Much more positive rapport with MO

[Hotoneii]

At the 1st visit with the MO consultant, bicalutamide and Leuprolide injection was recommended for 6 months before 20 IMRT sessions and HDBT plus continuation ADT for 18- 24 months. There was also mention of chemo, but I've explained I would like to leave that for later, if required.

Clinical trial of 5 SBRT was offered as an option, which I declined ( too many Gy in only 5 sessions, I prefer IMRT 40 Gy in 20 fractions plus HDBT to the prostate).

I've requested relugolix instead of bicalutamide/ lupron for ADT,

Relugolix is now mandated by NICE in the UK for locally advanced hormone sensitive PC, as of 14th August 2024.

So the NHS must ensure that it is being offered as an option.

Anyway, I had to scalate to the right levels, but after a couple of weeks the relugolix has been prescribed, but I've already started the bicalutamide ( MO was concerned about delaying treatment) on 08.10.24, so that needs to clear the system first.

Just been informed that PSA test on 16.09.24 was 46.

So with GS of 3+4 and 4+4 and locally advanced T3b N1 M0 adenocarcinoma, there has been no progression since 15.05.24 without taking any SOC drugs. This is not bad news really, as it gives me feedback on what Ive been working on ( diet, exercise, supps) for the past 4 months.

Also cholesterol dropped by half to within normal ranges. Triglycerides remain in the very low end of normal. All other blood, organs and bone test came back normal.

All to do with diet and exercise, possibly other controversial things as well which I won't mention.

I will reset the progress charts when the relugolix starts, as it is supposed to act quickly on hspc, we'll see.

IMRT for prostate bed is pencilled in for January 2025.

There is also HDBT scheduled, which I will accept but I will try to get this done before IMRT and get tested. I am not convinced 40 Gy radiation is really necessary for 2 small near sites at LN, but the team likes to throw the kitchen sink at it, I know, SOC...I am more concerned with tumor load, which is mostly within the prostate.

Anyway, the last phone consultation with the MO was very positive, in contrast to the initial face to face visit. I feel grateful for the wonderful hard working team assigned to my case; certainly they are not used to annoying inquisitive patients like this one, but now that boundaries are set, everyone seems happy with the plan. If I can manage a bunch of silly donuts on a construction site, I can manage this too, maybe!

Plus I still have the unopened Decapeptyl triptorelin shot just in case I need it later Ha!

[j-o-h-n]

"certainly they are not used to annoying inquisitive patients like this one".

Oh yes they are, if they're married.

Good Luck, Good Health and Good Humor.

j-o-h-n