High Risk Radiotherapy Options

I'm not understanding the diagnosis.

T4 is a stage, not a risk, and is advanced cancer and not curable. But I suspect you don't really mean T4.

Gleason 4+3 is grade group 3.

So, what's the staging, and what does the 4 relate to (PIRADS)?

Difficult to answer the rest without understanding the diagnosis.

You mention Lupron, but that's a brand of Luprorelin sold in the US (it's called Prostap in the UK). If your dad is in the US, treatment customs can be different.

We don't have accurate data comparing VMAT alone, with HDR Boost (VMAT + HDR), both plus hormone therapy. HDR Boost is intended for high risk patients with local or locally advanced cancer and no mets. It's thought to be at least as good as VMAT alone but with fewer side effects, but the data to prove this doesn't exist. This will be the results of the PIVOTALboost trial, when it completes. (I had this treatment.)

HDR Boost isn't suitable if there's any lymph node involvement - in that case you would have VMAT alone (plus chemo, plus hormone therapy).

I aimed to get my PSA ≤ 0.1 before starting radiotherapy, but you mustn't delay radiotherapy unless PSA is dropping at a significant rate, and not everyone will be able to get their PSA that low on hormone therapy. In the US, neoadjuvant hormone therapy (hormone therapy before radiotherapy) sometimes includes Abiraterone to get PSA lower, but that's never done in the UK.

Really need to know your dad's diagnosis better, to know his staging and which risk group he's in, and hence if HDR Boost would be viable.

Edited by member 30 Nov 2020 at 19:32  | Reason: Not specified

Thanks for the reply Andy62. It is T4 size tumour (locally advanced). Grade group 3 and the current plan is to give curative radiotherapy to prostate. We're in the UK so prostap then . There is no lymph node involvement on any scans including PSMA (Gallium-68) PET scan which was done when PSA went up due to lockdown. Hopefully I have been informative now than the first description 😀

Although we can help in a general way and offer constructive thoughts and possibilities, you really need to have in depth personalised talks with you consultants because they have your complete histology and scans and can suggest appropriate treatment options for you. Sometimes there might not be much advantage of one treatment over another but in some cases you will be strongly steered along a certain path.

Edited by member 04 Dec 2020 at 01:58  | Reason: Not specified

Thanks for you the reply Old Barry. Yes, I do agree with you - I am in discussion with the team treating him but I thought that I would use this forum to see whether other people think my opinions are reasonable and make enough sense to be brought up to discuss with the team. Or even somebody might make a suggestion which makes me think more logically about my opinion. But I do understand your overall point you are trying to make - thanks

Also possible that what was originally thought to be a T4 on the MRI was later downgraded to a T2 / T3 following the G68 scan?

LynEyre - Thanks for you info - that is a new point that I did not know about. Is extending the RT beam to include the pelvic muscle within the treatment description of radiotherapy to prostate? So are you saying that they could rather be trying to get more dose to cover the pelvis muscle area which is harder to reach, so that there isn't enough dose left to do nearby lymph nodes? I understand that there is a maximum dose rate to the body but was wondering whether the dose can be calculated appropriately to cover all (prostate, pelvis muscle and nearby lymph nodes)? or whether you are saying it is more effective if they try to use a lot of the dose go all out on the nearby pelvic muscle. I am still waiting to hear back from the team so these extra bits of info can help a lot.

As I said, best to clarify with the oncologist whether they have decided that it is a T2 / T3 instead, or whether it is a T4 and the likelihood of the RT being curative is slim.