Scan this Wednesday

It's a 30/30/30 risk isn't it.

- 33% chance that you will have RP with all the associated certain and potential side effects but unlikely to be curative

- 33% chance that you will have RT with all the associated certain & potential side effects but unlikely to be curative 

- 33% chance of focal therapy with fewer side effects but very unlikely to be curative

The downside of your proposed treatment plan is that there is no chance at all of it being curative but you can be sure of avoiding many of the side effects that most impact on quality of life - incontinence, for example. 

Whichever way you go, you seem to be almost certain of getting targeted RT to the known mets. Your call, and not an easy choice but I think my OH would want to avoid as many side effects as possible. 

There are three arms to the ATLANTA trial the control arm which is Standard of Care only and two Intervention arms

Intervention arm 1: Focal therapy to the primary prostate tumour 

Intervention arm 2: Either RP or curative dose RT. The choice depends on which they believe would be more successful and also your preference for the potential side effects the different treatments pose. 

If randomised to either of the intervention arms then you would also be offered SABR to the metastases you have.

I was randomised to Intervention arm 2 and awaiting the MDT meeting following a recent MRI and PSMA PET scan 

I think the difference is that SOC would be Chemo and ADT and not normally give the treatment to the mets that you seem to have been offered. What you don’t seem to have on offer is any radical treatment of the primary that the ATLANTA trial does offer. If randomised to Intervention arm 2 you would have the choice between RP or RT so would not have to have an operation. You are of course also able to stop being part of a trial at anytime.

It always seems odd when the North Lakes are classed as North East. In reality Carlisle is closer to Newcastle than Preston or Manchester. I noticed when I had my op South Lakes were referred to Blackburn for the op and we were referred to Preston.  I was offered robotic at Blackburn but didn't want the delay as the Preston surgeon gave me a quick assessment then op date, or my wife driving there in mid December.

It's pretty common for these cancer scans to show up other issues: think of it as a "body MOT". When I had my scans for prostate cancer, the scan also found an unrelated kidney tumour AND an aneurysm that I apparently could have dropped dead from at any moment. All three now sorted, thankfully. 

Chris

Hi Cayambe,

PSA looks good. I think mine dropped to 0.8 from 24 in the first three months and went on to become <0.1. I don't know if yours will keep dropping it's looking like it is levelling out, but I would say it is good.  

36 Grays in 6 Fractions. Well the total dose they intend giving you is 36 Grays. I can't remember the exact definition of a Gray, but it is just a unit of radioactivity. More interesting is how much they are giving you. I think in the old days they used to give about 80gy then it went down to about 50gy and it looks like they are trying to reduce it further. (they can do this because it is better targeted, in the past half of those Grays were missing the cancer and damaging other organs instead).

The 6 Fractions just means you will have 6 treatments and each will be 6 Grays each. Quite interesting because in the past they only gave between 2 and 3 Grays at a time. Giving fewer more intense doses is a topic of debate, it is certainly more convenient to only have to go to hospital 6 times rather than 20.   

I don't know if they will target the mets. If they are very close to the prostate they may be zapped at the same time.

If they don't treat them then they will presumably become the site from which further cancer cells will spread.

If they do treat them they really need to be zapped more than once, as they are only giving you 6 fractions I can't see how or when they will do the mets unless they are done at the same time. 

If RT starts in September, I think it is most likely you will be fine by Christmas. I think the side effects are proportional to the total dose not the strength of each fraction (unless they gave you all 36 grays in one go, in which case I think you would come out the machine smelling like a bacon sandwich).

Side effects are worse towards the end of RT and a few weeks after, so early November may be when they are at the worst, it could involve fatigue, or minor bleeding from bowels. I wouldn't book an expensive holiday just in case you can't go, but you might want to book a cheap holiday and accept you may lose the money if you do have side effects.

Hope the July holiday goes well pandemic permitting.