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[59M]What is best method of determining if prostate cancer has spread to lymph nodes?

User
Posted 16 Jul 2021 at 09:21

I apologise for making yet another thread with questions. Let me know if I'm asking too much on this forum.

 

59M

 

Diagnosis: Gleason 4+3=7, T2c, PSA 7.8.

 

Some classify as high risk, some as intermediate-unfavorable.

 

Is PSMA/PET currently best method of determining if cancer has spread to lymph nodes?

 

Cyberknife (SBRT radiation) doctor suggests 5 radiation treatments without adding hormone therapy or anything else.

 

If I will do this, I want to make sure there are no mets anywhere else and that it is localised in prostate only.

 

CT scan shows clean, MRI showed prostate only, but is this the most accurate way to tell?

 

Can't figure out if PSMA / PET would be useful in giving additional info here.

 

Cyberknife (SBRT) doc said its not necessary, but other docs online say it could be useful.

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 16 Jul 2021 at 11:37
If it’s in your lymph nodes then it’s in your lymph nodes if you get what I mean. I had two PETS which showed nothing , yet a CT scan identified 4 enlarged. Some people (8%) don’t show things via PET.

Truth is you need to tackle the ‘ mothership’ one way or another yes ? So a PET is a good idea , but if it shows up lymph nodes then you will still need radical treatment

If life gives you lemons , then make lemonade

User
Posted 16 Jul 2021 at 12:28

Ask as many questions as you like, personally I would have probably kept them all on one thread. So people can see earlier replies and history etc. but that's your choice.

As for scans, I don't know whether it is worth getting more diagnostic scans. G4+3, T2c PSA7.8 is not very severe as PC goes. Yes it needs treating, but it probably hasn't spread. None of your scans so far suggest it has spread so I would be looking at whatever targeted treatment is appropriate, and not worrying about more scans.

Yes it may have spread, and it may be undetectable on scans and then you will be looking at a life time of HT, but at the moment it looks like some radical treatment can cure you, so that is where to start. If a few years after that radical treatment PSA starts to increase then maybe more needs doing.

Dave 

 

Dave

User
Posted 16 Jul 2021 at 19:00
You can pay for the fanciest scan in the world, get the all clear and still find out later than you had micromets. If you only want yo have radical treatment once you know for sure that it is contained, you will never have treatment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 17 Jul 2021 at 07:28
Lots of evidence and trial results too now that PSMA Scan is a useful staging tool, as is MRI, so I think if you can and it doesn't delay treatment you should have PSMA.

A lot has changed in the 6 years since my diagnosis, back then I was unusual in that I had a MP MRI but most didnt and often guys had up front bone scans even though these rarely showed anything (until it was to late). I think PSMA will become mainstream as MRI soon.

An 8+3 T2C staging is a serious cancer that needs urgent treatment. 5 session Cyber Knife may not be ideal (PC is a notorious multifocal disease) and is unproven be careful you are not consuming marketing BS. If you are determined to go RT traditional EBRT is probably more appropriate for your staging.

User
Posted 18 Jul 2021 at 12:54
"So why not start with radiation from get-go?"

That's a view that many take.

As regards RT, it is unlikely that further RT will be given if it means directing it along routes that were used for original full dose RT. to the Prostate. Where it can be used is in cases where the cancer is further removed as for example in Olio metastases or to reduce pain in one or a very few more remote locations.

Barry
User
Posted 18 Jul 2021 at 20:00

Originally Posted by: Online Community Member

So why not start with radiation from get-go?

Some people do not like the idea of hormones or 28 visits to hospital for treatment.

Also, if you're young, some oncologists push you towards surgery, as the likelihood of long-term negative side-effects of RT become very much higher of you're expected to live 25+ years more.

And there is also the psychological "cut the b****** out and be done with it" thing, which shouldn't really carry a lot of weight, but can do with some.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

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User
Posted 16 Jul 2021 at 11:37
If it’s in your lymph nodes then it’s in your lymph nodes if you get what I mean. I had two PETS which showed nothing , yet a CT scan identified 4 enlarged. Some people (8%) don’t show things via PET.

Truth is you need to tackle the ‘ mothership’ one way or another yes ? So a PET is a good idea , but if it shows up lymph nodes then you will still need radical treatment

If life gives you lemons , then make lemonade

User
Posted 16 Jul 2021 at 12:28

Ask as many questions as you like, personally I would have probably kept them all on one thread. So people can see earlier replies and history etc. but that's your choice.

As for scans, I don't know whether it is worth getting more diagnostic scans. G4+3, T2c PSA7.8 is not very severe as PC goes. Yes it needs treating, but it probably hasn't spread. None of your scans so far suggest it has spread so I would be looking at whatever targeted treatment is appropriate, and not worrying about more scans.

