Advance Prostate Cancer and SABR treatment

Hi Confused about SABR , that is an interesting post. I don’t have any experience with SABR but coincidentally this week I had results of a PSMA PET which identified a new met in my Sternum.  I went through all the options with my oncologist including various RT options and her view was that as my PSA was above 2 and rising fast, the PCa was starting to gain a foothold again and I needed a systemic approach rather than trying to zap a single area.  Her view was that micromets could be all over the place already and it would be better to slow the progress with HT.  Unlike you, I have remained on HT since diagnosis in 2018 (as I was advanced at diagnosis), so I am already living with that and hopefully the new drug Enzalutamide (in addition to Zoladex) won’t cause too many side effects and should lower the PSA for a year or two.  
My question to you would be about the chances of collateral damage to your spine with SABR and will that treatment lower your PSA?  Best wishes, David

Hello Confused about SABR .

My husband recently had SBRT to the upper abdomen area mets which were difficult to get at and needed accuracy to prevent collateral damage. My understanding is that this kind of radiotherapy was originally designed for the treatment of brain tumours. Like any technique it is dependent on the machine used and the expertise of the oncologist and the technicians so I would be reassured that the experts will only do it if they are confident that they have the planning scan sorted. If you are concerned then don't be afraid to ask your team what their experience is with SBRT to the spine and what their success rate is with this procedure.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575366/

Thank you for the reply. Collateral damage is exactly what I am worried about. A concern reinforced by the fact that the team are having to go back and rework the plan.

I'm not suprised that you weren't offered SABR which, because it so finely targeted,  seems best suited to  those who have just 1,2 or 3 metastases.

Ironically I have just received the results of my most recent PSA test, last tuesday and it has dropped from 4.27 to 2.84 !  I know I was on bicalutimide for about three days but.......

I did not enjoy my 3 days on bicalutamide but this probably rather personal. I am suffering from atrial flutter and waiting for a cardioversion.  One of the side effects of bicalutamide is breathlessness,  atrial flutter also leads to breathlessness.

Best wishes John

Thanks for that though I am not sure I liked the survival rates very much until a bit of research told me that average live expectancy in Brazil is just 72.

I'm not just concerned about life expectancy. I'd like to be free of too many limitations as well and given the location of my single metasis I think I have cause for concern.

The RD&E does seem to have good reputation with SABR and they have been doing longer than most which is encouraging.

Thanks for your reply Confused about SABR I probably didn’t make it clear, but I only currently have 1 bone met and RT was dismissed.  I guess a lot is down to the individual consultants choice, but I have faith in mine and she has done well so far.  Interesting about the PSA reduction.  David

Hi Confused about SABR,

I recently had treatment on my C5 and T4. Both had 6mm tumours on my vertebrae. The Radiology team made a mask which locked me down and reduced any movement. A second mould was created for the T4 tumour. I did 3 days on each tumour. One month on and I have had no side effects, apart from finding it a bit hard to fall asleep. I am not on any medication which is great. It was really easy and painless.

Do you know if you have oligometastatic or metastatic secondary bone cancer. Oligometastatic is still curable.

All of the best.

Munster

That was just the encouraging response I was hoping for. Thank you so very much.

Up to now the only experiences of SABR that I have been able to find relate to other parts of the body whereas you had treatment to C5 which is only two above C7 and therefore much more relevant to me.

My understanding of oligo  is that it means that there are just a few matastases. I did read somewhere that SABR was only suitable for those with three or less and I have just one. Oligo is treatable by SABR whereas widespread metastases aren't because SABR is very focussed which does nothing for a widespread problem.

Hi Confused about SABR 

You will get through this with ease. This is what they may make for you to ensure you keep still. Your definition of Oligo is correct - it means a few and Radiation is very precise and can cure your cancer.

Cheers

Munster

Thanks again for your encouragement.

I have already been kitted out with the hoodie and was due for treatement on Monday. I got a phone call at 1600 on Friday saying that they weren't happy with the existing plan and were going back for a rethink. Good that they are that careful but I have to get psyched up all over again.

Hi David

I was put on enzalutamide instead of Arbiraterone because I had trouble with my heart.

Like you said enzalutamide just makes you fatigued and a little tired, of course we’re all different, but I think you should be fine.

Out of all the treatments I’ve had, this one was easy. You usually have four tablets daily and try to take them at the same time.

If your in pain from anything like back ribs etc, you can still take co codormol or paracetamol, I would get the coated type that way the taste does not linger.

Stay safe

Joe