(I believe that a breakthrough cure is going to come within the next 5 years that will change the whole approach to treating PCa. In the mean time I am going down the path of SOC because it seem to be the best available choice to make for survival but I want to limit the potential irreversible side effects.)
Has anyone seen a study that shows difference in side effects in length of radiation treatment and difference in daily dose. I know Dr.s have tried to shorten the treatment protocol, especially at the teaching centers where patients come in from out of the area and have to stay at hotels.
The trend has been towards higher doses and fewer treatments.
I am interested in side effects only, not "cure" rates.
Opinions welcome
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hello scout , Im headed for 3 fractions of SBRT to 1 hot lymph node in the pelvic area then 25 more fractions of IMRt to the pelvic area .. The PSMA-Pylarify scan picked that up . But Im thinking that undetectable metasasis were on the move already . .They call mine oligo-metasisis . They say it might be curable ? More like remissions in my mind .I would like to know if any on this great site had a good outcome from 1 hot node ? Thanks
I was offered this option as well but was told by RO that the side effect profile would be 30% chance of each of these occurring ( Bowel, urinary and sexual problems) vs. 20% without the more aggressive SBRT.
You make your bet and take your chances.
Our profiles are very similar except this is my first time through. ( oligo-metaseries . They say it might be curable)
I may be wrong on this, but based on what I have just been reading on this subject, perhaps those SE numbers are short-term and mostly dissipate over 2-4 months? The "late" acute SEs seem to be the most concerning?
I had one positive node and am off all treatment and have full return of testosterone and undetectable PSA. But it is still early. My last 3 month shot of Eligard was in September of 2020.
I haven’t seen enough information about your pathology to know how it compares to mine, even looking through your posts there isn’t much. PSA at diagnosis, your doctors, Gleason etc.
I do wish you the best. Oligometastatic disease is definitely curable, but a number of things have to go right, being lucky not the least of it.
Hypofractionation as a primary treatment has been well studied in 8 major randomized clinical trials. The side effects and the efficacy are no worse. ASTRO, AUA and ASCO strongly recommend it. The only problem is for ROs who are reimbursed by the number of treatments.
In those trials, patients were excluded who have cancer in the lymph nodes. For them, whole pelvic radiation and 2-3 years of ADT is required too. In your case, they would also give a simultaneously integrated boost dose to the known cancerous lymph nodes.
A STAMPEDE trial proved that in metastatic men, SBRT to the prostate (only 5-6 doses) gave the same results as a moderately hypofractionated course of radiation.
Do results measure side effects or only reoccurrence profile?
I am opting for whole pelvic radiation as per your suggestion.
According to the RO I spoke to, higher doses give higher % potential of permanent side effects ( adding SBRT to IMRT).
I am trying to think through that and extrapolate if lower doses over a longer time with IMRT portion will give me a chance for a better side effect profile.
From what I have learned so far I should not expect for radiation to cure me, only prolong my life.
My concern is quality of life, because I believe a cure is near.
My question is will the side effects be less severe with lower doses over a longer time. Clearly insurance companies would prefer fewer sessions but should I?
SOC was 40+sessions for many years, what is the history of the change?
Depends on the machine and the experience/mastership of the operator.
I will give you a mechanical engineering parallel:
A conventional manually-operated lathe in the hands of a fresh machinist will demand many successive passes to bring (safely) the part into dimension. An automated CNC lathe will do it in two passes (one to cut and then to polish by two different tools). The difference is that in the first case any mistake with the cutting tool will have as a consequence the part discarded, so it has to be a slow attentive process.
Back to your original question, if the machine is not of the latest generation and the operator not seasoned enough the probability of a mistake gets higher and hence a lower dose will be less damaging.
because i could not use a space oar, my RO did tell me that if I did the higher dose radiaton there was a risk of rectal ulcer that could conceivably result in my needing a colostomy bag. Maybe that doesn't apply to you if using MRI guided or otherwise, but it pretty well makes the point. I have had zero effects (so far) of 44 IMRT treatments starting in April. Major hassle showing up every day though. Zero effects does not include sexual, since I am still on Lupron, which has really changed things.
Thanks for your reply, although anecdotal, still helpful.I have an enlarged prostate (5x normal size), that is why one of the ROs I consulted with offered the choice of 44. 4 mos. into Lupron and my sex life is still going strong, although sometimes she has to shake and wake me to get started. My interest in initiating is a bit lacking sometimes. ;-((
I completed 6 weekly fractionsof 6 greys in November. I felt wretched before Xmas but now recovered apart from fatigue that I put down to zolodox and Xtandi. But my PSA is not measurable as is the testosterone so, to date, it has proven worthwhile approaching the first anniversary of my diagnosis (3 mets).
True there are near term which generally are over in a year or so for most people. However, after two to three years there can be troublesome cystitis generally in the urethra and anal canal/rectum. Severity varies from person to person.
Not sure if this is relevant for you but I was impressed with this when I was trying to get accepted to a SBRT trial for SRT at UCLA. Dr. Kishan ordered a "swab" test (see Garuda Trial) to determine my sensitivity to toxicity related to higher dose shorter term treatment. I "failed" the test but Dr. Kishan said it had no bearing on IMRT. Maybe this will be relevant for someone. I too feel good things are coming in new cures as I reluctantly head toward SRT. Good luck.
Ok, in May of last year, I went the full pelvic, high dose, 5-treatment route of SBRT from the City of Hope. So far, the side effects are manageable and remain as before.... frequent get-ups to go pee at night. ,PSA never went undetectable. No other obvious side effects, not too concerned with sexual issues at my age... 85.
At the time of radiation, I wanted to have the fewest sessions as possible for me as there are less chances for other damage. RO went from 42 to 28. I did have a Spac-OR. SE seemed no greater than others as discussed while waiting our turns to get zapped. <.1 still. Go to PHX Mayo tomorrow and Tuesday.
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