SIB/Flame Protocol

[805guy]

The RO recommends Simultaneous Integrated Boost (SIB) as part of my treatment. PSA was 19.76 (4/2023), then 21.78 (5/2023 to confirm initial PSA). He is concerned that the PSA does not match the Gleason score (4+3, grade 3) as PSA has surpassed 20. Multiplanar MRI and PSMA PET indicated no metastasis. He said it could indicate microscopic disease outside of the prostate that was not detectable on PSMA PET, so he ordered another PSA (currently 19.39). He recommends IMRT to target prostate, seminal vesicles and low pelvic lymph nodes (flame protocol). 37 fractions, 70-78 Gy to prostate and SIB boost to 85-90 Gy. Anyone else experience this technique?

[PSAed]

Thanks for posting that as I am Gl 4+3 =7 also. I am interested in reading the replies. Best wishes

[pd63]

Not sure of the correlation between gleason score and psa

[805guy in reply to pd63]

From my understanding, 4+3=7 grade 3 is intermediate unfavorable however once the psa surpassed 20, it is considered advanced.

[Lizzo30]

PSA can rise due to Covid invection or any infection There is also the option of HIFU my husband got a DX of prostate cancer in 2018 after doing research I told him HIFU looked like a good option to me he decided on robotic prosectomy

Imo HIFU looks like a better choice than radiotherapy

Best wishes to you whatever you decide

[Tall_Allen]

Since you don't know where it is, why not treat the entire pelvic LN area up through the common iliacs?