High Risk GS 9 radiation alternatives.

[VanRiper]

I was told SBRT is not appropriate for high risk GS 9? Could Prostox confirm this over IMRT or CMRT?

[Jpl506]

It was appropriate for my G10. I’d get another opinion if I were you.

[Tall_Allen]

SBRT is not currently SOC for high risk PCa. Some are treating it on a clinical trial or IRB-approved protocols. But the SOC is brachy boost therapy. Prostox shows your sensitivity to SBRT or HDR brachy therapy, but does not change the standard protocols.

[Jpl506 in reply to Tall_Allen]

5. Can I get SBRT for High-Risk Prostate Cancer?

Yes, as of 2020, SBRT is considered a standard of care option for patients with high-risk and very-high risk prostate cancer. Dr. Kishan led the largest study of SBRT for high-risk prostate cancer, which was published in early 2021 and pooled data from seven trials from across the world

[Tall_Allen in reply to Jpl506]

That is incorrect. Dr. Kishan is one of very few ROs that offers SBRT to high risk patients. He offers it as part of his clinical trial which I hope he will publish next year.

clinicaltrials.gov/study/NC...

ASTRO, which defines the SOC, has endorsed moderate hypofractionation for all patients, but has not yet endorsed SBRT.

"3C: High risk men should be not be offered SBRT outside of a clinical trial or registry."

prostatecancer.news/2018/10...

[Jpl506 in reply to Tall_Allen]

That statement is directly from the UCLA website. You should tell Dr. Kishan and UCLA to take the information down immediately as it is baseless.

[OGSteelGuy in reply to Tall_Allen]

Allen et al...I thought that the NCCN Guidelines were our SOC. My current 2025 copy has this in the radiation protocol:

Stereotactic body RT (SBRT; also known as stereotactic ablative radiotherapy, SABR) refers to a delivery of ultra-hypofractionated RT with high precision treatment setup and image guidance techniques. SBRT is acceptable for treatment of primary prostate cancer across all risk groups and for locoregional and/or distant metastases in practices with appropriate technology and expertise.

And there are tables, flowcharts, etc showing appropriate usage for very high risk patients as well. Am I missing something or has the new update changed the SOC?

[Tall_Allen in reply to OGSteelGuy]

"Acceptible" is different from standard-of-care. ASTRO sets SOC for radiation. You may find insurance unwilling to pay for it outside of a clinical trial for high risk.

[addicted2cycling]

Can't answer regarding SBRT but in 2015 I had a Cryoablation of right half of prostate with GL10 tumor that was first felt when PCP performed her DRE.

[EdBar]

I’m, Stage 4, Gleason 9, I’ve had IMRT early on and SBRT twice over the last 3 years. Together with ADT and early chemo. I’m coming up on 11 years battling this next month.

Ed

[Teacherdude76]

You need to schedule an appointment with a Radiation Oncologist before choosing treatments. They know more and are not biased either way.When I was first diagnosed, G9 aggressive, the uroligist said surgery best option and if radiation first he couldn't do surgery. Saw the rad onco and she said the long term results were basically the same, showed me stats to support that. Then said, and I quote " bullshit! I have seen him do surgery after radiation"! Also added that given possible spread would need radiation after surgery anyway.

Ask questions of your doctors, have a patient advocate with you to help you understand. Make the Dr explain in terms you can understand. If they don't switch doctors!

[j-o-h-n]

Greetings Van, Would you please be kind enough to update you bio. All info is voluntary but it helps you and helps us too. Thank you and keep posting!!!

Good Luck, Good Health and Good Humor.

j-o-h-n