Hello again. Gleason 4+3+7, Grade 3, Stage IIc cancer, Tumor cT1c, N0M0, PSA 7.4 (5 weeks ago on biopsy; 10.4 last week). Prostate volume 52 cc. Neither MRI nor ultrasound detected a tumor. Enlarged prostate is pressing on urethral area. Calcifications throughout. Unfavorable. Will have PSMA/PET in 2 days. Age 76 w/Parkinsons's, but fully mobile and (almost) 100% sane, according to spouse.
RO says to do EBRT and ADT, w/prophylactic radiation to all lymph nodes. Or, proton therapy w/ADT. (Already signed up for consult w/proton @UFPTI/Jax)
I'm wondering why not advise SBRT? Can SBRT also be used prophylactically on lymph nodes? I'm trying to do the least harmful treatment with the greatest benefits.
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conchjoe
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RO used the term 'prophylactic' meaning he wouldn't wait until the cancer in the lymph nodes showed up on a scan, but would prefer to treat the nodes as if they already had cancer, whether it shows up at this time or not.
Then you are stage T1c, and "unfavorable intermediate risk." Unless your PSMA PET shows evidence of lymph node spread, radiation there constitutes overtreatment. The clinical trial in Florida is worth considering. Or you can just have SBRT - I can recommend Debra Freeman in Tampa Bay. Or you can have HDR brachytherapy monotherapy with Matthew Biagioli in Orlando.
"Unless your PSMA PET shows evidence of lymph node spread, radiation there constitutes overtreatment" - I don't understand the basis for such a broad statement.
In my view, killing cancer tumors before they appear on scans is a good thing.
The OP has no evidence that the cancer has spread beyond the prostate, and has low risk for that according to his risk characteristics. One doesn't treat what one has little risk for. He has every reason to believe that his risk characteristics (PSA,stage and grade) fully describe his probability of success with standard-of-care treatment.
I know an RO who radiates not just the affected lymph node with his Cyberknife system but also the lymph nodes next to the affected one. This is 'prophylactic'.
The RO said at this time I have a chance of 17% lymph node involvement, therefore, better to take preventive measures now than extensive treatment later, ie, when I'm 81 or something.
Hello Joe, I can share how I ended up going with proton therapy with a little history..my father who was diagnosed with prostate cancer at age 67 some 34yrs ago had radiation therapy and hormone treatments that did not make a difference he passed at age 70.His youngest brother age 62 at the time witnessed this and was diagnosed with prostate cancer and sought out alternatives and found Proton Therapy. Early trials were being done at Loma Linda with a younger Dr Rossi.
From what I understand it was not nearly as refined as it today..fast forward 28 yrs he was vibrant to the age of 90 when he passed.
He attributed this to the proton therapy with a vigilance for balanced nutrition,exercise,and staying away from the sugars.
With that being said when my older brother age 56 at the time was diagnosed with
Gleason score similar to yours & mine he went for RP he didn't want to take any chances. After 4 yrs he had re occurrence in his lymph nodes, he wished he had done radiation of the pelvic floor. It was never presented to him.
So he has been tenacious over the past 13 yrs having lymph nodes removed. Intermitent hormone therapy, xandi, and many different therapies this has been keeping it suppressed. He has stayed vigilant and educating himself constantly..
So as a witness to all of these things, I was reading articles & lectures following the emerging therapies that my brother was sharing. Ultrasound oblation, cyberknife, proton therapy, brachytherapy, Imrt.
So many choices, but they get narrowed down pretty quick once the doctors review what you qualify for based on your biopsy..
So here are my results from 3 1/2 yrs ago.
58 Y old male with clinical stage T1cN0M0 adenocarcinoma of the prostate, Gleason score: 4 + 3= 7 with 3 of 14 cores positive, Gleason 3+4 in 1/14 cores, and Gleason 3+3 in 3/14 cores on on TRUS biopsy of the prostate on 10/8/19. Pretreatment PSA of 7.4 on 7/29/19. IPSS score: 15 / 35;
So two months later the psa had only risen to 7.9
I then had one 4 month dose of lupron and reviewed the many options available to me.
I went with the G.O.A.T. Dr. Rossi at California Protons.
I figured the therapy was at the peak of refinement as well as the same doctor that was early in his career at Loma Linda 30 yrs ago.
But above all I think confidence and comfort level with the doctors is top priority.
I noticed many of the doctors along the way have so much invested in time, talent, and finances that some lose their objectivity.
Case and point, the robotic surgeon leaned forward looked me in the eye and gestured "0" Psa that is what will happen if he does "RP" I thought to myself, tell that to my brother..
I hope you find the right treatment and are confident in your choice..
Saw the Cyberknife doc today, really liked him. Great guy! He was honest enough tell me that, given my records, he was 'okay' with doing Cyberknife - although he's going to wait on my Decipher score - but he would be more comfortable with me doing EBRT or Proton. The other RO I saw, who would do EBRT on me, also thought proton would be a good choice. So that's 2 ROs who are advising me to seek a treatment they don't offer. I guess that speaks highly of the proton therapy - and the honesty of the doctors.
That is good to hear, It sounds like you are thoroughly researching your options. I agree with Tall Allen the number of comparative studies for early stage are limited..I believe the expense of the equipment has made it a technology in its current form will sunset in the next 10 yrs.
Unless they are able to modify the process to compete with outpatient focused therapies that can reach a larger volume of the population.
But at the same time the proton equipment and personal are veterans of their processes..
One example:I was not aware that SpaceOAR hydrogel was being offered until I went for my proton consult..
I hadn't seen or heard of this even though I had attended multiple radiation options Q&A classes..
Again,It's great that you are in early stages and able to step back for that 1000 ft view.
Tall Allen may correct me but, to my limited knowledge, there are no (peer reviewed) studies that indicate that proton therapy is 'better' than SBRT for low-grade prostate cancer. On the other hand, proton therapy may well 'work' for your situation.
I had proton therapy in Seoul, South Korea in 2012. Very successful and have had no real side effects. Would go down this path again if I had a positive diagnosis now.
I wrote three books on my journey and reviewed all 10 therapies that are available to treat early stage PCa. 3rd Edition An ABC of Prostate Cancer Today available from Amazon.
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