing while raising toxicity risk. Accumulating evidence of doing that showed that within 5 years more mets popped up elsewhere in 85% of men who tried it. There is no evidence that it even slows it down. As you see from your own experience (which is typical) LN-only progression proceeds very slowly at first anyway, taking years for new detectable mets to appear.

I liken this to picking mushrooms from under an oak tree. The mushroom is only the visible portion of the fungus whose mycelium extends down to the roots of the tree and throughout the soil. You can pick as many mushrooms as you like, but they will just keep coming and will have no impact on the fungus's growth. To get rid of it, you have to treat the whole area systemically with a fungicide. You seem to have an opportunity now to get rid of it, but I don't think it serves any purpose to treat only what you can see.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.2,no lasting urinary, rectal or sexual SEs
my PC blog

Nomar Lupron 4 Me
Veteran Member


Date Joined Apr 2013
Total Posts : 1922
   Posted 10/8/2016 4:03 PM (GMT -7)   
Hi Mel:

As I think you know, I had SBRT to the prostate, tho what we would be calling the prostate bed had the prostate been previously removed and to the entire pelvic girdle, not just the 3 micro lymph nodes the C-11 Acetate identified.

at advice of Tall Allen, I did mine in conjunction with Provenge to leverage any potential abscopal effect.

pcri.org/the-abscopal-effect/

It's been since Oct 2014 and I stopped Zytiga after 9 months and Lurpon after 25 months a year and a half ago at end of April. PSA remains at < 0.01 but T slow to rise and only at 42 last time I had it checked a week ago.

With respect to Dr Kwon success stories, you can check with Wampuscat and Gunner34 among others.
screen name was LupronJim

66 - DX 64 2/13 PSA 3.68 (6 mo doubling) Gleason 9 (4+5)

T1CN0M1B stage IV w. 7 of 12 cores worst ones 70% right PNI

oligometastatic at Dx 5 tumors 1 right sacro, 2 on
T4 & T9, none visible on 5-21-14 whole bodyscan

Lupron 3-28-13 to 4-2-15
Zytiga June '14 to May '15
PSA < 0.01, T < 3 on 5/14
DHT < 5
Prostate shrunk from 50.4 to 15.0

Provenge in Sept & SBRT in Oct

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7184
   Posted 10/8/2016 4:34 PM (GMT -7)   
Thanks for the input. Not what I want to hear, of course.
Right now, I have not had a single PC symptom.
Unfortunately, the assorted txs take a large toll.

Hence, I am hesitant to do the dissection or the radiation of the entire pelvic region - very hesitant.

SBRT to the bad nodes sounds so much better. Kind of like wack a mole every time it comes up.

I will be chatting with Dr. Lam on Friday.

He might just suggest chemo, too.

I'm finding this decision to be difficult.

Mel

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8940
   Posted 10/8/2016 5:03 PM (GMT -7)   
I don't think he'd suggest chemo with so few mets, but I may be wrong.

Nomar is a great example of how well whole pelvic radiation can work. Correct me if I'm wrong, but I don't think you've had any lasting bowel symptoms. I've gotta say though that Nomar had one of the best looking dose-volume histograms for bowel that I've ever seen. It's a matter of careful planning and plenty of padding down there.

Unfortunately, whack-a-mole doesn't work very well.

Redwing57
Veteran Member


Date Joined Apr 2013
Total Posts : 2305
   Posted 10/8/2016 6:04 PM (GMT -7)   
This has been a fascinating discussion, which I've followed with some interest.

The recent kerfuffle with my first "new" oncologist was based on exactly that whack-a-mole idea. His concept was that if this very small increase in PSA was due to a lymph node "lighting up", which he considered likely, that I should see Dr. Kwon to find it and then have it removed or whatever. Exactly what you're discussing! Some I respect here very much have been doing precisely that, so the discussion is fascinating.

My theory all along has been that if my PSA actually trends up in a biochemical recurrence (hopefully never), and we do a scan finding it's not "local" in the prostate itself, then there won't be any focal treatments. My G9 cT3a case is fairly likely to be metastatic if it recurs anyway, local or distant, so I've never considered any sort of surgery or additional radiation to be likely. Even if it's local in the prostate (which is also reasonably possible per some links TA has shared) I'm not very excited about the available salvage local treatments. Surgery, cryo, HIFU, none too good post RT. It would take a great deal of convincing for me to take a chance with any of those, in light of my very high risk situation.

That's largely why I've been having my follow up care with a medical oncologist. Follow up care will likely be something systemic if it becomes necessary. I'm not excited about HT either, but to me it beats QOL risk of the others.
55@Dx 4/16/13
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3TMRI: Bilateral EPE, NVB+, SV-, LN-)

Pre:
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31

Tx:
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex

Post: (age now 58)
(HT 5/13-3/16) PSA <0.1 : 8/13 - 5/16.
(no HT 3/16- ) PSA 0.2 : 8/16

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7184
   Posted 10/8/2016 9:56 PM (GMT -7)   
This article seems to fit my situation:

https://www.ncbi.nlm.nih.gov/pubmed/27233779

Does anyone know how to get the full text (there is a link to it, but they want $39!!)

