RP/ Radiation/ ADT? OR
Radiation/ adt?
Radiation/ adt/ brachy boost (if one does not have size limitations)
I suspect there are new people and friends we haven’t met yet who would be interested in your responses.
My husband, the dachshunds, the big dog, the cat, and our 3 sons all thank you in advance for sharing.
What about: ADT/brachy boost?
I’ve ammended the post to include brachy boost.
I did hear back from Dr Kishan and he did say that even if my husband’s prostate shrunk the max expected from adt it would still be too big for brachy boost😪. And I was not happy to hear it, because I have read the good studies you’ve posted on it Tall_Allen.
Have you met with Albert Chang at UCLA? (He's the one that actually does the HDR brachy part). You can email Kishan these references (please feel free to use my name):
redjournal.org/article/S036...
brachyjournal.com/article/S...
But if you think this is beating a dead horse, I hope you talk to Dr King about SBRT monotherapy then. See this link:
ro-journal.biomedcentral.co...
Also speak to Mitchell Kamrava at Cedars-Sinai
Hi Tall_Allen
We have not met with Dr Chang. I did just email your references to Dr Kishan asking for his opinion and I’ll post once I have it.
Thank you for being a tireless advocate for people living with PC.
This disease needs more advocates. TheQOL impacts are so extraordinary. I had no idea until we were walloped.
I’m happy to have evaded surgery ..
Tall Allen
Why not:
1. adt right away without delay to soften it up.
2. Then some sbrt. (Making sure to use the most current machines)
3. Followed off with brachytherapy.
Is brachyboost different from normal brachytherapy?
Brachy boost therapy means external beam IMRT with a brachytherapy boost to the prostate itself. Why would you do sbrt and brachytherapy?
"Why would you do sbrt and brachytherapy?" Tall Allen
More is better?
I had IMRT & brachytherapy at Dattoli. It seems to me that SBRT is better than IMRT generally.
Though my analysis and thought process on these things is admittedly not as well refined or as well informed as yours. (I do learn a lot from your commentary)
So why "IMRT with a brachytherapy" and not "sbrt and brachytherapy"? It would seem that the only difference is that SBRT is more precise, with fewer treatments? I would think that would be better? No?
No - the results of SBRT and IMRT are comparable. The main advantage is 5 treatments vs 44 treatments. IMRT may be less toxic for treating areas outside of the prostate (it is unknown). I know Zelefsky at MSK had a trial using both, but I don't see the advantage.
The second alternative is not "ADT/radiation" but "ADT/radiation/36 months ADT"
There is another alternative: "Surgery/24 months ADT". In this study, 87% of the patients in the control arm treated this way were alive after ten years. 13% died overall and only 2.3% died of prostate cancer.
ncbi.nlm.nih.gov/pmc/articl...
Personally, I just don't like getting cut. And too many opportunities for them to cut where they shouldn't and end up in diapers.
And they never seem to be honest about the incidence of leakage. Seems you have to end up with a a lot of leakage before they even acknowledge it as an adverse event.
Screw the surgery.
If the Pca has spread beyond the prostate ADT then radiation would be the way to go.
In the study I cited, 16% of the patients had N1, i.e. local mets. So the ADT was sufficient to control these. I also think it will not make a significant difference whether you have an extended lymph node dissection or pelvic radiation.
Knowing what I know now, I wouldn't do any of those. I'd look for a treatment that made a significant difference in overall mortality after 10 years.
Any suggestions for unconventional approaches that make an appreciable difference in survival?
Thank you FCoffey.
None with strong evidence. I'm in the same boat, stage 4 with local lymph nodes only, no distant mets.
The PROTECT trial did not include men with locally advanced disease, it was limited to localized disease. But it showed no difference in mortality after 10 years for RP, RT, or active surveillance. The number of men needed to treat to prevent one case of distant metastases after 10 years was 27 for RP, 33 for RT. That means that only 3-4% of men got that benefit.
Perhaps those numbers will change for locally advanced disease, but there isn't a compelling argument for that, and I haven't seen any strong evidence.
I’m no expert . No doctor. I had stage #4 t-4 non op . Horse was out of the barn . I did 8 weeks imrt and double adt . It worked thus far for me . Follow your experts advice . I had only two lymph nodes lit up. Whatever is chosen will be the best for him.. Follow competent professional advice . Don’t hinge treatment from on line sources. Take care
Newly-discovered Micro-Mets: What would you do?
How do you know if radiation treatment worked?
Introduction - 56 years old, stage 4 - bone mets, lymph node and likely lung involvement
4 Months ADT or 6 months. 
