I saw my radiation oncologist as planned and we discussed the likely scenarios as to how the PC spread. It's worth noting that the radiation treatment (5 sessions of SBRT) in late 2022 appears to have been very effective. There is no sign of PC in the area treated. This suggests that some PC cells left the gland prior to that treatment and lodged themselves elsewhere. They didn't show up on the scans from 2022 because there were likely very few cells that had migrated and thus they were below the detection limit of the scanner. Over time that small number can grow and the PC becomes evident.
Today the PC cells are visible in one para aortic lymph node, but that doesn't mean there are no other locations. They could be anywhere, but again, at too low of a number to detect.
We moved on to possible treatments. One option is androgen deprivation therapy (ADT). This blocks the production of testosterone, a hormone thought to support the PC growth. The benefit of this approach is that it is systemic and it would starve PC cells anywhere in the body. Unfortunately this treatment has extensive side effects including loss of bone density, loss of muscle mass, fatigue, and a complete lack of libido. I experienced this once for about 6 months and it was awful. Often this treatment stops working after a few years. So it can create a period of time when you are not growing any PC but your quality of life is diminished during that time. If/when the PC returns then you're off to some other therapy, maybe, or you succumb to the PC.
Another option is more radiation therapy, and it breaks down to two approaches. The first is to blast the single lymph node known to be cancerous. This requires 5 sessions in the treatment machine. The second is to blast a whole group of nodes in the same area, the thought being that one or more of them may contain PC cells (too few to detect) so you blast them all with the hope of nipping it in the bud. This requires 28 sessions in the treatment machine. Side effects would be more pronounced than the single lymph node approach. With either approach, it's possible that there are PC cells elsewhere in the body so the radiation therapy may simply fail. It may be possible to switch to ADT at that time but it's not clear if that would be effective.
My next step is to meet with the medical oncologist who would be handling the ADT therapy and get his views on this. And finally, I need to check with two different surgeons who have treated me for mesothelioma (chest and abdomen) and see if there are any conflicts with the proposed PC treatments. I have to watch my back on this. Given the long history of cancer and treatments and the damage some of them has done, I can't assume that everything is compatible when in fact there may be a conflict that is counterproductive.
This is the information I have to inform making a decision. There are a lot of unknowns.
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