SBRT to rib

I had 20 sessions of IGRT last August and a 3 month shot of lupron. My PSA has been rising, latest was 8.5 last week.
I had PSMA PET scan which showed a spot on my 6th rib suspicious of met. My MO arranged for me to have SBRT to the rib.
My questions are...
1. What are side effects of SBRT to the rib for those who have been through it?
2. Should I request a more aggressive approach to the suspected rib met...ADT beside the radiation?
Thanks
John

John,
My wife had SBRT on the 4th rib for a BCa met in 2020 after 16-17 year remission The sequence of events was 1) CT scan of chest area noted suspicious rib, 2) PET scan verified tracer uptake in rib, 3) biopsy was taken from 4th rib and confirmed BCa. Her situation was different than yours as no cancer was suspected at the time. She said the biopsy was no problem but you could ask about it.

The treatment was 3 sessions of SBRT, Monday, Weds, Friday. This was followed with hormone therapy and oral BCa chemo (don’t think there is a PCa equivalent). Treatment plan per University and Mayo opinions. PCa is much better monitored with PSA but her BCa markers went up and down a bit after SBRT then settled in at normal level. I would think you will be on long term ADT also as you have a distant metastatic situation but maybe they want to monitor PSA after SBRT?

She says there were minimal side effects from SBRT other than some tiredness a few weeks later. However, the lung is behind most of the ribs and within the radiation field so she had some annoying minor coughing at times that the RO indicated may happen and continues. The bone integrity is damaged from RT for years after SBRT so plenty of warnings given about not impacting the rib in any manner. She also gets Xgeva bone strengthening injections for the rib and general HT issues along with being an older women.

Her rib cancer was right behind the breast that was removed in 2003 so the hope is that it is a local issue and she will do well for years but on meds and scans forever. Having one or just a few mets is a much better place to be in for the whack-a-mole strategy as well as HT therapy. Hope this helps a little.

SBRT to a rib is a completely different deal than to the prostate. It is pretty straight forward and goes fast per my wife and only 3 sessions that take minutes to do. The subsequent scans definitively show that rib has been treated as they treat a larger area than just the lesion noted.

Thanks Duck2. That's probably what my oncologist was thinking.
Since my PSA has been rising steadily from 0.5 last September to 8.5 last week , I was wondering if a more aggressive approach is needed.

Post Edited (John347) : 4/1/2023 3:06:13 PM (GMT-8)