This is an update regarding my 79 year old father who was recently diagnosed with PCa (Gleason 9, PSA 14.1, 12 core biopsy, all of which contained cancer).
I originally posted about my father's PCa diagnosis here: healthunlocked.com/advanced...
The CT and Bone scans both came back as negative regarding the PCa having metastasized. With that being said, the urologist said he would not be surprised if it has microscopically spread (micro-metastasized) based on Gleason 9 and 12/12 of the cores coming back as positive for Adenocarcinoma PCa.
His recommended course of treatment is 8 weeks of IMRT (after 8 weeks of ADT) and 2 years of ADT and 3 month intervals for monitoring PSA levels. ADT would be Bicalutamide and Eligard.
I asked for a PET scan and he said there was no clinical reason to do so.
On Monday we will be travelling to University of Michigan's Rogel Cancer Center for a second opinion. We meet separately with a Radiologist Oncologist and a Surgical Oncologist, but both are part of a "multi-disciplinary team" for PCa.
These URLs are scans of his pathology report:
14.100 ng/mL = Date: Apr, 2019
9.120 ng/mL = Date: Oct, 2018
5.470 ng/mL = Date: Aug, 2016
4.790 ng/mL = Date: Apr, 2016
3.520 ng/mL = Date: Sep, 2015
1.800 ng/mL = Date: Oct, 2014
1.520 ng/mL = Date: Jan, 2013
1.4 ng/mL = Date: Jan, 2012
I'm not sure what I am asking for here, other than any insight/comments regarding his original Uro's treatment plan, and anything specific that I should be asking the UofM docs on Monday. My father wants his prostate to be removed, but I'm inclined to see what each of his doctors say and come up with a pro/con list and go from there.
Brachy boost therapy has much better outcomes than IMRT radiation alone or surgery:
I recommend you speak to Daniel Spratt at the U of Mich. I think that a PET scan is a good idea, but it will be hard to get for a high risk patient (insurance probably won't cover it), unless they have a clinical trial going on. The reason why it's a good idea is to see if there are any detectable pelvic lymph nodes and to rule out distant metastases.
Thanks, Tall_Allen, we are meeting with Dr. Spratt.
A question for you Tall_Allen. Is standard protocol for "brachy boost" for the seeds to be implanted prior to EBRT or after EBRT? Does the standard 8 week EBRT still apply or is it shorter?
Finally, since I will be driving him to and fro NW Ohio to Ann Arbor (about an 1.5 hours each way), should I be "concerned" about radiation exposure from the brachy boost seeds?
The order does not matter - some brachy docs prefer one or the other. It's 25 treatments of EBRT over 5 weeks.
If you are coming from NW Ohio, you may want to meet with Alvaro Martinez in Detroit. He was a pioneer of HDR brachytherapy. You can have the EBRT done locally.
Thank you for the reply, I appreciate your knowledge and help!
In reading these articles, it appears that 3DCRT is better than IMRT. Am I interpreting that correctly? As a follow-up question, are all 3DCRTs/IMRTs created equal - i.e. would the success rate be the same with an IMRT treatment with a technician at Rogel vs. an IMRT treatment with a technician at a hospital in Toledo, OH.
The opposite - IMRT has supplanted 3DCRT for prostate radiation.