Hypofractionated SBRT for Prostate,local and distant nodes

[pj1121]

Hi all

I am happy with my MO and treatment at Kaiser, 3 months on Lupron then added abiraterone 1 month ago. Responsive PSA, started at 300, after 1 month 33 after 3 months 1. I’m oligometastatic with local and retropineal lymph nodes. 2nd opinion from UCSF Medical oncologist suggested I do prostate, local and distant lymph nodes in hopes of possibly being able to take ADT “vacations” in a couple of years. My Kaiser MO agrees it could work and says, “There is no evidence to support this in oligometastatic disease but we do this sometimes based on extrapolation of data from patients with local lymph node metastases via standard CT imaging.” My Kaiser Radio oncologist says he can do it if I want, but, “prostate only radiotherapy is science doing the lymph nodes is based on hope.”

I’ve decided to do it, Treatment would be Hypofractionation SBRT of 70 Gy total by 28 treatments equaling 2.5 Gy per treatment to the prostate, local and retropineal lymph nodes. Any feedback or thoughts on trials, studies, personal experience or speculation would be greatly appreciated.

Thanks

PJ

[Tall_Allen]

Just some terminology - that is called "moderately hypofractionated" not SBRT. Here is a clinical trial you can join. There will be another (hopefully, starting in the next few months) clinical trial using SBRT:

classic.clinicaltrials.gov/...

[Hidden in reply to Tall_Allen]

He probably meant EBRT.

is 28 X 2.5Gy even close to being called hypofractionated, let a lone moderately hypofractionated?

[Tall_Allen in reply to Hidden]

"Normal fractionation" is 1.8 or 2.0 Gy/fraction; "Moderate hypofractionation" is >2.0 and 5.0 Gy/fx.

[maley2711 in reply to Tall_Allen]

why would someone want to be part of that trial.....to "test' if a new treatment is not inferior?

[Tall_Allen in reply to maley2711]

Because the researchers have equipoise between the alternatives- they don't know which, if either, is inferior.

Because the care and attention one gets on a clinical trial is the best.

Because it helps others.

[pj1121 in reply to Tall_Allen]

good point - it helps others

[jackwfrench in reply to Tall_Allen]

Hi Tall_Allen - if this included post RP I would be interested, SBRT too - I cant get to a clinic that agrees to radiate me short of 37 sessions within 100 miles, how might I search?

[Tall_Allen in reply to jackwfrench]

No -it is only for primary treatment. Moderate hypofractionation post-prostatectomy is used, but you have to call around.

prostatecancer.news/2016/08...

[maley2711]

Also with Kaiser in Oregon......has your RO mentioned placement of fiducials for image guidance?

[pj1121 in reply to maley2711]

Yes I have fiducials in place. I agree, to me the only reason to take part in a trial is if you cannot get a particular treatment otherwise.

[maley2711 in reply to pj1121]

Where do you access your Kaiser clinics? RO here said no fiducials....only for SBRT.

[pj1121 in reply to maley2711]

my ro Oakland reccomended it I am getting SBRT

[maley2711 in reply to pj1121]

Thanks..yes I think the RO here mentioned with SBRT...did you also discuss hypofractionation 20-28 sessions, with/without fiducials?

[pj1121 in reply to maley2711]

Yes 28 session with markers

[maley2711 in reply to pj1121]

would the markers have been placed even if you had never discussed possibility of SBRT???

[pj1121 in reply to maley2711]

I was reccomended sbrt from start by mo and ro no other discussions

[maley2711 in reply to pj1121]

28 sessions is not SBRT...apparently you are having what is now called hypofractionation. SBRT is very high dose radiation over 4-8 days

[cesanon]

It should be done by someone that regularly does this as part of their practice.

You should get an opinion from an imrt radiation guy and a sbrt radiation guy.

I had oligmetastic radiation. It worked out ok. Though it seems like it killed off most of my irreplaceable cd4 t cells.

[pj1121]

Good advice. Would you mind telling me what your regimen was? Type, total Gy, fractions, results, any other side effects other than cd4 tcells. I understand if you dont want to share

Thank you

Pj1121

[j-o-h-n]

Sorry, but I had to research two words: Hypofractionated and extrapolation. Thanks....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/07/2023 2:27 PM DST

[j-o-h-n in reply to j-o-h-n]

Thanks to T_A I had to add another word: equipoise........... Man oh Man it's like English Class of the 50's.....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/07/2023 2:32 PM DST

[Mgtd]

Not sure if we are talking apples to apples but I had 25 sessions to the prostate and pelvic lymph node area. Honestly do not know the strength of each sessions. Treating the pelvic area was suggested by the RO to kill any microscopic cancer cells and hopefully control future spread. I did some research at the time and it seemed reasonable so I said OK.

Minor diarrhea at week three of radiation, normal radiation fatigue. The diarrhea was Controlled fairly easily and a short afternoon nap helped the fatigue. My six month follow up with the RO is in January. Three month follow up where both PSA and testosterone were indictable. My prior and after radiation shots of Lupron runs out this month. Hoping that my testosterone level returns to where it was (787). Thirty percent chance that will not happen at my age and if it does it could take up to 15 to 18 months.

I do aerobic walking and resistance training. Started that four months prior to radiation. I have lost 12 pounds and seems to have helped with Lupron side effects.

Hope this is what you asked for in your original post.

[Jewelrylady in reply to Mgtd]

did you have spaceoar prior to radiation?

[Mgtd in reply to Jewelrylady]

Yes it was inserted one week prior to beginning radiation. No real effective pain killer. I also had three gold fiducial markers at the same time. I began a special diet given by the nutritionist. That was to reduce gastrointestinal gas, etc.

Any other questions just ask.

[Jewelrylady in reply to Mgtd]

My husband was told to take Beano to reduce gas prior to mapping this Monday. He also needs to eat a low fiber diet. They will let him know his SBRT schedule at that time. Do you feel the spaceoar helped? Are you feeling ok now?

[Mgtd in reply to Jewelrylady]

No way to really tell