Yes it may have spread, and it may be undetectable on scans and then you will be looking at a life time of HT, but at the moment it looks like some radical treatment can cure you, so that is where to start. If a few years after that radical treatment PSA starts to increase then maybe more needs doing.

Dave 

 

Dave

User
Posted 16 Jul 2021 at 19:00
You can pay for the fanciest scan in the world, get the all clear and still find out later than you had micromets. If you only want yo have radical treatment once you know for sure that it is contained, you will never have treatment.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 17 Jul 2021 at 06:14
Yes, of course it is no guarantee. I was just thinking maybe it would shift odds in my favor to maximum.

Looking for SBRT (Cyberknife) or Brachy treatment. Brachy seems to statistically have proven itself to be most effective long term, no?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 17 Jul 2021 at 07:28
Lots of evidence and trial results too now that PSMA Scan is a useful staging tool, as is MRI, so I think if you can and it doesn't delay treatment you should have PSMA.

A lot has changed in the 6 years since my diagnosis, back then I was unusual in that I had a MP MRI but most didnt and often guys had up front bone scans even though these rarely showed anything (until it was to late). I think PSMA will become mainstream as MRI soon.

An 8+3 T2C staging is a serious cancer that needs urgent treatment. 5 session Cyber Knife may not be ideal (PC is a notorious multifocal disease) and is unproven be careful you are not consuming marketing BS. If you are determined to go RT traditional EBRT is probably more appropriate for your staging.

User
Posted 18 Jul 2021 at 11:02

Originally Posted by: Online Community Member
Lots of evidence and trial results too now that PSMA Scan is a useful staging tool, as is MRI, so I think if you can and it doesn't delay treatment you should have PSMA.

A lot has changed in the 6 years since my diagnosis, back then I was unusual in that I had a MP MRI but most didnt and often guys had up front bone scans even though these rarely showed anything (until it was to late). I think PSMA will become mainstream as MRI soon.

An 8+3 T2C staging is a serious cancer that needs urgent treatment. 5 session Cyber Knife may not be ideal (PC is a notorious multifocal disease) and is unproven be careful you are not consuming marketing BS. If you are determined to go RT traditional EBRT is probably more appropriate for your staging.

Thanks for input.

My case is 7+3, T2c, 7.8 PSA. Doc says that is intermediate-unfavorable risk.

Since PSA has been under 10 at all times and while its T2c, the doc believes the cancer is localised in two spots on prostate... I think that is the main rationale for him suggesting to do only Cyberknife without hormone therapy. I will still consult more doctors and high standing specialists overseas just to be safe. 

My biopsies were targeted, so that is the reason where idea that its localised comes from.

Still considering PSMA/PET for added security that there are no mets outside prostate.

Can't make up my mind between Brachy and SBRT Cyberknife.

Surgery... I don't know. Relapse is too high and its too invasive and side effects are higher compare to radiation.

If radiation fails apparently you can do more radiation.
If surgery fails (high chance) you will still have to do radiation.


So why not start with radiation from get-go?

Edited by member 18 Jul 2021 at 11:03  | Reason: Not specified

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 18 Jul 2021 at 12:54
"So why not start with radiation from get-go?"

That's a view that many take.

As regards RT, it is unlikely that further RT will be given if it means directing it along routes that were used for original full dose RT. to the Prostate. Where it can be used is in cases where the cancer is further removed as for example in Olio metastases or to reduce pain in one or a very few more remote locations.

Barry
User
Posted 18 Jul 2021 at 20:00

Originally Posted by: Online Community Member

So why not start with radiation from get-go?

Some people do not like the idea of hormones or 28 visits to hospital for treatment.

Also, if you're young, some oncologists push you towards surgery, as the likelihood of long-term negative side-effects of RT become very much higher of you're expected to live 25+ years more.

And there is also the psychological "cut the b****** out and be done with it" thing, which shouldn't really carry a lot of weight, but can do with some.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 18 Jul 2021 at 20:10

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

So why not start with radiation from get-go?

Some people do not like the idea of hormones or 28 visits to hospital for treatment.

Also, if you're young, some oncologists push you towards surgery, as the likelihood of long-term negative side-effects of RT become very much higher of you're expected to live 25+ years more.

And there is also the psychological "cut the b****** out and be done with it" thing, which shouldn't really carry a lot of weight, but can do with some.

 

What do you think of new radiation technologies like SBRT Cyberknife where its only 5 visits?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery or HDR Brachytherapy+EBRT or Cyberknife(SBRT)?

User
Posted 18 Jul 2021 at 21:09

Originally Posted by: Online Community Member

What do you think of new radiation technologies like SBRT Cyberknife where its only 5 visits?

I haven't seen any results data (that doesn't mean it isn't out there, I just haven't seen it as I haven't done much "homework" in this area). I had to make my decision in March 2020. If I'd have been offered the above, I'd have seriously considered it - particularly if...

* it didn't need hormone treatment

* there was encouraging results data

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

 
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