Posted 5/26/2017 10:51 AM (GMT -7)
After stopping ADT3 PSA climbed to 2.3. Axumin scan found met on right femur. I've decided to have SBRT, three fractions, nine gray per fraction. I went back on ADT3 and RO recommended xgeva once per month as well. The xgeva circular says xgeva is used to among other things preclude or delay the need for radiation or surgery to bone mets.
So I'm wondering if xgeva is warranted now. I was on prolia for over a year but stopped when ADT3 stopped. I had no SEs from prolia that I'm aware of but who knows given the SEs from ADT? Xgeva is much more costly than prolia for some reason plus I don't wish to take meds unnecessarily.
Since I had one bone met, with my pathology I'm a good candidate for more bone mets when ADT becomes ineffective.
Any thoughts ?
DOB January 1944 (now age 73)
PSA: 8/12 2.7; 5/13, 6.6 (actually double due to finasteride)
7/13 (age 69) Bx GS 4+4=8 (Bostwick); GS 4+5=9 (Epstein); 2 of 6 cores, 10%, 40%; stage Pt1c
8/13 bone scan negative
9/13 ORRP at John Hopkins, GS 4+5=9, BLSVIs+, margin+ (4mm,G7), EPE, 10 Nodes resected (clear); stage upgraded to pt3bN0M0
PSA: 11/13 0.1; 2/14 0.2; 5/14 0.3
6/14 SRT by IMRT/IGRT, Lewis cancer Ctr. 68.2 grays/38 sessions to prostate bed, ADT (6 months Lupron)
PSA: 9/14 to 8/15: <.1, <.1, .1, .3, .7, 1.2
7/15 CT-PET f-18 bone scan negative
9/15 MRI, CT-PET at Sand Lake Imaging find iliac lymph nodes suspicious for PCa; organs and soft tissue clear
9/15-12/15 IMRT/D.A.R.T. at Dattoli , 75 grays/50 sessions to all pelvic lymph nodes
9/15-11/16: 13 months ADT3 (Lupron, bicaludimide, dutasteride) plus Metformin, Cabergoline, Estradiol patch, Prolia , Vitamin D3, calcium
6/16: color-flow Doppler ultrasound, combined helical CT pelvis, abdomen and chest and QCT for bone density and FDG 18 Pet scan negative for PCa
12/16: color-flow Doppler ultrasound, combined helical CT pelvis, abdomen and chest and QCT for bone density negative for PCa; finasteride added to dutasteride.
PSA: 11/15 .084; 3/16 .034; 6/16 .028; 9/16 .045; 12/16 .194; 1/17 .484; 2/17 1.1; 3/17 1.3;