Mel

Time101
Regular Member


Date Joined Dec 2012
Total Posts : 184
   Posted 10/9/2016 7:41 AM (GMT -7)   
Mel,

Just my opinion...I am with Allen and Jim. If it was or becomes me, I would do SBRT or IMRT to all potentially affected nodes. If there are cancer cells in nodes that did not show up on the C-11, I would not want to take the chance of missing them doing spot RT and have to go back again. Kwon said, if IMRT, he would probably do all LN's and possibly get a cure. Will be interesting to see what Dr. Lam says.

Robert
Current age: 70
1/28/13 PSA 5.3
Dx'd 2/27/13, 2 of 12 pos. GS6 (3+3) <1.0% and
GS7(4+3) 10% 5.5mm, DRE neg., 39cc,
2/13 - 12 months Lupron
6/13 IMRT 41 treatments 77gy
10/13 PSA 0.02
12/13 thru 6/14 PSA <.015
6/6/14 Metformin
9/14 PSA 0.085 (Lupron effects)
12/14 PSA 0.2
2/15 PSA 0.20
5/15 PSA 0.23
8/15 PSA 0.249
11/15 PSA 0.27
2/16 PSA 0.31
5/16 PSA 0.29
9/16 PSA 0.50

George_
Regular Member


Date Joined Apr 2016
Total Posts : 423
   Posted 10/9/2016 9:12 AM (GMT -7)   
Mel,

here is a similar article that does not require a payment:
Androgen deprivation and high-dose radiotherapy for oligometastatic prostate cancer patients with less than five regional and/or distant metastases

You could get a Ga68 PSMA PET/CT which will show smaller mets down to 1mm in size which cannot be detected with C-11. I would prefer a selective radiation of these mets since it will take some time until the unvisible ones have grown to some size again. This takes usually over two years as reported in several small studies.

With IMRT you can radiate all lymph nodes which could possibly be affected which is a valid alternative. However, this in your case would just have a chance of 37% for success. Mr. Tendulkar published the following probabilities for success:
71% if PSA value between 0.01 to 0.2 ng/mL
63% if PSA value between 0.21 to 0.50 ng/mL
54% if PSA value between 0.51 to 1.0 ng/mL
43% if PSA value between 1.01 to 2.0 ng/mL
37% if PSA value greater 2.0 ng/mL

So the alternative would be repeated SBRT radiation as described by Decaestecker and Berkovic in their studies. IMRT cannot be repeated in the same area.

George

81GyGuy
Veteran Member


Date Joined Oct 2012
Total Posts : 2082
   Posted 10/9/2016 10:01 AM (GMT -7)   
Mel -

It looks like full text of the article you are interested in is available on Researchgate. Take a look at

/www.researchgate.net/publication/303595181_Stereotactic_body_radiotherapy_in_oligometastatic_prostate_cancer_patients_with_isolated_lymph_nodes_involvement_a_two-institution_experience

I'm not all that familiar with that site, but it looks like access to content is charged for corporate entitles but not individuals (unless I missed something), but one has to sign up as a site member (with whatever that involves, and if you want to bother) to get it.

But maybe worth a look.
Age: 70
Chronic prostatitis (age 60 on)
BPH w/ urinary obstruction, 6/2011
TURP, 7/2011
Ongoing high PSA, 7/2011-12/2011
Biopsy, 12/2011: positive 3/12 (90%, 70%, 5%)
Gleason 6(3+3), T1c
No mets, PCa likely still organ contained
IMRT w/ HT (Lupron), 4/2012-6/2012
PSAs (since post-IMRT): 0.1 or lower

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8940
   Posted 10/9/2016 10:36 AM (GMT -7)   
Mel,

All of the studies you and George are citing do not tell you what you need to know: is there any benefit to survival of irradiating a limited number of pelvic lymph nodes? To know that, you would have to have (1) a control group in which you didn't do this, and (2) a longer term study to understand the effect over time. There have been no controlled studies to date, although there are some in clinical trials. The studies so far have been very small, limited time, and uncontrolled.

Here's an article about a meta-analysis that tried to accumulate data from several studies. The data are sobering:after the kind of treatment you are considering, 69% nevertheless had distant mets detected within 3 years, and 85% within 5 years. The second from last paragraph is particularly applicable to you.

I said...
Because most of the detected oligometastases were in the pelvic lymph nodes, there is a special opportunity for lymph node-only treatment. Arguably, the entire pelvic lymph node area, and not just individual detected nodes, ought to be treated, and this was done in about 40% of the cases. There may be micrometastases that are too small to be detected in the pelvic lymph system. That area is typically not treated during primary radiation therapy, or during adjuvant/salvage radiation treatment. It may, in some cases, be amenable to additional radiation if previous treatment was not too wide, was long ago, and anatomic considerations (e.g., visceral fat) allow for it. Recent analyses by Rusthoven et al. and by Abdollah et al. found a survival benefit to such whole pelvic salvage radiation (type unspecified), but Kaplan et al. failed to find a benefit. Salvage SBRT whole pelvic treatment for recurrent patients with positive nodes has yet to be explored in sufficient numbers of patients to draw conclusions about it.


SBRT for Oligometastatic Recurrence
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.2,no lasting urinary, rectal or sexual SEs
my PC blog
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