HIFI versus RP Results: urologytimes... - Advanced Prostate...
HIFI versus RP Results
A possibility in Intermediate Disease setting and age is considered. But this kind of rules out advance disease
I agree. When I posted this I purposely did not comment on the findings or express any opinion. I wanted the article to speak for itself.
However my first thought was why RP? Why not go head to head with radiation. To me at least in my mind it would have been a “apples to apples” comparison.
I agree as has been stated by TA and others this may only be of limited use to non metastasized disease.
I've tried to convince a few of them to compare HIFU to RT. They won't - the reason is obvious.
This trial treated men with low to intermediate risk localized prostate cancer with either RP or HIFU. They only followed up after 30 months to see if the patients had salvage therapy. They did not biopsy the men in the HIFU group to see if they needed salvage therapy. After 30 months, few men in those risk groups would have progressed to advanced disease requiring salvage, so I'm not sure what was proved here.
To those of us who may not fully understand HIFU and other focal therapies, what is the "obvious reason" as to why they wouldn't compare HIFU to RT?
What is your overall point about this study?
Thanks!
HIFU has a very high failure rate compared to RT, and RT has comparable toxicity to focal HIFU. Even when the whole gland is treated, HIFU fails in over ⅓ of patients, and there is little or no toxicity advantage.
My point is that this study is useless to patients because of a poor choice of endpoints and short follow-up. The patients would have gotten similar efficacy and much less toxicity with no treatment whatsoever.
Since I posted the article I will take a shot. That does mean I am correct in the following.
The three most common modes of dealing with this cancer are surgery, while prostrate radiation and limited application radiation.
If you want to evaluate the effectiveness of a radiation modality why would you limit your study to an analysis of a non whole prostrate radiation protocol to a surgical protocol. Why not deal with the elephant in the room and evaluate the effectiveness of the two current radiation protocols as well as surgery.
Second as someone who had to make the choice of surgery vs radiation for my level of cancer I would think most of us made that decision based on side effects and potential cure. Regardless of which we chose most of us probably chose to go with the modality that gave us the least potential side effects and the greatest potential cure from our point of view.
We know that at least for now in a head to head analysis surgery and whole prostrate radiation are considered equally effective at a potential cure if the cancer is contained.
Why do the researchers not do a three way level one study considering those three protocols. Honestly I am not qualified to answer that question but I sure would have liked to have the data when I was making my choice.
As TA said 36 months may not be sufficient and the design may have some other limits.
That is my thinking.
I follow another group and the amount of Tulsa and HIFU failures that just posted after 3-4 years is concerning, not to mention side effects are more common than one would think. I decided no.the risk wasn’t worth it and went with MRI Guided LINAC 5 SBRT sessions.
no side effects so far finished my last treatment this month December 5 total SBRT sessions November 25, 26,27, Dec 2, 3. No urinary bowel or sexual issues. I know it’s early, but it’s like they didn’t do anything….. no fiducials no catheter empty bladder, and empty rectum. Electra unity MRI guided Linac at MSK.
Did you had SpaceOAR?
No SpaceOAR ….I opted out after being scheduled… I asked my radiation oncologist if I really need it then do it but he confidently said no the Unity Electra is that precise....my decision
I also didn't have a SpaceOAR and nobody asked me if I want it or not. I believe that my radiation failed and also I have side effects with urgency. I have urge to go to the toilet. I am not sure if a radical prostatectomy would be a better solution for me? I know it would result with using a permanent nappy plus my GP's husband had a six hour long robotic surgery. Therefore it is also not like walking in the Park. My cancer was crpc in 95 % of my prostate and they also radiated bought of my seminal vesicles.
I had 40Gy....38 Gy might be a optimal dose minimizing SE's I read just recently....I was just reading your profile and journey, wow that's alot of meds...maybe thats why you're getting urgency? I decided to move forward because I wanted to avoid ADT if I waited and it spread.
My PSMA pet scan showed a slight SUV uptake of 2.6 in Aotic pelvic node, my RO thinks is a false positive my decipher is low at .29 so no ADT.
What was your PSMA SUV max value of your prostate before the radiation. I am only on bicalutamide plus ADT and rosuvastatin plus Metformin plus doxycycline plus Silymarin. You are correct that these medications could cause urgency but I will continue using them. I hope that 2 years after the SBRT radiation you will not develop urgency because it is a common side effect of the radiation therapy.
I understand that you made a good decision by going forward with the radiation quickly in order to avoid ADT. I think that is a good idea. Did you come out with that decision alone or was it advised to you?
Thank you for the thoughtful perspective. Opting for radiation therapy without delaying for ADT (and its potential side effects) can indeed be a strategic decision, especially in cases where early, localized treatment offers a high chance of success while avoiding hormone therapy's systemic impacts.
