Another Radiation Delay

[JWPMP]

So Jim had his CT simulation scan at the RO facility (here locally) on June 25th.. The RO of course, knows of all the metal in Jim's pelvic area, no surprise. They spoke about it in detail with the UCSF tumor board...thats been the monkey in the wrench from the start, ssooo...

(FYI he's supposed to be having EBRT to the prostate 20 treatments)

So two weeks and two days later, (after messaging and calling) we get a call. Due to all the metal, they can't get a clear picture at their facility they need better equipment. I asked her (Jim's case manager) if there's a possibility that Jim won't be able to have RT and she said she has no idea she doesn't understand the whole thing.

Ssooo, with Jim's numbers so good ( 0.1 PSA <10 T) how much is another delay going to hurt him??? I've messaged Dr Mohamad at UCSF, but as I wait for an answer I'm getting anxious again. I just can't believe that it's been this much trouble getting his radiation treatments...just one thing after another.

And once again, thank you all...

Paula

[Hidden]

I think your okay...ADT freezes the progression and will kill a bunch...it's suppose to make the radiation more effective. You can relax..your probably talking another week of delay...no biggie iIMO

[JWPMP in reply to Hidden]

Thank you!The original plan was to start in March, but they needed to shrink the tumor more. The plan went to May. Then they changed to the beginning of July. Now it's looking August because they're having a hard time finding a facility to work with...not really understanding that but...

Appreciate the input

[Wordman in reply to JWPMP]

My husband had delays, also, which were very frustrating and scary. However he is now almost finished with his radiation therapy. Recent CAT and Bone scans were very good so the delay really didn’t hurt anything. Best wishes!

[JWPMP in reply to Wordman]

Thank you for sharing that!Everything with his plan has been derailed since February and it's quite stressful. I'm starting to worry they aren't going to be able to do the radiation because they repeatedly tell us how complicated Jim's case is...

thank you again and so glad to hear you're getting such good results!!!

[Tall_Allen]

I know at UCLA they have a CT machine that's supposed to show fewer artifacts. I'd guess they have it at UCSF too.

[JWPMP in reply to Tall_Allen]

Thank you.That's a relief to know.

[JWPMP in reply to Tall_Allen]

Are there any guidelines regarding the start of ADT and the commencement of Radiation Therapy to the prostate, or is it random from man to man like everything else about this disease. Thank you

[Tall_Allen in reply to JWPMP]

Usually wait 2 months, but can wait much longer. As long as ADT has stopped cancer activity, it's OK. In his case, the radiation is debulking (rather than curative). Consider intensive systemic treatment with chemo and Zytiga per PEACE1.

[Tall_Allen in reply to Tall_Allen]

Correction- I read he has already begun Zytiga. Probably too late to begin chemo.

[JWPMP in reply to Tall_Allen]

He started Zytiga in March.The original plan was to start it After RT. But the end of February, after discussing with the board, due to his previous RT and extensive hardware in the pelvic region, they had to drastically reduce radiation plan. (which was originally 45 treatments to the entire prostate bed and the two positive pelvic nodes)

They decided to do HDR Brachytherapy followed by EBRT 20 sessions in May. So they wanted to reduce the prostate tumor as much and quickly as possible, so they started Zytiga early. Then in May after the PSMA scan found the suspicious bone spot, they canceled the Brachytherapy and opted for just EBRT to Prostate only, no nodes, then SBRT to bone spot. But it seems now we are at another obstacle.

I also asked his MO about the PEACE-1 study adding chemo to the Lupron/Zytiga and she said that wasn't indicated for Jim's case at this time. So I have no idea what's next other than waiting to hear from the Drs about a better CT scan.

[Dett in reply to Tall_Allen]

TA, why is it too late to begin chemo? I thought chemo was the conventional next step after Zytiga or equivalent (for those who did not do chemo first). This is getting confusing.

[Tall_Allen in reply to Dett]

Because Zytiga causes cellular senescence, so docetaxel may not do much until after Zytiga begins to fail.

[JWPMP in reply to Tall_Allen]

thank you I was wondering also. But I thought that PEACE-1 trial was the one that said adding chemo as the third wheel was showing good results...anyway, my brain is overloaded and really appreciate your time

[Tall_Allen in reply to JWPMP]

Peace-1 said adding abiraterone as the 3rd wheel showed good results. That was true when abiraterone started concurrently with chemo or after chemo.

[JWPMP in reply to Tall_Allen]

Oh! Didn't understand the importance of timing...Of course there's a whole lot more I don't understand about all of this than what I do manage to wrap my brain around...

Thank you again

[Tall_Allen in reply to JWPMP]

I want you to understand that this is mere conjecture on my part. All I can say for sure is that docetaxel started before or concurrently with abiraterone markedly slows progression. Eventually we will have better clinical data.

[Dett in reply to Tall_Allen]

Got it (I think). So I guess you either have chemo before or at the same time as starting Zytiga, or you wait until castrate resistant so the chemo has something to attack. That would explain why a recent poster was advised to discontinue Zytiga for several months before chemo. Thanks.

[Spyder54 in reply to Dett]

I met with a new Oncologist, Dr Carlos Alemany, in Orlando last month, he said, with you on Lupron and Zytiga, your cells are in sennescence. He said the Docetaxel only works when PCa cells are dividing and multiplying rapidly. Further, if we give you Docetaxel now it will be of no benefit. I then brought up the PEACE Trial, and he said I would have needed Chemo first. He added, when you become Castration Resistant, then we can start Chemo.So strange/frustrating for me 9 months from Dx:

No Chemo=later

No Surgery=too dangerous making me worse off

No Bracchy Radiation plus boost

No SABR/SBRT Rad. of multiple lymph nodes because there is no curative benefit but risk of lymph edema.

STUCK on the ADT TRAIN passing all the known Starions. Maybe its good news? Such a crazy slo-mo bad dream.