Gleason 6 Treatment options .

[Conlig1940]

Has anyone experienced Monotherapy - LDR Brachytherapy , without , EBRT or ADT . for Grade1

( Gleason Score 3+3=6 Prostate Cancer ? OR LDR With EBRT Only ?

[Tall_Allen]

Here are current guidelines:

prostatecancer.news/2017/03...

And monotherapy results:

prostatecancer.news/2016/08...

[Conlig1940 in reply to Tall_Allen]

Thanks Tall_Allen,

Is there anything later than 2017 that you are aware off ?

[Tall_Allen in reply to Conlig1940]

There are no more current guidelines.

[Conlig1940 in reply to Tall_Allen]

Thanks - much appreciated . ( Canada )

[GP24]

I would recommend active surveillance. You can live with your cancer at least 15 years without treatment. Then you are 100 years old. See this study:

nejm.org/doi/full/10.1056/N...

[Conlig1940 in reply to GP24]

Thanks for your timely response - it's very much appreciated .

At this juncture - prior to consulting with my Urologist and Radiation Oncologist , I am leaning heavily towards "Active Surviellance " which is more rigorous than " Active Monotoring " .

[addicted2cycling in reply to Conlig1940]

Conlig1940 wrote -- " ... I am leaning heavily towards "Active Surviellance " which is more rigorous than " Active Monotoring " . "

With in-depth information regarding your complete diagnosis your *leaning heavily towards "Active Surveillance" seems to be a reasonable way to proceed at this time.

p.s. -- I was recently diagnosed with 3 recurring 3+3 spots in the remaining left half of my prostate and have chosen to monitor my situation. Would sound reasonable enough but in 2015 the right half of my Gleason 10 prostate was cryo-ablated. NOT SOC for sure.

[MikeUSNA64]

No, but I had localized Gleason 7 (4/3). I went to a highly recommended doctor, and he prescribed ADT, radiation, and Brachytherapy. Started with ADT. Felt terrible. Getting ready for radiation, he did a scan of the prostate. Send to urologist who was going to operate to trim my prostate before radiation. Went to the Cleveland Clinic for a second opinion. Change to Cleveland Clinic doctor. Got monotherapy, i.e., only brachytherapy. Now 5 years and PSA <.09.

[Conlig1940 in reply to MikeUSNA64]

I agree ADT is tough road . I would avoid at all costs if possible .

Both my brother-in-laws , one in the USA and one in the U.K. , were on ADT .

They maintained it was worse than the cancer - sick as hell plus other side effects .

Temporary blackout crashed his car , later a heart attack .

[Conlig1940 in reply to MikeUSNA64]

Re: Your Brachytherapy alone -- 2nd Opinion .

Any side effects and did the Cleveland Clinic suggest reducing the size of your prostate , via ADT or Trimming prior to placing the seeds ?

Reducing a large prostate improves the positioning of the seeds .

[Conlig1940 in reply to MikeUSNA64]

Yes . Many Urologists favour performing ADT to reduce the size of the prostate prior to performing Brachytherapy , for more accurate positioning of the seeds . I plan , if possible , to avoid ADT at all costs . Both my brother-in-laws , diagnosed at Stage 4 , and since passed said it was worse than the cancer side effects .

[Conlig1940 in reply to MikeUSNA64]

Was your Monotherapy HDR or LDR . ?

[MikeUSNA64]

Residual side effects from ADT as the drug wore off, no trimming of my prostate as recommended by the other doctor - each doctor has his/her own playbook, especially concerning prostate cancer. Cleveland Clinic doctor was very experienced.

[MikeUSNA64]

HERE IS MORE FROM CHAT GPT—I WOULD HAVE CLASSIFIED ME AS INTERMEDIATE RISK. I ASKED THE FIRST DOCTOR IF ADT AND RADIATION WERE NECESSARY, AND HE SAID YES.

When is Monotherapy Appropriate for Brachytherapy and Prostate Cancer?

Brachytherapy, also known as internal radiation therapy, involves placing radioactive sources directly into or near a tumor. It is used to treat prostate cancer by delivering high doses of radiation to the prostate while minimizing exposure to surrounding tissues. Monotherapy with brachytherapy can be an effective treatment option for certain groups of prostate cancer patients.

Appropriate Scenarios for Brachytherapy Monotherapy

Low-Risk Prostate Cancer:

Definition: Low-risk prostate cancer is typically defined by a PSA level of less than 10 ng/mL, a Gleason score of 6 or lower, and clinical stage T1c or T2a.

Suitability: Brachytherapy monotherapy is often recommended for patients with low-risk prostate cancer because it provides effective local control of the disease with fewer side effects compared to more aggressive treatments.

Sources: Cancer Research UK and NCCN Guidelines.

Intermediate-Risk Prostate Cancer:

Definition: Intermediate-risk prostate cancer is characterized by PSA levels between 10-20 ng/mL, a Gleason score of 7, or clinical stage T2b or T2c.

Suitability: For selected patients with intermediate-risk prostate cancer, brachytherapy monotherapy can be appropriate, especially if the disease is more confined to the prostate and the patient's overall health is good.

Sources: National Cancer Institute and Radiation Oncology Journal.

Patient Preferences and Health:

Considerations: Monotherapy with brachytherapy may be chosen based on patient preferences for a less invasive treatment option, their overall health, and any comorbidities that might make other forms of treatment more risky.