The decision to proceed quickly with radiation was likely influenced by multiple factors, including:
1. Consultation with Specialists:
A radiation oncologist might have explained the advantages of early radiation, especially if the cancer was localized and had a low risk of spread based on imaging (e.g., PSMA PET/CT or MRI) and biomarkers (e.g., Decipher genomic testing).
2. Personal Research:
Patients often spend time reviewing treatment options, side effect profiles, and outcomes to determine the best course of action for their individual circumstances.
3. Desire to Avoid ADT:
The side effects of ADT (e.g., fatigue, hot flashes, bone loss, mood changes, and sexual dysfunction) can be significant. For patients with low-risk or early-stage disease, avoiding ADT by acting quickly with local therapy is a common goal.
4. Confidence in Technology:
Advanced treatments like MRI-guided LINAC SBRT are precise and effective, making radiation a more appealing option for many patients.
Ultimately, while expert advice plays a critical role, the patient's active involvement and preferences are crucial in making such a decision. It sounds like the choice to proceed without ADT was informed, proactive, and well-aligned with the clinical situation.
ChatGPT said
Q. My real problem is that after eating at 11.30 am a lots of healthy fiber reach food I develop diarrhoea
A. If eating a fiber-rich meal leads to diarrhea, this could be due to several factors, especially given your history of prostate radiation therapy. Post-radiation, the digestive system, particularly the rectum and lower gastrointestinal (GI) tract, can become more sensitive, making it challenging to process certain foods.
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Why Fiber Might Cause Diarrhea in Your Case
1. Radiation Effects on the Rectum:
Chronic Radiation Proctitis: Damage from radiation may result in reduced rectal elasticity or inflammation, which can lead to an overreaction to fiber-rich foods.
Impaired Absorption: Radiation can sometimes affect the intestines’ ability to absorb water properly, causing loose stools after fiber intake.
2. High-Fiber Overload:
Soluble vs. Insoluble Fiber: Soluble fiber (e.g., oatmeal, bananas) tends to slow digestion, while insoluble fiber (e.g., bran, raw vegetables) can speed up bowel movements, especially in sensitive systems.
3. Gut Microbiome Changes:
Radiation and other medical treatments can alter the gut microbiome, potentially leading to difficulty digesting certain foods.
4. Irritable Bowel Syndrome (IBS)-Like Symptoms:
Radiation therapy may trigger IBS-like symptoms, where high-fiber foods act as a stimulus for diarrhea.
5. Timing of Meals:
Eating large meals at once, particularly with lots of fiber, can "overload" the digestive system, triggering urgency or diarrhea.
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How to Manage Diarrhea After Fiber-Rich Meals
To address this issue, consider the following steps:
1. Adjust Your Fiber Intake
Reduce Insoluble Fiber:
Limit foods like raw vegetables, nuts, seeds, and whole grains if they aggravate diarrhea.
Gradually reintroduce them in smaller amounts to test your tolerance.
Focus on Soluble Fiber:
Choose foods like bananas, oatmeal, applesauce, and white rice, which are easier on the gut and help firm stools.
Avoid Fiber Overload in One Meal:
Spread your fiber intake across the day instead of consuming a large portion at once.
2. Modify Eating Habits
Eat Smaller, More Frequent Meals:
This reduces the load on your digestive system and helps avoid overwhelming the rectum.
Chew Thoroughly:
Proper digestion starts in the mouth, and breaking down food well may reduce irritation.
3. Include Gut-Soothing Foods
Add probiotics (yogurt, kefir, or supplements) to support a healthy gut microbiome.
Include low-residue foods (e.g., chicken, fish, and well-cooked vegetables) to minimize stool bulk.
4. Hydration and Electrolytes
Diarrhea can dehydrate you, so drink water or oral rehydration solutions to replace lost fluids.
Avoid caffeinated or carbonated drinks, which can exacerbate diarrhea.
5. Medications or Supplements
Use loperamide (Imodium) sparingly for severe diarrhea, but consult your doctor first.
Consider taking a soluble fiber supplement (like psyllium husk in small doses) to regulate stool consistency.
6. Consult a Specialist
A gastroenterologist can help evaluate whether your symptoms are related to radiation or another underlying GI issue, such as IBS or bile acid malabsorption.
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When to Seek Medical Attention
Contact your doctor if:
Diarrhea persists despite dietary adjustments.
There is blood or mucus in your stool.
Symptoms are accompanied by severe abdominal pain, fever, or weight loss.
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Next Steps
Track your meals and symptoms to identify specific food triggers. With tailored dietary adjustments and possibly medical intervention, it’s likely you can reduce diarrhea and regain better control over your digestion.
ChatGPT said
RP + Radiation Question
PSA after RP. 
Creeping PSA after RP
One year after RP. 
Night sweats after RP
