Timing and intensity of radiation?

[qidao23]

Hi, my father has been diagnosed with Stage four PC spreading to a couple of small lymph nodes in the abdomen and neck area but no bone involvement. Doctors says because his case is mHSPC on PSMA but locally advanced in traditional imaging, it is not known whether treating him more aggressively offers more benefits. His current treatment plan is Lupron and Zytiga. Both MO and RO hinted radiation could help and provided two options. The first option is to go with the 1802 trial to receive full dose radiation to pelvic area if he responded well after six months in the treatment group. The 2nd option is to do a reduced dose prostate-only radiation based on stempede data.

We are more inclined towards the 2nd option because we are less blind about whats going to happen, but we are worried about the effectiveness of reduced dose (2/3). Does anyone know the rationale behind the reduced dose? Another question is how to choose the best timing to start the radiation, should it happen as soon as possible or should it be based on certain labs/imaging results?

Thanks a lot in advance!

[KWman]

I have no experience with recommendations for radiation. I am on Lupron plus zytigo with prednisone and have had very good luck. Over two years, I have managed to reduce psa to undetectable .<.02.

[qidao23 in reply to KWman]

thanks a lot for your reply!

[qidao23]

@Tall_Allen, could you please provide some advice to us? Last time you suggested extensive radiation but our RO only offered reduced prostate only radiation following stempede or full dose pelvic radiation in a trial after six months. Part of me wants to choose reduced dose given it has more certainty than the trial. The other part of me worry about the effectiveness of reduced dose but has no leverage to ask doctor to do more intensive treatment. Does adding chemo help? Is waiting for six months to start radiation late?