Sorry to hear about your recent events during the Holidays. As a fellow high risk guy, I read these stories with great interest and some uneasiness that I have to confront each time.

Sounds like you are seeing the best doctors so not much else you can do. Did you have the lymph nodes treated during ART? That would seem to be the only contradiction to more radiation treatments.

You are probably right on more Lupron but some other things may be added from what I read. Lots of arrows in the quiver nowadays so don’t be surprised at what comes next. Worry about it next year and enjoy the holidays.

So what are the folks at Cleveland suggesting? I would be pushing for a spot weld on the bone spots and surgery to yank the nodes.

The docs are new to psma results as well. It provides actionable intelligence years before previous generation scans. I was watching a presentation from Dr Kwon at Mayo and he stated they will be finding things 7 years earlier than they did previously. I call that a head start!

There are lu-177/ac-225 trials running in the USA with some not requiring you to be castrate resistant.

https://www.prostatecancer.news/2020/08/psma-targeted-radiopharmaceutical.html?m=1

You can get lu-177 treatment in India and Germany with those scans.

Sorry to hear this Schoolpsych, try to stay positive. Dont waste the holiday worrying about this (i know, easier said than done), Keep us posted on MO reco's

Sorry to hear this schoolpysch, but it does sound like you're on the verge of putting together a good plan of attack. I'm thinking your situation might have some similarities with compiler. (Also a Dr Lam patient.) He had good luck zapping some hot spots post RALP and SRT and is doing well now. Hopefully, he'll see this and weigh in.

You've been great at rolling with the punches throughout this, so this might just be one more obstacle you'll have to over-run.

Bill, they just didn't realize the ripples in the universe they were making with the name change...

Let us know what Dr Lam says this week!

So, I had my virtual appointment today and learned some interesting things from Dr. Lam. He indicated that if this were even a year or so ago, prior to wider-spread PSMA scan availability, my spots are so small that they wouldn't have been seen with prior imaging and basically, I would have been in a "watch and wait" period since my PSA on its own isn't high enough to start up ADT again. However, with the PSMA scan, we now know that they are there. One good news piece is that he feels one of the spots had weak enough uptake that it could be a false positive which would leave me with three spots. Thank God for the advancements that keep coming in the Pca realm like this scan. I understand that it isn't yet completely accessible to all but hopefully it will eventually be available at every major hospital.

His recommendation is to start Zytiga again immediately to stop further development. He indicated that the Zytiga could be with or without Lupron but suggests that we do add three months of Lupron at this time. The Lupron bit is especially interesting as he said new studies are showing that Zytiga on its own might be just as effective as Zytiga with Lupron. Regardless, my personal preference is the kitchen sink approach so I'm going to do the Lupron along with the Zytiga. So, back to the ADT gang I go for now.

On the treatment of the individual spots, Dr. Lam indicated that one or two spots would be a "no brainer" to radiate. Anything over five is a no go. So, I'm right in the middle. He indicated that he sees radiating the spots I have as still having a small chance of putting it into "cure/very long term remission" so he recommends that it be done in March or April. I expressed my concern that my local RO might not go along with doing that and Dr. L was confident that, if not, he could get it scheduled for me at UCLA. He indicated that the SBRT would take about two weeks. So, perhaps a two-week visit to LA is in my future.

I meet with a CC MO on January 11th so it should be interesting to see what their recommendations are.

It certainly sounds like you covered a lot of ground in your meeting and good to know the PSMA scan is getting you a head start on re-starting Zytiga. Regarding your local RO's input, I presume that will wait until after you've seen the CC MO?

You are ON this, SCHOOLPSYCH!

Wow! Proactive plan, taking shape, as we speak!

ZYTIGA --- now the generic version ABIRATERONE ACETATE --- has been part of my daily routine for over six years & ADT since diagnosis in 2013.

We "gotta' do, what we gotta' do" ! And you, GOOD SIR, are doing JUST THAT!

With your multi-tiered treatment options --- medication, injections, ad possible radiation --- I have no doubt that's going to pack a might wallop against those renegade trouble spots!

And yes, I am thankful for the ever-increasing specificity of these newly emerging scans!

Keep your sights set on the future --- and the KNOCK-OUT punch these treatments will pack!

KA-POW! KA-BOOM! KA-ZING!

All my best --- onward, UPWARD!

CYCLONE - # Iowa State University

Thank you, Steve. I was excited to read your update in the other thread. Success with new treatments brings hope to all of us. Keep up the good work!

I actually did ask Dr. Lam about the Orgovyx tablets vs. Lupron when I met with him last week. He indicated, like I saw you mentioned in the other thread, that the SEs seem to be about the same for both but noted that the tablets can be harder to get through insurance and/or require a significant copay. My insurance completely covered the Lupron doses last time around so he suggested that in my case, I might as well just go with the shot. I would be getting the Lupron shot at the Cleveland Clinic anyway and meet with an MO there next Tuesday for the first time so I'll see what she has to say on the subject.

Hello, SCHOOLPSYCH ~~~

You have assembled a MAJOR LEAGUE medical team --- and you, good sir --- advance warning to the fans in the stadium --- are SWINGING FOR THE FENCES.

Others reading your thread --- with updates --- will learn that a fellow has to do his due diligence --- assembling a medical team --- asking informed questions --- following up --- pursuing state-of-the-art scans --- remaining open-minded --- and asking about new medications and treatments.

Like you -- some of us have to remain open to the idea of TRAVEL --- in order to consult with doctors and take advantage of diagnostic scans in distant medical facilities.

It's commonly called "medical tourism" --- and I see the AIRPORT sign every time I arrive in Rochester, Minnesota, when I visit Mayo Clinic.

Nowadays, virtual consultations are ALSO possible --- as your posts underscore --- and we both have benefited from our doctors being able to share scan results --- electronically --- across the miles.

I applaud you for putting together all the moving parts --- and I sincerely feel you are on a GREAT PATH FORWARD!

Here's to TREATMENT SUCCESS!

CYCLONE --- # Iowa State University

Schoopsych,
Erleada (Apalutamide) is very similar to Xtandi (Enzalutamide). As you may know, the "lutamides" work by tightly binding to the androgen receptors and thus keeping our beloved Testosterone from doing it's job. I also liked the idea of avoiding the Prednisone. Not having to fuss with taking it on an empty stomach makes things more convenient too.

Sorry you are back on the "juice," but it works!

Hope all goes well!