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Primary SBRT failure Stage 4a-m1

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Posted 12/10/2021 9:01 AM (GMT -5)
Hello , I had the PSMA pylarify done at VA and it showed 1 lymph node in the pelvic area .The RO gave me an injection of my 1st ADT , a 6 month injection of Eligard in the stomach. yesterday . No side effects yet . My long term plan maybe to radiate all the lymph nodes in the pelvic area with a higher dose to the bad node ? We will see . My question is once you are stage 4 does anyone ever go down a stage or is Stage 4 a lifetime of treatment ? Is a cure still possible if they radiate what I described ? Thank You
Posted 12/10/2021 9:23 AM (GMT -5)
To quote my RadOnc: If this doesn't kill the cancer, you are incurable.
Meaning, if the radiation doesn't cure me, nothing will.

But, but, but: In your case you still have your prostate gland, so you will always have a PSA.
You need to watch PSA over time and determine it's doubling rate. Up until your ultra-sensitive test, your rise looks slow (but we don't know how often those were taken, looks like every 3-4 months. Which means it appears to be slow. But we don't know.
The UltraSens test was a different assay, so you need to track one assay and then that will tell you better.
Posted 12/10/2021 7:00 PM (GMT -5)
I can totally understand you are alarmed. But your questions about stage and cure are not germane.
What is relevant is that, in the very near future, your PSA will likely drop to something very low because of the Eligard (ADT). This will give you time to consider further treatment. Dr Hirsch should be your first source of guidance, but you can certainly include a medical oncologist in developing a treatment plan. How long will you be on ADT?
Finally, as alephnull already stated, stay with regular PSA tests at the same facility at regular intervals. Because you are on ADT, tests at three-month intervals seem reasonable (to me). Do ask to include testosterone assays to make sure the ADT is doing its 'thing'.
Posted 12/10/2021 9:44 PM (GMT -5)
If you are determined to be a stage 4, that won’t be reduced to a stage 3 due to treatment. Your treatment may result in remission or even a cure, but it doesn’t retract the earlier staging diagnosis.

The key now is management of the disease. As long as the treatment keeps you in remission, the stage is unimportant. Our goal with PCa is to keep the disease in remission until a heart attack, car wreck, jump off a bridge or jealous husband takes our earthly life.
Posted 12/10/2021 10:09 PM (GMT -5)

JNF said...
jealous husband takes our earthly life.

This was the funniest thing I read all day!
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