Planned EBRT plan

[davebliz]

Diagnosed in April/18, Gleason 4+4, PSA 38, Stage N1. Been on Firmagon for 3 months, PSA down to 0.44. Met with Radiation Oncologist yesterday and here's his treatment plan. 70-74 Gy, 23 sessions of 2.0 Gy to Prostate and Lymph Nodes and then 15 sessions of 2.0 Gy to Prostate alone. Thoughts on the plan. Thanks.

[Tall_Allen]

Consider a plan with 46 Gy in 23 treatments to whole pelvis (2.0 Gy each) with a brachytherapy boost to the prostate. Among those with high-risk prostate cancer (like yourself), 9-year PSA progression-free survival was 83% for the brachy boost cohort vs. 62% for EBRT-only.

pcnrv.blogspot.com/2017/03/...

You have to meet with a brachytherapy specialist (either kind) to get this treatment. As you can see, the oncological outcomes are much better, but the risk of obstructive urinary problems is greater.

If you go with IMRT-only, you should have about 2 years of ADT with it. If you go with brachy boost therapy, no ADT is needed.

[davebliz in reply to Tall_Allen]

Thanks for the quick reply. Unfortunately my RO said I'm not a good candidate for brachy as I have urinary problems and he is quite concerned it will cause more. How does it sound otherwise?

[Tall_Allen in reply to davebliz]

I think you should hear that from a specialist - preferably in high dose rate brachytherapy. How big is your prostate? Where are you located? I see on your other post that you are taking ADT anyway - that should prevent any urinary difficulties.

[davebliz in reply to Tall_Allen]

Prostate is 49 cc. My RO is a brachy specialist. I'm in Victoria, BC, Canada. Yes, I'm currently on Firmagon and switching to Zoladex. Is it possible to do brachy later after EBRT? Thanks.

[Tall_Allen in reply to davebliz]

The Vancouver BC Cancer Agency is excellent - James Morris, Mira Keyes, or Juanita Crook would be good choices. They are right that the brachytherapy is likely to exacerbate existing urinary retention. They are starting to experiment with high dose rate brachytherapy. In the ASCENDE-RT clinical trial they shrank everyone's prostate first with 8 months of ADT before beginning radiation, and then continued ADT for 4 months. A few months of ADT may clear up your urinary problems, especially if you have enlargement in the transition zone. You can wait to see if the ADT works for you before deciding on which radiation approach is best for you. They did 46 Gy in 23 fractions of EBRT + 115 Gy of I125 seeds.

[j-o-h-n in reply to Tall_Allen]

You keep on amazing me... almost as much as when I wake up "not dead" every morning.

Good Luck and Good Health.

j-o-h-n Sunday 10/07/2018 9:42 PM EDT