Best form of radiation

[leach234]

a friend of mine has been diagnosed with a Gleason 9 (4+5). He also has perineal invasion. Bone scan was clean. His Urologist is recommending radiation. Is there one form of radiation that has a better success rate? I thought I remembered Tall Allen saying brachiotherapy had a better success rate. Can someone elaborate?

[Tall_Allen]

Brachy BOOST therapy. That means external beam radiation+brachytherapy boost to the prostate+1 year of ADT.

[leach234 in reply to Tall_Allen]

Thanks. Sounds like he’s already on top of it. He’s meeting with a Brachy consultant next week.

[Monitoring]

Hello leach234:

For 16 years, I was on AS with a PSA ranging from 2.1 to 4.9 and a Gl 3+3. Then, in H2/2019, I went to PSA of 18.3 and a GL 4+5. I was immediately put on ADT (8 planned Zoladex injections every three months). The ADT hormone injections were designed to lower my testosterone (T) levels to as near to Zero as possible in order to make 40 planned EBRT radiation treatments the most effective. After three injections (Sept/Dec/March 2020), my PSA went to <0.02 and my T level to <0.4 (Canadian measure) or to about 4.5 on the U.S. scale.

I do a lot of my own research and learned that 6 three-monthly injections were just as effective as 8, and 25 rad sessions were just as effective as 40, and that is what I had. If I had to do it over again, I would stop the ADT after that third injection. The combo of hormone injections and radiation treatments deliver varying kinds of Side Effects (SEs) to PCa patients. In fact, I would discuss thoroughly with the rad onc whether it is necessary to have the ADT at all. BTW, I would have had brachytherapy but I was ineligible having already had three TURPs previously. My prostate onc confirmed that having EBRT + Brachy was the best route to go. Good luck to your friend.

Monitoring in Toronto

[Monitoring in reply to Monitoring]

That should be 8 planned Zoladex injections given one every three months.

[chrisNYC in reply to Monitoring]

out of curiosity, what are some of the established SEs to the ADT/radiation combo?

i was fortunate to only require 2 months of adt prior to adt but, yeah, had some unanticipated SEs to my mind, including peyronies.

[Monitoring in reply to chrisNYC]

Chris, my worst SE was/is hot flashes, which I call hot waves. I am still experiencing them. Usually about 2-3 each day and almost every time I get up at night to pee. Since I have nocturia, my nightly get-ups range between 2 and 5 (used to be 8-11). Most of the waves are dry, but I still get some wet ones. They all force me to sit up on the side of the bed until they pass. Disrupts sleep patterns. The hormone injections gave me arthritis in my hands, which I still have. They started to ache before I began the rad sessions. Another SE was fatigue, although I am sure that my nocturia was a contributing factor on that one. I have hereditary RLS (Restless Leg Syndrome) and this got much worse. Fortunately, I have subsequently found a pill for my RLS and it is so much better.

Monitoring

[Magnus1964]

You might consider cryosurgery instead of radiation.

[conbio]

My diagnosis was similar. Was 65 at time. 4+5 Gleason. Two lesions, bone scan clean. No escape from prostate. 24 sessions of beam, two weeks later had Brachy. Total of 18 months on Lupron. Yaa know, considering, it was not all that bad. Had a down week as the beam radiation caught up to me - felt a bit seasick. Exercised throughout.

Now 5 months out of the Lupron effects and feeling stronger with starting to get testosterone back and my RBC nudging upwards. I would strongly recommend getting a trainer once a week to lift weights. I was pretty active to start - climb, backcountry ski, and mt bike. But I did not know my way around the weights. I continue to lift once a week with trainer and once on my own. Has really helped keep on muscle and keep a good attitude.

So far so good. Best of luck. Last week at Rainier.....

June 2023 post treatment

[Lost_Sheep]

I have Gleason 4+3 scattered all over my prostat left side and some on thexright with left seminal vesicle and PNI (perineural invasion) but PSMA PET scan negatine for lymph node or other metastasis and a clean bone scan.

