My treatments to date

[Canton44]

Dx 1.5 years ago with Gleason 9, Mets to bladder and pelvic bone. PSA at Dx was 3.45! PCa was found during a TURP surgery. Started Lupron and Erleada. PSA has been undetectable since. Testosterone is basically zero 🙄. Recently had 37 rounds of RT to all sites, and Brachytherapy. Will be having 10 more rounds of RT next month (EBRT). Any thoughts on my treatment decision path? Good or bad?

[LearnAll]

Your treatment is aggressive.... But it is needed as your PCa seems aggressive based on initial low PSA (3.5) and Bladder Metastasis (Visceral met)Keep PSA and T near zero like it is right now.

[Canton44 in reply to LearnAll]

Thanks!

[Hidden]

Next treatment will probably be Taxotere

[Tall_Allen]

Why weren't the 10 rounds of RT next month (I assume those are for the pelvic metastases) done at the same time as the 37 rounds of RT? And why so many? It's usually done in many fewer treatments.

[Canton44 in reply to Tall_Allen]

Thanks TA. The 37 rounds of EBRT were focused to all areas of PC (prostate, bladder and pelvic bones) Then (directly after these 37 rounds) brachytherapy seeds were implanted into my prostate. Final 10 EBRT sessions will focus on my lymph nodes (even tho scans claim PC is not detectable in my lymph nodes.

[Canton44 in reply to Canton44]

Thoughts?

[Tall_Allen in reply to Canton44]

Brachy boost therapy is usually done with only 20-25 TOTAL external beam treatments. That would include the pelvic lymph nodes, the prostate, the bladder, and the pelvic bone metastases. However, if you're in the US, your RO is compensated by the number of treatments, which is probably why he dragged it out.

Your pelvic LNs don't have to show up on a scan to warrant treatment. With your risk factors, they should be treated.

[Canton44 in reply to Tall_Allen]

Agree, he is getting very aggressive with me, as I wanted. He is a very successful RO that does PC only, really good success rates.

[Canton44 in reply to Canton44]

He uses 4D Doppler ultrasound, DART radiation, and his specialty is Brachytherapy. I believe he “sees” PC and “hits”it better than most.

[Tall_Allen in reply to Canton44]

Sounds like hype to me - he is clearly making a lot of money off of you

[Canton44 in reply to Tall_Allen]

Thanks TA. I certainly agree that could be a possibility.

[Canton44 in reply to Tall_Allen]

Have you heard of a PCa doc named Snuffy Myers?

[Tall_Allen in reply to Canton44]

Yes, of course. He's retired.

[Canton44 in reply to Tall_Allen]

When Snuffy got PCa himself, he went to the RO I am going to.

[Tall_Allen in reply to Canton44]

Snuffy was hardly an expert at radiation oncology. It sounds like you've been fed a lot of kool-aid. I know Dattoli reduces the dose per treatment in order to bill for more treatments. I don't think there is any harm in it to the patient, nor in separating treatments for the different areas (other than outrageous medical bills). The trend in radiation treatment has been going in the other direction for some years now - towards moderate or extreme hypofractionation. It has been proven to be equally effective and no more toxic, while being more convenient and cheaper for the patient. However, it puts a real dent in RO billings.

BTW- nearby is one of the original innovators in brachy boost therapy, John Sylvester.

[Canton44 in reply to Tall_Allen]

Very interesting TA, your thoughts, views are always appreciated !!

[Canton44 in reply to Canton44]

SBRT does make sense, I get it. I just chose the lengthy IMRT. Praying for good results. Wondering, if “down the road” I will be able to have SBRT?

[Tall_Allen in reply to Canton44]

You mean as salvage? Yes:

prostatecancer.news/2016/08...

[nonm in reply to Tall_Allen]

the brutal truth has value.

[j-o-h-n]

TA is on the ball...........

Ask the doc "how does he like his new mercedes?"

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/14/2021 6:07 PM DST

[Canton44 in reply to j-o-h-n]

I am not as concerned about the cost as I am the right treatments. Thankfully, good healthcare.

[j-o-h-n in reply to Canton44]

Good attitude....for someone in China...........

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/14/2021 6:34 PM DST

[Canton44 in reply to j-o-h-n]

???

[j-o-h-n in reply to Canton44]

Canton China...a/k/a Kwangchow

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/14/2021 6:41 PM DST

[Canton44 in reply to j-o-h-n]

I’m not from China

[j-o-h-n]

Sorry.......... I'm not either..........

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 03/14/2021 7:13 PM DST