IMPRESSION: Seventy-four-year-old male with unfavorable intermediate risk prostatic adenocarcinoma, PSA 6.8 ng/mL and Gleason 7 (4+3).
RECOMMENDATION: He wishes to proceed with definitive EBRT to the prostate & SV. Total dose will be 81 Gy/45 fractions on TrueBeam using RapidArc VMAT with daily CBCT for IGR
Plus 4-6 months of ADT:
jamanetwork.com/journals/ja...
Also, your RO is trying to pay for his next vacation by giving you more treatments than necessary. You can do it in just 5 treatments (SBRT) or with moderate hypofractionation:
prostatecancer.news/2018/10...
This is his reasoning, I prefer 5 treatments.
RECOMMENDATION: Life expectancy by SSA calculator is 12 years. We discussed NCCN treatment options are RP vs. RT + ADT. A Decipher is pending which we discussed may sway us regarding the aggressiveness of treatment. However, at the current time, he wishes to proceed with definitive EBRT + short-term ADT. He has travel plans over the summer therefore I recommended he initiate ADT with Dr. Patel neoadjuvantly and we may treat him with RT when he returns.
We discussed the logistics of EBRT. He is a candidate for SBRT, moderate hypofractionation or conventional RT. The data suggest a slightly higher risk of GI toxicity with hypofractionation. He will think it over and let us know which regimen he chooses. Treatment would be delivered using RapidArc VMAT with daily CBCT for IGRT. Possible side effects of radiation therapy were discussed at length, including but not limited to fatigue, dermatitis, acute or chronic bowel, rectal and bladder irritation or damage, bone weakening or fracture, decreased blood counts, erectile dysfunction, neurologic injury, and secondary malignancy. He will return after the summer for follow-up and CT simulation.
This is what the data actually say:
prostatecancer.news/2019/02...
There is a major RCT you can sign up for:
classic.clinicaltrials.gov/...
Thanks I’ll check into trials
I have a similar condition as you. Gleason 4+3=7, unfavorable intermediate. No evidence of metastasis in bone scan, pelvic scan PSMA-PET scan. But biopsy indicated a high likelihood there would be metastasis sooner or later. Radiation Oncologist recommended ADT (Androgen Deprivation Therapy) prior to and following pelvic-wide radiation in a 28 day regimen (as opposed to the 5 day or 45 day). I went with prostatectomy because, while the chances of 100% success are slim (1 out of 7) the reward is high. And radiation carries side effects down the road (difficulty of future surgeries for one). So I am swimming against the current.
As I understand it, 5 treatments are at a higher dose than the 28 day regimen with is a higher dose than the 45 day regimen. (I could be wrong) Tall_Allen knows more about this than I.
One thing I wonder is your RO's lack of recommendation of ADT. As I understand it, it shrinks the prostate, slows prostate cancer growth and makes cancerous cells more vulnerable to the radiation (without adversely affecting healthy cells).
I emphasize that I am not very knowledgeable about this, only having studied since my diagnosis in April 2023.
Incidentally, I sailed a Hobie Cat while stationed in Florida. Loved it!
Why not triple treatment? In radiating the prostate your RO is doing it with curative intent.
You need to take high dose of ibuprofen during RT to enhance its effectiveness.
New here - considering treatment options
Treatment Options Analysis Paralysis
Aetna appeal for Firmagon denial 
My turn for advice
Short-term vs Long-Term ADT for High Risk Men 
