Still Waiting on Radiation

[JWPMP]

Some of you are familiar with my husband’s case. He has a metal plate and screws in his pelvis. They are having a terrible time getting clear pictures of his prostate. Sent him out to an Advanced Imaging facility and still no luck. They are going to look at the mpMRI from UCSF and see if that helps. There is a possibility that they may not be able to do EBRT.

Dr Ghiam (Modesto RO) says that radiating the Prostrate for low volume disease is very new and may not even make that big of a difference...is that so??

Also, they may consider going back to brachytherapy if they can't do EBRT. Which I wish they would have just stuck with that plan, not sure why they changed it.

I am going to contact our RO at UCSF if this local RO is unable to proceed.

Any thoughts on our situation?

Thank you

Paula

[Tall_Allen]

I hope they are able to get a good image to work off of.

"radiating the Prostrate for low volume disease is very new and may not even make that big of a difference...is that so??" Well, if is newish (September 2018). What they found is that if there were less than 4 distant metastases, there was still an advantage in radiating the prostate:

prostatecancer.news/2018/09...

Now he had "several" cancerous extra-pelvic lymph nodes, but they were found on a PSMA PET/CT scan. If they were found on a bone scan/CT instead, it might be an indicator that there would be no benefit in radiating the prostate.

They should be able to do prostate brachytherapy at UCSF under ultrasound guidance, no?

[JWPMP in reply to Tall_Allen]

Thank you for the information and the link. Great to know!Not sure if it matters, but the extra pelvic nodes were not enlarged at all.Anyway, I'm not sure why they canceled his HDR Brachytherapy in favor of EBRT in the first place, other than originally they were going do both then when they found the bone spot changed the plan. But they all knew he had massive amounts of metal so don't know why they've messed around all these months.

Jim's stress level is off the charts now, which can't be good for him.

Hopefully UCSF will do the brachytherapy, as this local RO didn't sound optimistic for getting clear pictures.

Really appreciate your time more than you know.

[JWPMP in reply to Tall_Allen]

one more question.did I understand correctly, that the time of start of ADT to start of RT was also significant? Jim started Lupron in January and Zytiga in March. Have we passed the effective timeliness for RT?

Thank you again

[Tall_Allen in reply to JWPMP]

At least 2 months is good. It doesn't matter if it's more than 2 months. As long as he's still hormone-sensitive, he's fine.

[JWPMP in reply to Tall_Allen]

Oh fantastic Thank you

[cesces]

If radiation won't work, then why keep using it.

You have all these radiation oncologists and no medical oncologists? I think you got it backwards.

Hurry up and get some second opinions from some medical oncologists. They will focus on drugs and chemo treatments.

If it has metastasized, radiation is probably the wrong tool.

If he is not already on androgen deprivation therapy, he should be on it yesterday.

[JWPMP in reply to cesces]

Thank you.Yes he has an MO at UCSF. He started 4-month Lupron injections in January 2021 and Zytiga March.

Radiation will work, but due to a previous injury, Jim has a titanium plate and large screws in his pelvic bone which has completely complicated a normally "simple" procedure. He also has a metal hip replacement. And had RT to the same region 29 years ago. Soo...here we are

[cesces in reply to JWPMP]

It may be radiation treatment just isn't right for him.

It's not the worst thing in the world. There are lots of treatment options.