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Targeted Radiotherapy.

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User
Posted 08 Feb 2020 at 16:07

Hi all, 

Only posted a few times, but read posts everyday.

My husband G9 DX one and a half years ago PSA 310, G9 Metastatic to LN  and Bones.

Started Lupron and Chemo straight away, PSA came down to 1.5, had 6 sessions of RT, PSA hovering around 1.9  to 2.4 for the last 11 months. Saw OC in Dec 2019, and PSA now 4.7, so added Biclautimide, PSA now 3.9 so heading in the right direction.

What I would like to know is if anyone has been offered Targeted RT ? My Hubbie has 2 lesions on his spine and 1 on his left hip, all LN seem ok now according to the OC. 

We see our OC in March when we return off holiday, my Hubbie has no pain so dont need the R223 yet.But im considering asking about SBRT to the 3 mets. Been reading that it can really help and sometimes even eliminate them, I know that other mets will probably appear later on down the line, but surely it is better to try and sort this problem out sooner rather than later ?Especially as they are in the spine (one at the bottom,and one about half way up )

Any thoughts or experiences would be much appriciated

Kim 

 

 

 

User
Posted 09 Feb 2020 at 09:49

Chris, you have had no radiotherapy, is there no benefit to be had from a preemptive strike on all your known Mets?

Dr Kwon seems to think so https://youtu.be/60P98QLWf70

 

User
Posted 09 Feb 2020 at 16:32

Hugely difficult decisions Chris and I respect you for your courage in your chosen path. That I might have chosen a different path is by the by but Quality of Life is a massive factor. Hormone Treatment damages your quality of life and that is beyond dispute. When I started on this journey I read any number of articles from advocates of an aggressive approach to treatment through to those who were wary of "over treatment."

It's a truism but it is such an individual decision.

User
Posted 10 Feb 2020 at 12:09

This lecture was given in 2014 but is still relevant today other than there are now better scans than were available at the time. Patients come from far and wide to be treated at Dr Eugene Kwon's clinic as reported on a large USA forum, such is his reputation for aggressively treating PCa.

An interesting but much shorter video but Dr Kwon is on Immunotherapy https://www.youtube.com/watch?reload=9&v=Xb1z1tU-Dec

This has been further developed and works for some but not all (just like all types of treatment because individuals react differently)

Edited by member 10 Feb 2020 at 12:10  | Reason: Not specified

Barry
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User
Posted 08 Feb 2020 at 20:09
This treatment is much bigger in the USA than here. I think the rule is that if it is three or less mets then you can have guided RT. It can even lead to cure they say. But when lymph nodes are involved I think they think they are wasting their time as it will only pop up somewhere else. My last scans showed spine mets identical to yours but two lymph’s in my abdomen also. All he offered was systemic chemo and HT for life. Final results in 12 days. Not sure what I want ....
User
Posted 09 Feb 2020 at 00:06
I would certainly ask about it although this form of treatment is not widely available so might necessitate travel. If your Oncologist feels this might be suitable he/she would most likely know nearest facility providing this form of treatment.
Barry
User
Posted 09 Feb 2020 at 09:49

Chris, you have had no radiotherapy, is there no benefit to be had from a preemptive strike on all your known Mets?

Dr Kwon seems to think so https://youtu.be/60P98QLWf70

 

User
Posted 09 Feb 2020 at 11:35

Cyberknife is one of the specialities at Mount Vernon, and we're planning to have a session on it at one of the upcoming monthly Mount Vernon Prostate Cancer Support Group meetings, but we don't know which month yet. I'll let people know when we have a date.

It won't be the topic this month. For this month's MVPCSG meeting (Wed 19th Feb) see this post.

User
Posted 09 Feb 2020 at 14:41

Yes - I am about to have it. The form that it will take in my case is SABR or Stereotactical Ablative Radiotherapy. It is similar too but not quite the same as Cyber Knife.

The background to my case is that I had 20 sessions of EBRT in April/May 2016. This was described as "dose painting" where a much higher dose is directed to the tumours themselves and less to surrounding areas.

Fast forward to last autumn and my PSA was rising steadily. Bone, CT and MRI scans revealed no mets but the oncologist was convinced something was going on and ordered a PET scan which showed 3 small tumours in lymph nodes. She said that they could use the SABR technique to blast these. 3 sessions delivering a total of 30 Gy of radiation. The maximum pelvic dose was not an issue in my case because these nodes, although in the pelvic area, were above the prostate. The SABR technique, like Cyber Knife, is highly targeted and the dose to surrounding tissue is minimal.

I am just starting 24 months of bicalutamide as an adjuvant treatment. Unlike with my initial RT, they want to do the SABR pretty soon as the tumours are of a size that could quickly become to small to aim at if the bicalutamide is taken for too long before treatment.

I'll be updating my threads and profile with progress. 

User
Posted 09 Feb 2020 at 15:12
My Onco has received a really long email based on input from my GP , myself, my councillor and my wife. It basically explains that I’d try anything other than plain systemic treatment and that I don’t really want it and may reject it. I’ve always been a difficult case and it may adjust his decisions or outlook I hope. I’m tempted to refuse any treatment until I actually feel ill in any way. Massive gamble I know but QOL has always been my aim.
User
Posted 09 Feb 2020 at 16:32

Hugely difficult decisions Chris and I respect you for your courage in your chosen path. That I might have chosen a different path is by the by but Quality of Life is a massive factor. Hormone Treatment damages your quality of life and that is beyond dispute. When I started on this journey I read any number of articles from advocates of an aggressive approach to treatment through to those who were wary of "over treatment."

It's a truism but it is such an individual decision.

User
Posted 09 Feb 2020 at 20:47
Thanks for all your responses.

Kim

User
Posted 10 Feb 2020 at 12:09

This lecture was given in 2014 but is still relevant today other than there are now better scans than were available at the time. Patients come from far and wide to be treated at Dr Eugene Kwon's clinic as reported on a large USA forum, such is his reputation for aggressively treating PCa.

An interesting but much shorter video but Dr Kwon is on Immunotherapy https://www.youtube.com/watch?reload=9&v=Xb1z1tU-Dec

This has been further developed and works for some but not all (just like all types of treatment because individuals react differently)

Edited by member 10 Feb 2020 at 12:10  | Reason: Not specified

Barry
User
Posted 15 Feb 2020 at 12:02

I need to enter a correction to my earlier post above. Somewhat embarrassingly I had forgotten that my SABR treatment involves 9 sessions not 3. The confusion arose because they gave me a letter after my planning scans showing 3 sessions. These were just the first 3 and my oncologist did say I would have 9 now I remember.

Brain fog kicking in early this time! So my SABR treatment to lymph nodes above the prostate is still 30 gy but delivered in 9 sessions over 3 weeks. Monday, Wednesday, Friday each week.

User
Posted 16 Feb 2020 at 10:12

After spinal cord compression discovered last September, I had three targeted areas on my spine zapped with RT, 4 x 45 minute sessions given over 4 consecutive days. It has definately improved my situation. Still a bit of numbness in my left leg but nothing really.

Only downside is that I received the maximum yearly radiation, so if another tumour pops up, they could not treat it with more RT. High dose of steroids to reduce swelling and maybe risky surgery, but, touch wood, situation has not occurred .

Worth investigating as it will improve your quality of life if they can give it to you.

Best regards

 
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