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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 48801
Experience:  Board Certified Physician
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I'm 63 and have recurrent metastatic prostate cancer, and

Customer Question

I'm 63 and have recurrent metastatic prostate cancer, and have previously had a salvage prostatectomy and a metastasis on 2nd left rib down from top removed with cryosurgery. 9 months later I have rising PSA and so had a choline C11 PET/CT scan. It shows a little uptake of the choline in an aortocaval lymph node which has changed from 6mm in size on a scan 6 months prior to a 8mm now. Can/should this lymph node be removed? (I've been going down the path of treating oligomestastatic prostate cancer by going after each tumor as it appears, rather than going on Androgen Deprivation Therapy.)
Assistant: Are you keeping a personal medical record while dealing with this?
Customer: Yes
Assistant: Anything else in your medical history you think the doctor should know?
Customer: Initial diagnosis of my prostate cancer was 11 years ago. It was T3b N0 Gleason 9 at that time, with extracapsular growth into seminal vesicles. I was treated with External Beam radiation and 12 months hormone therapy. I got 10 years of undetectable PSA out of that. Then with rising PSA found Gleason 9 cancer again in the prostate bed and a lesion on one rib which have both been removed. 9 months later, with rising PSA, I have another lesion at the same site on rib, plus the aortal caval node looking suspicious - but inconclusive.
Submitted: 4 months ago.
Category: Medical
Expert:  Dr. David replied 4 months ago.

This is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 4 months ago.

it sounds like you have been fighting prostate cancer for a long time

it sounds like you are resistant to getting lupron LHRH androgen ablative therapy.

you can try high dose 150mg casodex therapy which can slow down your cancer and treat you all over your body.

treating oligometastasis will not prevent your PSA levels from continuing to go up and will not prevent the next spot of prostate cancer spread.

150 bicalutamide therapy daily will not drop your body's testosterone therapy, but can cause gynecomastia, but this can be prevented by 5 days of radiation therapy to both breast tissue with electron radiation therapy.

let me know if you have questions.