Bone mets detected and SBRT started

Hello All. Hope everyone is fine and in good spirits. Update from my side. My PSA since sept 25 was creeping up and my onco advised the pet psma scan.

Past one month i had pain in my left shoulder and at the back of the neck radiating to.left side. Initially i thought its a gymn injury doing deltoid exercises or chest fly.

But the scan showed by a significant psma uptake of 93 at the neck area. The lesion showed up bright.

So as a first mitigative measure, i am on SBRT radiation. Therr is already some epidural area invasion so the radiation has to be planned v v carefully to.protect the spinal cord.

So 5 sessions are planned and 2 done, 3 to.go.

Once the RT is done after a gap.of max one week.its going to be docetaxel chemo.

Today i would like to share one very major learning. I had prostate surgery with margins, had no extra prostetic extension, yet i had BCR within 6 months. Even initial IMRT radiation never brought doen my psa to.undetectable.levels. my ADT which was a combined andrigen blockade of orgyvyx and abirwterone too did not give me a year of low psa.

I was always perplexed by the aggressiveness of my disease ciz my psa post surgery has never even touched 1.0. But scans reveal lymph node lesions, and now bone mets.

I re read my reports and self analyzed with help from.the.net.

What i found is that my histopathology report of my prostate reveals IDC called intraductal carcinoma wherr thr cancer cells had colonised these prostate ducts. Apartfrom LVI.

It seems that when the IDC happens it means the biology is to be considered aggressive, independent of the gleason score.

Therr is enough literature.on the net which highlights how in the case of IDC, the PFS, overall survival and BCR free survival are impacted negatively by Idc.

What IDC means is that the.clones have already adapted to the low andrigen environment, so initially they may respond to adt, but very soon will gain resistance. So with IDC Castrate resistance will set in early. These clones will also be resistance to radiatiin treatment.

None of my oncologists could explain to me why my trewtments have failed despite a low psa threshold.

Thsi time armed with this new knowledge of IDC i took it up with my onco and he agreed that yes there does exist studies on  intra ductal invasion and its relation to aggressive biology in prostate ca.

So now coming back to what treatmemt options i have. Docetaxel chemo, lutetium 177, and cabazitaxel chemo. But again my aggressive biology will not give me a longer remission as others would have gained. At max i may get a remission of 6 mo ths post 6 cycles of chemo with docetaxel.

So in my case its now a race against time..will be exhasuting options soon within say 3 years. Also i did mu liquid biopsy for the possibility of detecting certain mutations like BRCA 2 etc, or MSI H. But i dont bave tbese, so immunotherapy is ruled out in my case.