Recurrent treat with Hypofractionation RT?

[OldTiredSailor]

I've posted my story earlier but summary:

RALP August 2018 pT2a G7(3+4) epe+ sm+

PSA<0.1 until late summer 2023

PSA 0.2 October 2024 and 0.4 December 2024

77-years old very healthy - expect to live another 15-years

It is time for radiation therapy but what kind?

I have done a lot of reading about hypofractionation (fewer than 36 treatment days) as it applies to salvage radiation after BCR.

Several studies have determined that men like me with recurrent PCa after RALP will do as well, considering freedom from distant metastasis and PCa related death, when treated with 70Gy radiation in 20 to 36 doses rather than the traditional 70Gy over 40 or so treatments.

And, radiation therapy side effects are no worse, and in some studies less, with hypofractionation compared to longer treatment regimes.

For example:

Stepe et al (2018) found that 60 months after 21-28 doses (38 to 74 Gy total) of RT - 87% of 1,208 patients were BCR free with no G3 or greater side effects

Macchia et al (2017) found that 60 months after 25 doses (64 Gy total) of RT - 87% of 124 patients were BCR free with only 1 patient developing distant metates and only had G3 or greater side effect.

I found eight other studies reporting similar results over shorter observation durations.

The radiation oncologist I saw in mid-December at Moffitt Cancer Center was quite opposed to hypofractionation but gave me no reason other than: "it is not appropriate." He said that even if the PSMA/CT scan shows no spread from the fossa he would not consider hypofractionation.

The local radiology center does not do hypofractionation and would not tell me why.

Does anyone have any experience with hypofractionation radiotherapy as an SRT protocol?

Any opinions or thoughts?

I am in no rush to get started but would like to minimize the number of treatments.

[cscmetsfacil]

When you say Moffet Med Center, does that mean San Jose, CA? I would certainly talk with someone who does the hypo fractionation - second/third opinion. In the Bay Area I suggest UCSF. Where did the PSMA show uptake? "It's not appropriate" is not an explanation, it's a judgement, - it's information, but does not give you any knowledge. Don't be afraid to ask why. Most of us find docs are more responsive to informed patients who ask informed questions. If you doc does not respect your desire to get the info you need to make an informed decision , get another one! Also, check out the advice line at the Prostate Cancer Research Institute (PCRI) - give them a call and pose your questions. They have tons of information and resources. Feel free to respond to me.

[OldTiredSailor in reply to cscmetsfacil]

Moffitt in Tampa Florida.

I have not yet had the scan. My PSA is 0.4 (December 4) and PSMA is only about 50% sensitive at that level. I have a virtual appointment with a Mayo urologist/oncologist this afternoon and will be sure to press him on the issue.

[cscmetsfacil in reply to OldTiredSailor]

Eugene Kwon at Mayo has the "Kwon Clinic" for PCa. He is a great resource and also presents at PCRI conferences. You are of course correct about PSMA readings and 1 before I do another scan. Luckily I am holding steady at <.006 undetectable PSA for the timbering. Good luck.

[Xavier10 in reply to cscmetsfacil]

Hopefully Kwon doesn't do that Choline scan anymore. It said all kinds of crazy things on me.

[garyjp9 in reply to Xavier10]

I believe he does, last I heard.

[Xavier10 in reply to garyjp9]

Maybe I was an exception.