prostate cancer round three

A brief history:
2010 prostate surgery at Mayo Phoenix, PSA 19, gleason 4x4
2019 very slow psa rise
2021 lost < psa increased to .33 in 8 months
2022 33 radiation treatments at Mayo and one 3 month lupron injection, refused second due to serious side effects.
psa to zero
2024 psa increased to .36, 4 month doubling time. Had psma pet ct a week ago. scan showed two hot lymph nodes
located just below right kidney. No other hot spots in body which surprised me.
The Doctor suggested 5 high dose radiation treatments over 5 weeks then hormone therapy for a year. My question
what is the best type of hormone therapy and for how long. One suggestion was to radiate the two close together nodes then check to see if psa goes to zero. would surgery to remove the nodes be an option.?
Over all really can't complain, been living with this for 14 years, at 74 looking for a few more years.

Surgery to remove individual suspected lymph nodes can be very tricky, often ineffective and to my understanding isn’t common. I stretch to remember anyone on the board in the last 13 years having such surgery and I can’t recall. Though numerous men have used radiation in such a situation.

Perhaps the node is located such that surgery would be damaging to the area and do more harm than good. Certainly I am not a doctor, but have read enough to know it is uncommon to attempt to remove lymph nodes in a situation like yours. Plus, if the PCa is in one node, it is assuredly in others, just not an amount any scan could detect. The radiation oncologist will no doubt broaden the beam a bit to radiate the node and some area around it. Surgery often can’t do this without causing harm. My wife recently (January) had 10 daily radiation fractions to two spine tumors that developed from her BCa in 2010. She had nearly instant relief from the pain they caused and has had two PET scans since showing great improvement. So it can be wonderfully effective.

Regarding ADT, as Newspaper stated, we have many more options than when you, and I, were first treated in 2010. I was on Lupron/Eligard for three years and it was not fun. I am a bit surprised that your doctor wasn’t specific as to the ADT he suggests. I certainly hope the doctor is a medical oncologist that has extensive experience treating high risk PCa recurrence similar to yours. Have you met with the radiation oncologist?

Hopefully this is but an inconvenience in your life as you have done well for 14 years. Let’s hope these treatments buy you another 20-30 years of high quality living.

An MO will give you the fullest chance to explore ADT options. IMHO, worth the drive if Mayo is your best bet a consult at a comprehensive cancer treatment center. If your disease is broadly metastatic, and not an artifact of a few nodes, ADT is the only effective option. There are men on this Board who have been kept alive by ADT for a decade or longer. Best wishes… Bill

It is sort of simple to me, surgery and radiation did not work over the long term so time to get a prostate MO to run the show and can use RO and Uro as needed.

Take a look at the Abbreviations and PCa drugs list at the top of the homepage to see how many prostate drugs there are now.

There is another well known prostate oncologist that moved to Mayo Rochester a year or so ago, Dr Oliver Sartor, who was at Tulane. I have read good things about him and he would be a good alternate to Dr Kwon but may have similar scheduling issues.

I moved my care from an RO at UMass Medical Center to an MO at Dana-Farber in 2016 after my PSA rose to 0.2 a few years after salvage radiation. When Lupron started to fail in 2021 scans at D-F showed some enlarged iliac lymph nodes and nodes in prostate bed. My MO consulted with an RO at D-F. the RO concluded radiation was too risky due to previous radiation dose and location of nodes.

This is as it should be. In your situation, IMHO, there is a need for consultation and medical judgment between an MO and RO as to whether it would be best to attempt spot radiation or go directly to ADT.

In my situation, because spot radiation was not an option, my MO started me on Zytiga (Abiraterone Acitate), which shrank the nodes back to normal size and to-date has kept my PSA undetectable.
Jim

A brief update on treatment.
After reading everyone's comments several times my short range plan is to proceed with targeted radiation to the two lymph nodes that lit up on the psma pet ct scan. My first appointment at Mayo Phoenix was Tuesday with a nurse then the simulation setup. Setup wise this was way easier than the 33 previous treatments. The only prep is an empty bladder. Was interesting and told the wife this is the start of a new adventure.

The nurse said the appointment scheduler would call in 7-10 business days to set treatment dates. They are to be 5 treatments over approximately two weeks.

The radiation Dr suggested Leuprolide (lupron) or Relugolix (Orgovyx) for hormone treatment. Really don't want to tangle with lupron again so still looking for more information. Part of this is also tied into what the drugs cost and if insurance will ok their use.

I am still trying to make a connection with Dr Kwon and his clinic for his take on my situation.
Thanks for your advice.

Sorry about the double post, summited the first one and site said that I had timed out so typed another one. Getting to old and drifty for this I guess.

Orgovyx may have advantages, but it may bear repeating that MOST of the side effects of Lupron and Orgovyx are due to low testosterone.