A table (NCCN?) tells me I have about a 1 in 8 chance of no micro-metasasis, so I am on the fence about having prostatectomy or radiation.

I figure if the prostatectomy has a slim chance of getting all the cancer, if it has not metastasized at all. And with the possibility of saving my lymph nodes, and the tissues in the margins around the prostate, if I am lucky. Prostatectomy would avoid the side effects of radiation. But if there is metastasis outside the prostate gland, radiation might be the way to go. The radiation oncologist does not recommend targeted radiation, but simply flooding my pelvis with the 28 day protocol.

so, I am seeking advice and hoping for a genomics read of my biopsy to determine how aggressive the cancer is. I think that might inform my decision.

any help, folks? Thank you in advance.

[PSAed in reply to Lost_Sheep]

I was Dx in 2020 Gl 4+3,PSA 17, N1M0. I was offered surgery and RT/HT. I decided on RT/ HT only. I didn't see the point of having surgery, nor did I want to "run the gauntlet" of side effects with both procedures. I had 39 fractions ( I think ) of EBRT and 2 years of LUPRON. I had my last LUPRON injection June 2022 and my first post treatment PSA/Testosterone Blood test April 2023 =<0.01. My next PSA/T test will be in September '23. I won't deny it, my experience with the side effects of LUPRON were not good, but I would make the same choice again. By the way my treatment was considered "curative"....that remains to be seen, still too early to make a call.

If you decide to go for RT/HT, it is highly recommended that you start physical exercise ,resistance exercise in particular . Best Wishes

[Lost_Sheep]

The radiation therapy (RT) offered is 3 months of androgen-deprivation therapy (ADT), then non-targeted, but area-wide throughout my pelvis followed by another 3 months of ADT. My alternative is prosatectomy (which I hope might spare my lymph nodes). Prostatectomy would certainly be NOT nerve-sparing and would take both seminal vesicles, but I hope would not have to take too much margins (hoping for a pathologies to read the removed tissues during the surgery).

I am lobbying now for something I just learned is available, a "Tumor Review Board" which consists of a panel of oncologists who would review my tests and come up with a recommendation. So far radiologists have recommended RT and I am seeking a second opinion from a surgeon, who I expect will suggest - you can guess - surgery.

Thank you for your thoughts. I have been doing a LOT of research and participating in support groups, but every time I turn around and talk to another person or find another medical journal I find something completely new to me. And that does not include the journal articles that do not apply to my situation, either. I am smart enough not to chase dreams - or nightmares.

[Scout4answers in reply to Lost_Sheep]

Something you might want to consider is that close to 80% of men who choose surgery end-up needing salvage radiation, and it is often 40 sessions.

[Lost_Sheep in reply to Scout4answers]

Right, Scout4. Thanks. I was showed at table (I believe the NCCN table applicable to my diagnosis, T3bN0M0) showing either (I forget the exact number) 83% or 87% of men go on to need radiation (chance of micro-metastasis undetected by the PSMA PET scan I had). But I (if my cancer tests out as less-aggressive) am hoping that surgery might find me in the minority of men. I hope prostatectomy might leave me 100% cancer-free.

[u302000]

I would consider Proton Therapy as the lease invasive and damaging to the rest of your body.

It is a series of 41 treatments of less the 30 min a day with no side effects. In and out and spend the rest of the day doing what you want to do. I completed mine in Jan-Feb,2022 at Univ of Florida Proton Therapy Institute in Jacksonville and my prostate is cancer free PSA dropped to 0.02x for a year after treatment. They have treated over 5000 Prostate cancer patients over the last 16 years. One at Loma Linda, CA is the oldest in US but there are many sites available around the world. I first learned of them in Uppsalla, Sweden!

Cheers

[JimmyJet]

Would like all thoughts. TA? 4+4 9/21. Failed FLA 10/21. PSA flat 3.5. PSMA Pylarify 12/22. On Orgovyx since 4/22. PROTON BEAM OR PHOTON EBRT? ROs I’ve met with say both so similar in Results and side effects but, on paper, Proton seems intuitively better… or actually better. If you have a choice, is Proton a no brainer choice? Thanks for all input.