how many oncologists and treatment centres are moving away from the standard of 6-8 weeks of RT to 4 weeks of moderate Hypofraction or even hypofaction? In all stages and Gleason scores of locally contained PSMA clear N and M ?
Seems equivalence is beginning to be the consensus especially with the newer PSMA CT screening. Must also be driven by cost and patient experience.
The other concomitant and question is ADT and if that also is being seen to be less of a BCRS and OS for shorter than 24 or 18 and some cases even 6 months.
Is it all still controversial given research data is only 5 years so far ?
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SimMartin
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It has been the consensus for several years. Unfortunately, ROs bill insurance by the 3 of treatments, so independent ROs are reluctant to give up the income.
Early pre-treatment use of PSMA PET may someday result in less severe initial treatments for certain unfavorable intermediate risk or even high risk men, and maybe even more severe treatments for a selct small group of favorable intermediate risk men. Combo of PSMAT PET and genomic results might hopefully spare some men harsher treatments that now are SOC for those men. High quality studies yet to be done, unfortunately. and unfortunately with PCa, are 5 year results sufficient to form conclusions???? Meanwhile, probably large numbers of men continue to be overtreated, and some number also undertreated.
it’s obviously like most things around PCa an evolving field almost year by year.
I declare a vested interest as a wheelchair user and only around 12% lean muscle from polio as a child it means that the well discussed decision to put me on 20 sessions of 3Gy each with maybe only 6 months ADT for a G9 T2cN0M0 localised contained and PSMA negative spread (obviously as far as we can tell) is probably for me the best individualised treatment plan - luckily (well maybe more pushing than luck!) I am with a very experienced team and facility both RT and oncologist.
So I am looking at positives as I near the last 5 sessions if RT with very mild symptoms- so far 🤞. Then we will have to discuss pros and cons of more Zoladex or not - the small voice in my head as someone who has worked in healthcare is of friends and even colleagues who had PCa and had much longer RT as well as 2+ years ADT - but I read and see times move fast these days and so many opinions and so look for the positives and try to ignore that often common comment on the discussion part of research papers and studies that suggest more is best especially for high risk.
The big questions for unfavorable cases seems to be specifics of radiation protocol, eg brachy or not, SBRT boost?, degree of pelvic treatment, and last but certainly not least .....ADT intensity/duration......and now the suggested benefit of a abi/prednisone? which men should have the kitchen sink treatment, and which men can probably do well with less intense.....there are a lot of men needlessing experiencing very reduced QOL when a less impactful treatment would have been effective for those men.....but we don't have the proven way to differentiate yet.....or have I missed it?
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