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Radiation Oncology • Genitourinary Cancers
How would you treat a newly diagnosed hormone sensitive high risk prostate cancer with one small lung metastasis and no other evidence of metastatic disease per PSMA PET?
Per the NCCN guidelines and clinical trials, the patient does not fit the criteria for low metastatic burden, and therefore the benefit of radiation to the prostate is questionable. (Per NCCN: "Conventional imaging defined number of bony metastases without visceral involvement may be preferred to define candidacy for treatment of the primary tumor".) Would you treat the prostate? Would you treat the lung met? Systemic therapy alone?
Answer from: Radiation Oncologist at Community Practice
I think there is no solid answer to this. De-novo visceral metastases are very rare in mHSPC, and lung-only oligometastases on PSMA-PET are even more rare. Since lung metastases is expected to be visible on CT, this is undeniably a high-volume disease based on the CHAARTED criteria. Patients wi...
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Answer from: Radiation Oncologist at Academic Institution
My preferred management strategy would be related to the likelihood I thought the lung lesion was (1) a prostate cancer metastasis, (2) a primary lung cancer (which can be PSMA+), or (3) a false positive from another process. Lung cancers can be PSMA-avid, and having a lung metastasis at diagno...
Comments
Radiation Oncologist at MultiCare Deaconess Hospital
Dr. @Patel, I very much appreciate your answer! It...
Dr. @Patel, I very much appreciate your answer! It...
Radiation Oncologist at Quillen VA Medical Center
I knew NCCN would be useless for your unique case,...
I knew NCCN would be useless for your unique case,...
Answer from: Radiation Oncologist at Academic Institution
Given the clarifications provided (lung met is biopsy-proven prostate cancer and visible on CT), systemic therapy is clearly the priority. Drs. @Patel and @Felefly have provided nice summaries of the evidence. I assume neuroendocrine was ruled out. Also, this is a great situation for genetic sequenc...