Most likely radiation schedule

[leebeth]

My husband was diagnosed April 2021 with cT3b cN0 cM1b. Extensive mets, skull, shoulder, ribs, spine, pelvis, hips, femurs. Started on ADT and docetaxel. Interim scans show near complete resolution of mets but activity in prostate. Will reevaluate after 6th chemo, but likely course is adding abiraterone or enzalutamide, and radiation to prostate.

We are both still working and live by our calendars. We can relocate to Rochester, MN and work remotely if necessary but it would be great to plan for possible scenarios.

How soon would radiation normally commence? What is the usual course of treatment? What specific clinical features would influence which type of radiation and course of therapy would be recommended?

We don’t know if we have to put all things from mid August and beyond on hold, or if it’s reasonable to think we could be vacationing by October.

Also, putting our house on the market and moving sometime during this, just to complicate things more. It seems like an ideal time to downsize and get to a first floor master situation.

I also assume radiation at Mayo would be better than at our small community hospital…is that accurate?

[Tall_Allen]

Suggest SBRT to prostate - just 5 treatments. I don't think Mayo offers that. Are you in MN?

[leebeth in reply to Tall_Allen]

No, we are in SE WI. The Rad Onc we are referred to specializes in “stereotactic body radiotherapy” so I am hopeful that is what they might offer. We would love just 5 treatments. Is there any downside to that? The rad onc is Sean Park. Is there someone else you would recommend?

[Tall_Allen in reply to leebeth]

I only know of Zachary Morris UW Carbone Cancer Center in Madison or Arica Hirsch at Advocate Lutheran General Hospital in Park Ridge, IL. As I understand your post, the only reason you are contemplating radiation to the prostate is prevent urinary problems. Otherwise, there is no benefit to prostate radiation.

[leebeth in reply to Tall_Allen]

Thanks for those names. Interesting. Both Kwon and our local MO think that since the mets are resolved, with only uptake seen in prostate and seminal vesicle, after 3 chemo treatments, that radiation to the “mothership” or primary tumor will improve overall survival. It won’t?

He has no urinary problems now. I would think radiation would be more likely to cause issues like radiation cystitis or rectal issues.

His local MO is part of Advocate Aurora. If you recommend Dr Hirsch, it should be easy enough to get a second opinion there. Thoughts?

[Tall_Allen in reply to leebeth]

There have been two major clinical trials that have proven without a shred of doubt that there is no survival benefit whatever to treating the prostate unless there are fewer than 4 distant metastases.

prostatecancer.news/2018/09...

I'm surprised that Kwon and your MO don't know this. But Mayo is certainly deficient in good prostate MOs.

It doesn't matter that you have previously shrunk his metastases with chemo - the cancer is still there. Chemo does not cure prostate cancer, unfortunately.

You can extend survival with further systemic treatment, with ADT and Xofigo.

[leebeth in reply to Tall_Allen]

Our MO is not at Mayo. He is local, John Hopkins trained, part of Advocate Aurora. Thank you so much for giving us info upon which to base our discussion.

[GP24]

SBRT means Stereotactic Body RadioTherapy. You can get the five sessions with the RO you are refered to. Some ROs do it in three sessions.

[leebeth in reply to GP24]

Thank you. Is there any reason that would not be preferable? It sounds much better to us!

[GP24]

The SBRT radiation systems are more expensive than the usual IMRT radiation systems. Therefore most ROs have IMRT systems and cannot treat you with SBRT. I personally prefer SBRT or SABR as is called too.

If you want to get the mets radiated in a second step, you can ask your RO if he will take part in this clinical trial which will use SBRT for up to 10 mets:

bmccancer.biomedcentral.com...

clinicaltrials.gov/ct2/show...