Sources: American Cancer Society and UpToDate.

Benefits of Brachytherapy Monotherapy

Targeted Treatment: Delivers high doses of radiation directly to the prostate with minimal impact on surrounding tissues.

Fewer Side Effects: Generally associated with fewer side effects compared to external beam radiation therapy (EBRT) and surgery.

Convenience: Often involves fewer treatment sessions and can be completed in a shorter time frame.

Limitations and Considerations

Not Suitable for High-Risk Patients: Monotherapy is typically not recommended for high-risk prostate cancer patients who may require a combination of treatments to achieve optimal control of the disease.

Potential Side Effects: Although fewer than other treatments, side effects such as urinary problems, bowel issues, and sexual dysfunction can still occur.

Sources for Further Reading

National Comprehensive Cancer Network (NCCN): Prostate Cancer Treatment Guidelines

American Cancer Society: Radiation Therapy for Prostate Cancer

National Cancer Institute: Prostate Cancer Treatment

By considering these factors and consulting with healthcare providers, patients and doctors can determine if brachytherapy monotherapy is an appropriate treatment option for their specific case of prostate cancer.

[Conlig1940 in reply to MikeUSNA64]

Mike ,

Thanks . I had read this report.

I am having a 2nd opinion of my Biopsy slides ( Pathology Report ) to check if they missed Gleason 4 cancer . Additionally I may have a Biomarker analysis ( Decipher ) of my Biopsy slides before making a final decision on selectinng AS .

[Conlig1940 in reply to Conlig1940]

Did you have a Rectal Spacer installed during your Brachytherapy procedure to protect the rectum from radiation .

[j-o-h-n]

Based upon your learned posts, if I were you I would seek a position as an Engineering Corporate / Business Owner Executive.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Conlig1940 in reply to j-o-h-n]

j-o-h-n

I appreciate your humour .

[j-o-h-n]

Thank you Sir, and welcome to a great site for information and comradery. Both of us War Babies.......

Good Luck, Good Health and Good Humor.

j-o-h-n

[Conlig1940 in reply to j-o-h-n]

j-o-h-n

FYI War baby originally from Northern Ireland . 60 + years ago .

Spent my career between Canada & the USA ( N.Y. State , Maryland , Pennsylvania & California ) Travelled & conducted business in ALL 52 States .

[j-o-h-n]

Hmmm different war then... Well you've seen a lot down here, in fact you've seen two extra states.... Thank Goodness we changed our flag to 13 rows of 4 stars each. I wonder if you're like I am, which is the Old Normal? I Love to laugh and can't deal with the New Normals..

Stay Well and keep posting.

Good Luck, Good Health and Good Humor.

j-o-h-n

[MBOY1 in reply to j-o-h-n]

loved the 52 states. That must be “new”math!

[Conlig1940 in reply to j-o-h-n]

52 Just testing how sharp you are . Most Americans could not name the states or fill in a blank map . Florida in Hawaii etc ,-- You have to agree .

The new normals - WOKE crowd etc . Basket cases .

[j-o-h-n in reply to Conlig1940]

To share,

This young small woke kid is working in the fruit/vegetable section of the local supermarket in the U.S. In walks a huge customer and is checking out the cantaloupes and asks the kid where are the cantaloupes grown. The kid responds that they are imported from Canada. The man responds that that's unusual. The kid says that that's sure is because all they have in Canada is prostitutes and hockey players. The huge man pumps up his chest and says to the kid.... hey buddy, watch what you say, my wife is from Canada. The kid says 'eh 'eh oh what team does she play for?

Good Luck, Good Health and Good Humor.

j-o-h-n

[j-o-h-n]

90% of Americans cannot describe the American Flag.

1. 13 stripes (7 red which alternate with 6 white stripes - represent our first 13 colonies).

2. 6 stars in alternating 5 rows =30 starts. With 5 stars in 4 alternating rows = 20 stars. Total of 50 stars for 50 states.....

Note: 2 extra stars on flagstaff (pole) for future use (for the basket cases).

Note: There is no one in the entire world who can say (without singing or humming) the American National Anthem (Star Spangled Banner).

Good Luck, Good Health and Good Humor.

j-o-h-n

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

John I am sorry to correct you BUT …

I pass the Flagstaff pole at least 4 or 5 times a week and I have never seen those stars you mentioned but I will keep watching for them.

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

No issue, many people have that same reaction until they realize those stars are really Pidgeon shit....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Researcher50]

Treated right around the time these guidelines were published. As a result, RO then suggested ERBT only with NO ADT for Favorable Intermediate. There was also no additional imaging. BT was not even offered as a mono treatment! Of course, we were clueless and panicked into making decisions that could have stood better research. So far, so good, with a couple of concerning PSA upswings, after which a PSMA Pet-CT failed to detect anything. Still no ADT at this point. My husband's friends who have been recently diagnosed at his level are all getting short term ADT plus RT.

[NanoMRI]

In your bio you raise concern for missed G4 - my case. I do not see that you have noted imaging or liquid blood biopsy testing.

[Conlig1940 in reply to NanoMRI]

No I did not any any Biomarker , liquid Biopsy , tests . My tear uses such markers sparingly BEFORE PERFORMING A BIOPSY , not after . They maintain the advances in MRI's is superior to a biomarker test to identify cancer . Then a Biopsy and pathology report .

Of course - there as many opinions on this as you can shake a cat at .