Good evening all,
I’ve just completed my diagnostic journey (summary details in profile) and feel so much better for coming to the end of it. The last hurdle was a PSMA PET scan which I didn’t quite manage to clear as low volume spread to lymph nodes beyond the pelvis was identified and I was restaged to advanced from locally advanced. WB-MRI had previously not detected any metastases. I came across an interesting report from the European Urological Association where researchers from the Netherlands seem to be suggesting that there is a flimsy boundary between high risk M0 identified by conventional imaging and M1a identified by PSMA PET and that the latter, M1a, should be treated in a similar way to M0, and possibly with similar intended outcomes. There is also the interesting consequence that some patients with low volume spread are being migrated into stage 4, with possible consequences for data on survival outcomes in both stage 3 and 4 - effectively improving the stats for both stages (removing more high risk patients from stage 3 but adding the same, relatively lower risk, patients into stage 4). Has anyone done any reading or gathered any thoughts on this as I’d like an informed chat with the oncologist when I meet her or him in a few days? Also how is high-risk stage 3 N0 M0 with curative intent typically treated nowadays? From conversation with the urologist, for M1a, treatable but not curable, I am aware that abiraterone will be used from the off and I’ll have radiation to the prostate but not to the larger pelvic region. For myself, I don’t feel particularly disappointed by the change of label from M0 to M1a - after all, my cancer is the same, cure rather than remission always seemed a bit of a long shot with my initial psa, and it’s better to know what you’re dealing with - but I want to reassure myself about treatment protocols. Sorry for the questions but any advice or comment would be much appreciated.
