Brief, intense radiation and hormone therapy for very high risk prostate cancer

[Tall_Allen]

Another trial suggests that SBRT may be as good as brachy boost therapy for very high risk patients. They added a short course of Erleada and Zytiga to just 6 months of Lupron. I think they erred in not treating the pelvic lymph nodes.

prostatecancer.news/2021/06...

[Spyder54]

Thank you TA. Really a comprehensive summary of RT on high risk, and very high risk. Hitting all the hyperlinks really brings you a complete look. Right down to Pelvic lymph nodes and the UCLA/Sunnybrook study on 5 treatments only. Mike

St Pete

[jjpeabody]

I agree with radiating pelvic lymph nodes. My PSMA PET/CT has shown recurrence after RP in surgical bed posterior bladder, I am also high risk for metastatic disease with extra-capsular ext, perineural invasion, and PSADT < 8mnths. PSMA showed no metastasis to lymph nodes. Can you recommend a center of excellence and experienced RO in southwest (AZ or CA) who will treat bed and lymph nodes, clinical trial would be great but I didn’t see anything. I am assuming IMRT/IGRT. Thank you for any help you can provide Tall_Allen.

[Tall_Allen in reply to jjpeabody]

I can wholeheartedly recommend Amar Kishan at UCLA. He may even be able to do it in just 5 SBRT treatments, but I'm sure he will want to check your anatomy on your PET/CT before committing to that.

[jjpeabody in reply to Tall_Allen]

Thanks for the quick response, I did see where he was recruiting a few months ago, didn't realize SBRT might be used for pelvic lymph nodes in general and prostate bed. I'll contact early next week to see. Also may call Dr. Mark Scholz for any referrals, not sure how that will work but try. Thanks, Jim

[Tall_Allen in reply to jjpeabody]

I would recommend against getting Scholz involved. He knows nothing about the subject and would only get in the way.

[jjpeabody in reply to Tall_Allen]

Actually it was Scholz where I first heard many months ago that for my type of recurrent cancer treatment should not only include surgical bed but pelvic lymph nodes. My Mayo AZ RO does not want to do lymph nodes. Scholz recommended a center of excellence and experienced RO, and said he was pretty selective in who they recommended, so if I got names from him I could compare with any other I find. So far Chang and Kishan have come up. On another interesting note, I see where Mayo has trial using AI to help calculate treatment plan area for delivering RT. Looks like it is for the doctors, but use of AI for SRT etc could result in better outcomes? Thanks, Jim

[Tall_Allen in reply to jjpeabody]

You can hear that your pelvic LNs should be treated by any number of people (including me), but that doesn't mean we should be leading your case. I am very familiar with the doctors in LA. Chang does HDR-BT, which is irrelevant to you. Just talk to Kishan. If you want to get another opinion, talk to Howard Sandler at Cedars - he won't do SBRT on your LNs, but he wrote the book on IMRT treatment.

[jjpeabody in reply to Tall_Allen]

Great, thanks for the additional recommendation Tall_Allen, I really appreciate it. Jim

[bean1008]

I’m currently in a trial at the University of Washington for ‘neutron’ radiation. The advantage is it is extremely focused and super powerful they say. It’s been used in salivary gland cancer and they’ve had great results. Unfortunately I am in the control group so not sure if it will help with my bone met in my hip quite yet. The study lead said that I am eligible to receive the radiation at the end of the study… I believe that is later this summer.