Query on EBRT Treatment

In mid 2021 had my regular PSA test, and it had risen to around 12. In the state health system in NZ for someone over 70, PSA has to be over 12 for 3 months before they take notice, it was and I was asked to go for an MRI which proved positive. The diagnosis wasT3b prostate cancer and a subsequent biopsy came up with a Gleason score of 4 +3.

I saw an oncology surgeon, who recommended surgery, and an oncology radiologist, who recommended EBRT. Confused? Sure I was. I then saw the HoD, another surgeon but one who recommended EBRT because he said that if I had surgery then I would need EBRT as well. OK, choice made I thought, and I started treatment in mid November 2021.

The treatment was for 20 sessions, and the total Gy of 60.

My question is that the number of sessions and the total Gy dosage both seem low. Other people I talk to at the prostate cancer support group have at least 30 sessions, sometimes more. And internet research (always dangerous I know) suggests that 70 to 80 Gy is the norm.

So I would welcome input from anyone who has any comments to share. My next consultation with the radiation oncologist's registrar is in the coming week.

Thanks

[Tall_Allen]

It's called "hypofractionation." Because of the way radiation kills prostate cancer, 60 Gy over 20 treatments (3 Gy/treatment) is roughly biologically equivalent in its prostate cancer killing power to 80 Gy over 40 treatments (2 Gy/treatment). The toxicity is no different.

[Hidden in reply to Tall_Allen]

Thanks for the quick response.

It does beg the question though that why doesn't everbody do it that way? People who are treated privately in NZ invariably have 30 and upwards sessions, my brother in UK had 40 sessions, although he did have T4 PC.

Is there a downside to hypofractionation?

It was far more convenient for me - 20 sessions as opposed to over 30, but obviously not if the treatment is less effective and the cancer returns.

[Tall_Allen in reply to Hidden]

In the US, some radiation oncologists do not hypofractionate because their insurance reimbursement is per treatment. I have no idea why they wouldn't hypofractionate in UK or NZ. Slow to catch on? Old habits die hard?

No downside. Same effectiveness. Same toxicity.

prostatecancer.news/2018/10...

[Tall_Allen in reply to Tall_Allen]

Of course, I elected to have SBRT, which is called "ultra-hypofractionation." It was 40 Gy in 5 treatments. It makes sense especially during the pandemic to limit the amount of time hanging around hospitals.

[Hidden in reply to Tall_Allen]

Thanks.

I suspect you are right on both counts, charge per treatment session and conservatism.

My brother, with his 8 weeks treatment, used the state NHS system, so that was probably a case of "we've always done it that way, and why change".

The cynic in me says that the state system here uses hypofractionation because its cheaper and they can churn more people through fewer machines.

Anyway, thanks again for your input and I'll talk about it with my oncologist later this week.

[Tall_Allen in reply to Hidden]

It is cheaper and does churn more people through, but those just extra advantages. In the US, there is some concern that community-level radiation providers will be driven out of business by hypofractionation, thereby limiting treatment options for people who live in out-of-the-way places.

[Desanthony in reply to Tall_Allen]

Certainly at my hospital

In the Uk and others

I know of here they hypofractionate and some use a lower dose over a longer time usually 30 or 35 days and then

the slightly higher individual dose over 20 days. All in all it equates to the same overall dose.

[Hidden]

Seems like there is some risk for higher doses to the rectum, in certain circumstances.

[Hidden]

Thanks, but doesn't seem a longer term problem in my case. Some discomfort during and shortly after treatment but settling down now - six weeks after last session.

[IMCW]

Hi ParrotX, I hope that you are keeping well and glad to hear that the discomfort you experienced has now settled down. I had exactly the same treatment here in the UK within the National Health Service. However it was not straight forward to get the treatment I wanted. I was originally being treated at East Surrey hospital but lost confidence after seeing a different Urologist on different appointments. I am fortunate that I live not to far from the Royal Marsden Hospital where they had completed trials comparing 20 sessions at 60 gy and 37 sessions at 80gy a few years previous. This showed that the 20 sessions were ‘better’ with less side effects and was therefore the way forward. It was relatively simple to transfer to the Marsden by asking my GP for a second opinion from the Royal Marsden. So what I trying to say in a long winded way is that it here are good and better places for treatment within National Health Systems and don’t accept what can seem like a fait-a-compli of where you are treated.Best of luck for the future.

[Hidden in reply to IMCW]

Thanks for that. My query was prompted by a concern that I was being shortchanged by an overly budget concious state health provider.

However, these concerns have been allayed by Tall Allen and your good self, plus a bit of research around the word I'd never heard of provided by Tall Allen.

So all good and I'll be better informed when I talk to the radiation oncologist tomorrow.

BTW my brother was treated at Guildford NHS Hospital, and he got the full 8 weeks, so it seems there is a considerable difference of opinion in treatments within the NHS.

[j-o-h-n]

Greetings ParrotX,

Would you please be kind enough to tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/10/2022 11:39 PM EST

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

Would like to know who "us" is.

But 73, Auckland, Feb 2021, EBRT plus ADT - PSA and Gleason in my original post.

Hopefully that is enough for your purposes, the rest is confidential until I know why you want to know.