I have to decide whether to radiate the prostate or not. I was diagnosed in February with Gleason 8 T4N1M1 PC with one met to the hip-bone and 8+ affected lymph nodes in the pelvic area. Currently on Firmagon and Erleada with good response. My PSA is still declining - now at 0.63 (down from a high of 63.3), some hip pain but less than at diagnosis and very tolerable, and I generally feel very good with only hot flashes, mostly at night.
I have discussed triplet therapy with my MO but she is reluctant to go with it until she gets more information on whether it would be beneficial to me (she is waiting to see stratification data).
I have not received any radiation at this point. My RO and I have discussed the STAMPEDE trial that indicates benefits of radiation to the prostate for patients with a low metastatic load. Here is my conundrum: the one met to the hip-bone and the affected lymph nodes in the pelvic area are fairly large, which put me borderline high load. My RO says there is no indication radiation of the prostate will necessarily benefit me because I am tending towards a high load, but there is always the possibility it could be beneficial. We did discuss the possible side effects of radiation.
So, the decision is mine on whether to radiate the prostate or not. If I decide to go ahead, he is recommending 5 fractions of 35 greys delivered every other day. I am seriously considering going ahead. Would like to hear from anyone in a similar situation to mine. Did you choose radiation? What have your side effects been? What made you decide to radiate or not to radiate? Any regrets? I must admit my main concern is possible loss of bowel function because of the radiation. Any thoughts? Also interested in hearing from anyone who has had radiation to the prostate and what negative side effects they have experienced.
Here are the common acute side effects of radiation. Late term rectal side effects are extremely rare.:
The data showing a benefit to prostate debulking with radiation in men with up to 3 mets only counts bone metastases and non-pelvic LNs. Would your RO be willing to give you whole pelvic radiation, or just the prostate? Would he be willing to zap the site on your hip bone too? There is no known benefit, but why not?
The new STAMPEDE data is shows no benefit to docetaxel when there are multiple nodes ± bone metastases.
Thank you. i believe the RO is suggesting only the prostate but I will double check with him. I think he is concerned about damaging other tissue . I think he wants to hold back on radiating the bone as it can increase the risk of bone fracture and may reduce the amount of radiation I could take in the future for relief of bone pain.
You can have SpaceOar hydrogel inserted between the prostate and rectum to reduce the risk of rectal burns.
I had 3x20 Gy of IGRT (with SpaceOar) completed just over a week ago. Minimal side effects. Fatigue during the 20 sessions but improving day by day.
Here's a video that explains the SpaceOar procedure:
Does this stampede trial mean it is worse for men who have lymph node and bone Mets to do docetaxel whom are on Firmagon, Zytiga and Prednisone?
Does Docetaxel make it worse? Or shorten the time to castrate resistance?
My apologies, I need clarity, Thank you
It only applies to newly diagnosed men (and only with lymph nodes detected by CT or MRI imaging). It says that abiraterone is a better initial treatment in that case. Docetaxel should be used afterward.