MRI guided Stereotactic Body Radiotherapy (SBRT) for favorable intermediate recurrence?

[Piano777]

65 years old. PSA below 3 then 4.35, 3.06, 4.93, and 4.52. Had MRI and then biopsy

Diagnosed 19 months ago with PCa localized on left side with 3+4 on one core and 4+3 in second core, all confined to prostate.

Joined NanoKnife (Irreversible Electroporation (IRE)) focal ablation clinical trial. Pre ablation PSA was 5.76. Post ablation PSA 1.25, eventually rising to 1.96.

One year later, left side clean in MRI and biopsy. However, right side determined to have 2 cores with 3+4, and 4+3. Regraded through Johns Hopkins (thanks to reading here) down to both 3+4 with significantly less pattern 4 in both cores.

PROMISE trial genetic tests showed no gene mutations and Decipher scores were .34 and .36, well below .45 cutoff for more aggressive prostate cancer. Showed probability of metastasis of 1.2% for 5 years and 3.0% for 10 years with therapy

I am now considering MRI guided SBRT. I'm in the Chicago area but willing to travel. I keep reading about De Kishan at UCLA. Is there anyone like him in the Chicago area. Any reason to consider a different treatment?

Thanks

[Tall_Allen]

In Chicago, you may want to consult with Arica Hirsch.

[Piano777 in reply to Tall_Allen]

Tall_Allen, thanks for the quick reply.

I looked at Dr Hirsch and she is listed as working for Radiation Oncology Consultants. Does she do MRI Guided SBRT? I couldn't find that in any of her material.

It appears Northwestern has capability, but not having luck yet finding doctor doing the procedure.

[Tall_Allen in reply to Piano777]

Don't fall in love with the technology - the RO's experience counts for a lot more.

[j-o-h-n]

I FOUND THIS IN OUR ARCHIVES:

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Amar Kishan, MD, on Optimal Sequencing of ADT With RT in Nonmetastatic Prostate Cancer

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Yearofthecow•

6 months ago•7 Replies

"For patients with nonmetastatic prostate cancer, the optimal sequencing of short-term androgen-deprivation therapy (ADT) when delivered with radiotherapy (RT) has been uncertain. Only two randomized trials have investigated this question. Now, however, a study in the Journal of Clinical Oncology, has provided more definitive evidence.

Amar Kishan, MD, of the University of California Los Angeles, and colleagues pooled individual data from 7,409 patients in 12 randomized trials. The patients were treated with RT and short-term neoadjuvant/concurrent ADT (n=6,325) or concurrent/adjuvant ADT (n=1,084), and outcomes were examined by RT field size.

In men who received prostate-only radiotherapy (PORT), concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, HR 0.65, P<0.0001) and overall survival (HR 0.69, P<0.0001).

"These data strongly suggest that when PORT is being delivered with short-term ADT -- as is recommended for men with intermediate-risk disease -- concurrent/adjuvant ADT sequencing should be the standard of care," the researchers concluded."

medpagetoday.com/reading-ro...

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Yearofthecow

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Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 08/15/2023 7:29 PM DST

[TFU589]

Dr. Zelefsky is at Memorial Sloan Kettering in NYC. Have only read his studies, Tall Allen might have more info.

mskcc.org/cancer-care/docto...