I was treated according to one of the PIVOTALboost trial arms because my onco thought it was my best option, but I wasn't treated on the trial.
Brachytherapy boost is where radiotherapy is provided as external beam, but boosted in the prostate (and seminal vesicles if appropriate) using brachytherapy.
PIVOTALboost is about providing evidence to show that HDR boost is (or isn't) a beneficial treatment over plain EBRT in high risk patients with no known lymph node spread. It's widely thought that it is beneficial, but there's no proper proof at the moment, and this is a randomised trial to provide this. The trial has many arms, because there are many variable parameters, including using classic EBRT.
The arm I was treated according to was tri-modal:
Hormone therapy, 18-36 months in total.
EBRT: 23 fractions of 2Gy (46Gy) to prostate, seminal vesicles, and pelvic lymph nodes (often incorrectly called whole pelvis or wide beam - it's not, it's accurately aimed at organs and pelvic lymph nodes).
HDR Brachytherapy 1 fraction of 15Gy to prostate only.
In spite of the differences in Gy, these two treatments are both half the dose they would be if done as monotherapies, so it's a half dose EBRT plus a half dose HDR Brachytherapy. Some of the trial arms adjust this ratio a bit.
I was told the half dose EBRT doesn't generally give any side effects, but bear in mind your rectum does get spill from both doses. I do have some minor rectal bleeding as a result, but in my case is painless and it has no impact on quality of life, and I don't regret my decision.
I was offered SpaceOAR on the NHS as part of the original NHS trial, but in discussion with my onco, we decided not to. As a high risk patient, there's a theoretical chance the spacer could push micromets out of the radiation field, allowing them to survive and cause recurrence. (The ICEMAN trial at UCLH is looking to get evidence on this, but it's closed now.)
You could ask to be treated according to one of the trial arms instead of on the trial. I was offered PIVOTALboost or this trial arm off-trial. My onco thought I might not get accepted on to PIVOTALboost because my hormone therapy had been messed up for 6 months, and in my case, also thought I should be doing one particular arm, not something you can control on the randomised trial.
Edited by member 23 Feb 2021 at 09:04
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