To be honest, Cocker, I think you may have overdone the Googling - the oncos and urologists tend to just talk about prostate cancer in normal language so if you start asking them about metachronous and synchronous mets, they might look at you a bit odd.
Generally speaking, it is very difficult to determine whether a met has truly developed months after radical treatment or whether it was always there but not spotted at diagnosis.
If the PSMA scan is positive, I would be surprised if you hear the word 'oligometastatic' - they are more likely to tell you it is 'advanced' or 'stage 4' or words like that. Also, since you have already been started on the bicalutimide, it will be even harder for them to spot small clusters of cancer cells so don't build up your expectations too much just in case.
Edited by member 09 Aug 2020 at 22:11
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"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Thanks for that Lyn. Actually had choline rather than PSMA in the end. As I understand it the definitions are purely dependent on time of finding the mets relative to the initial diagnosis and radical treatment. I am simply trying to understand why SABR is a recognised treatment path on NHS in one case but not the other.
User
When you originally posted, I did a little search for some research that might suggest different responses to metachronous and synchronous mets, but didn't find anything, but the search was far from exhaustive.
User
Originally Posted by: Online Community MemberThanks for that Lyn. Actually had choline rather than PSMA in the end. As I understand it the definitions are purely dependent on time of finding the mets relative to the initial diagnosis and radical treatment. I am simply trying to understand why SABR is a recognised treatment path on NHS in one case but not the other.
SABR isn't approved for NHS use for prostate cancer - you either have to get on a trial or the doctors have to write a business case to get approval from the local NHS fund.
There was talk of a possibility of John having it a couple of years ago but we would have been self funding. The rationale was that if the PET scan just picked up one or two distant lymph nodes or small bone mets, the onco was prepared to try Cyberknife but any more than that, the additional treatment would be pointless as there were likely to be many more met sites than had been seen on the scan. But that was 6-7 years post salvage RT with a long history of low stable PSA.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Lyne, I think that's out of date.
Mount Vernon will do cyberknife on up to 3 prostate mets found after radical treatment, and this is recognised by the NHS as a treatment which usually significantly delays the requirement to start systemic treatments, and might occasionally cure.
They do also do cyberknife on the prostate itself, but I think this is only when HDR brachytherapy was planned and couldn't happen for some reason at the last minute.
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I think this may only be because the SABR steering group is based at Mount Vernon; it is still only available as part of a trial or by self funding.
https://www.sabr.org.uk/consortium/
Edited by member 10 Aug 2020 at 10:45
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"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
I was looking at
https://www.england.nhs.uk/wp-content/uploads/2020/04/1908-sbar-for-metachronous-extracranial-oligometastatic-cancer.pdf
I may be misinterpreting but it seems to say available for metachronous oligometastatic cancers from any primary that has been treated and been clear for six months prior to the mets being found.
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Members who have been on this forum for quite some time will have seen this talk linked to previously but there are newer members who may not have seen this before who may find something of interest. The talk was given by Dr Eugene Kwon of Mayo in 2014, so is a little dated in certain respects for example the 68 Gallium PSMA is an advance on the Choline Pet scanner he talks of in this talk on Oligometastatic Prostate Cancer. https://www.youtube.com/watch?reload=9&v=NkqizmvqJPo
Edited by member 11 Aug 2020 at 00:31
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Barry |
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Thanks Barry. I have my meeting with he urologist this morning and this has given me some information which may be useful to discuss along with the many other things I’m sure he will tell me.
Will report back later!
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Originally Posted by: Online Community MemberI was looking at
https://www.england.nhs.uk/wp-content/uploads/2020/04/1908-sbar-for-metachronous-extracranial-oligometastatic-cancer.pdf
I may be misinterpreting but it seems to say available for metachronous oligometastatic cancers from any primary that has been treated and been clear for six months prior to the mets being found.
Interesting reading - looks to have been issued this year which may explain why the NHS England guidelines haven't been amended yet, or most of the local NHS trusts. You can get a list of Trusts offering SABR by doing a simple Google search but when you download their brochures, almost all are only offering for PCa on trial or fee basis.
I am still not sure how you think it may or may not be relevant to your diagnosis?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Thanks again Lyn
I’m not sure it will be relevant but IF there are mets then it may be - hopefully will know later today. I’m also interested in exploring all of the possibilities even if they can only be accessed on a fee basis.
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Well still not much wiser! Had been led to believe that the MDT meeting had taken place - apparently not! So today simply told that The PET scan confirmed that it is likely to be in the pelvic bone and a MDT meeting, hopefully this week, would decide what the best options might be - probably oncology rather than surgery.
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Sorry to hear that.
Note that if you are interested in private treatments, it's worth letting your consultant/MDT know. If you are having an NHS consultation, they are not permitted to mention or offer any private treatments, unless you've explicitly asked them if there are any appropriate private treatments, in which case they should say so, although they may not know of those outside their area of knowledge of course.
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Thanks Andy, It’s on my list of questions to ask.