External radiography for localized prostate cancer

I presume you mean radiotherapy rather than radiography?

Do you know what the staging is (T2.....?)?

External beam radiotherapy might be preferable if the cancer is close to the edge of the capsule and there's some concern it might be T3a, or if any lymph nodes are suspicious (but then it's not localised), or if you are high risk (PSA >= 20 or Gleason >= 8), but otherwise I would have thought Brachytherapy would normally be the preferable radiotherapy path for T2xN0M0 diagnosis from the side-effects viewpoint.

You should be being advised by a multi-disciplinary team (MDT) where the urologist, oncologist, and others collectively decide what's best for you, rather than each one pitching their favorite procedure (at least, if you are on NHS treatment). It might be that the MDT decided that either option is good for you, but you should never be in the situation where the urologist and oncologist are disagreeing - that would be a failure of the MDT. How has this come about? Are you sure you are correctly understanding what they recommended?

OK, I assume you are not in the UK.

In the UK, that would often be treated with active surveillance (although your PSA is probably too high for that), i.e. no immediate treatment, but periodic scans and biopsies. However, ultrasound guided trans rectal needle biopsy (TRUS) is notoriously unreliable - it can't reach the anterior (front) of the prostate, and sampling the apex (base) is difficult and often not done. So you could have more extensive cancer than the TRUS result implies.

The mpMRI should give you a PIRADS score, and also an indication of which part(s) of the prostate are suspect. Was the mpMRI done and reported on before the TRUS? If so, I hope the TRUS was guided by the mpMRI results towards the suspect areas.

I would be a bit concerned that the cancer found by TRUS is a bit small to account for PSA 10. It's not impossible, but should raise the question about whether all the cancer has been found. Depending how well the TRUS was driven by the mpMRI result, I would consider more investigations first. The other thing that could count towards that PSA level would be an enlarged prostate (large prostates generate more background PSA). Does the mpMRI report say how large the prostate is?

In the UK, I think you would get a bone scan for mets and possibly a transperineal template prostate biopsy depending on the mpMRI result.

Edited by member 02 Aug 2019 at 09:30  | Reason: Not specified

How many sessions is your oncologist suggesting you might have, and is that with or without hormone therapy?

UK cost to the NHS for 150mg bicalutamide is about £10 for 4 weeks supply. US cost is similar. You probably want to take tamoxifen with it to prevent growing breasts, but that's very cheap.

The Zoladex and Prostap treatments cost more, around £250 for 4 weeks.

If you can't afford or can't get Zoladex or Prostap, I would certainly look at taking 150mg bicalutamide to bring your PSA down during 3-6 months before starting radiotherapy and keeping it low for at least 6 months afterwards. Some research shows if you can get your PSA under 0.1 when starting RT, you don't need to continue with HT afterwards. (I'm not aware this is done in the UK, although I did delay my RT to get as near as possible to 0.1 beforehand.)

Edited by member 04 Aug 2019 at 09:52  | Reason: Not specified

Lyn, he's not being offered any of those. He's being offered 34 sessions of external beam radiotherapy, and I was very clear in saying it's what I would do if being offered that.

Of course, any meds need discussing with the oncologist.