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Treatment Considerations

User
Posted 11 May 2021 at 10:15

Thought it best to start a new thread now I have a diagnosis of cancer (see profile updates).

I'm now facing the decision about treatment that many on here have already contemplated and I naturally have questions.

I am told it's either Radiation/HT or RALP and my knee-jerk reaction was to go for the latter which is now booked. I have a week or two to reflect and that's what I have started to do and received helpful comments from you guys (see my old thread)...so thanks for that.

The RT thing - I don't understand how it protects you from recurrence. If you already have a prostate that is pre-disposed to generating cancer cells of varying degrees of risk, then killing them does not prevent more popping up later.

So it seems 'safer' in my rather simple mind to throw the kitchen sink at it by removing the offending body part and cleaning up with RT if anything is left behind.

There seems to be some support out there for multi-modal treatment rather than mono-modal.

Where is my thinking going wrong?

User
Posted 11 May 2021 at 23:06
After bone scan about 6 weeks ago and starting HT that will progress to RT in 6 months I am awaiting CT scan to confirm staging. I'm not sure yet what it all means!
User
Posted 13 May 2021 at 16:56
You can look at this a number of ways because although there are similarities, each case is different medically and his assessment to risk and various treatments differ. My view is that if the cancer is well contained and nerve sparing achieved surgery is a very good option or without nerve sparing if this is not of great concern to you or any partner. You then have to accept the risk of some incontinence for a time or for a very few permanently. You also have to accept the risk that once on the operating table it may be found necessary to remove more nerve bundles than originally thought. Where the cancer is found closer to the edge of the gland, with the possibility that some is outside it, the change towards towards External Beam which can go further than the knife or modern equivalent can be used. You come to a point where putting yourself through surgery and all that that entails plus additional radiation means you may think you will just go straight to radiation anyway. This was my situation with a T3A. The surgeon said he would remove my Prostate if this is what I wanted but he had strong doubts he could remove all borderline cancer, so it was his view and that of the MDT that I would be best going for radiation which I had. And yes, to answer a question made at the beginning of this thread, there is a chance while you still have a Prostate that cancer will grow in it again (as happened to me) or that in maybe in 20 or so years time there is a smaller risk of the RT initiating another form of cancer. It has to be considered as part of your risk and treatment assessment.

There are of course a lot of men where the options are more clear cut but there are other aspects that can influence a treatment decision, age, aversion to either form of treatment and or potential side effects among them. Regardless of what treatment a man opts for, there is a chance of PCa coming back if not in the Prostate, somewhere else. Of course better results for surgery can be expected from better more highly experienced surgeons or where very good radiologists have cutting edge linacs, but regardless there will still be some failures. It's not surprising when all things are considered that men can come to different conclusions.

Barry
User
Posted 11 May 2021 at 12:58

Real-world data shows that RT and RP have virtually identical long-term success rates, so there's little or no reason to choose one over the other in terms of the likelihood of a successful outcome. It really is just a question of which set of side-effects you consider less bad.

Best wishes,

Chris

User
Posted 11 May 2021 at 15:31

Hi 

It is very difficult to decide on the best option when confronted by decisions that will change the rest of your life good or bad and possible side affects.

I had the choice of robotic surgery or Brachytherapy and i believe both the specialist believed his option was the best for me in his own way but neither of them could guarantee any of the side affects i may have to contend with.

I had a private medical to renew my 7.5 ton licence at 70 and microscopic blood was picked up in my urine so doctor asked  for further tests and found a slightly raised PSA of 2.19 and after MRI and other tests i had Gleason of 3+4=7 and 5 of 20 samples positive.

I had Brachytherapy in September 2016 at Mount Vernon and was in and out in two days and put on Tamsulosin and a few pain killers.Four and a half years on my PSA is 0.08 and was signed off in January 2021.

If you click my Avatar you can see my journey so far.

Good Luck John.

Edited by member 11 May 2021 at 15:34  | Reason: Not specified

User
Posted 11 May 2021 at 17:03

Originally Posted by: Online Community Member

 

So it seems 'safer' in my rather simple mind to throw the kitchen sink at it by removing the offending body part and cleaning up with RT if anything is left behind.

 

Where is my thinking going wrong?

Personally I would absolutely not consider this as an option. Worst of both worlds. What staging have they given you? Is nerve sparing an option? 

User
Posted 12 May 2021 at 02:31
Make sure you see both a surgeon and and oncologist before you make your choice. You could also ask for a further second opinion from two more.

Have you ordered the comprehensive information folder “Tool Kit” from the publications section of this website?

Best of luck,

Cheers, John.

User
Posted 12 May 2021 at 08:39

don1two,

A little like you I wasn't keen on RT and although I really didn't want treatment ( and went on AS for a couple of years) surgery was my preferred choice. But for me it was really important that the surgeon was aiming for full nerve sparing. I'm not clear why your surgeon says he may be able to spare nerves only on one side- might be worth exploring further. It really depends on what is important to you and whether ED is a major concern or something you could deal with. I did a fair amount of research to find the best surgeon I could and was fortunate I had private healthcare. If nerve sparing had been in doubt I'd have probably held off a little bit then gone down the RT route.

Good luck with whatever choice you make. It's not easy

User
Posted 12 May 2021 at 19:54

As well as looking at how much cancer there appears to be in the prostate (using the MRI plus the number of positive cores), they also look at what % of each core is cancerous, the position of the positive core within the grand and the position of the cancerous cells within each core. In your case, they can presumably see that some of the cancer is towards or at the edge of the gland near the nerve bundles, rather than settled centrally. Imagine they stuck a straw into a melon and pulled it out carefully to inspect the thin tube of melon flesh:-
Cancer cells clustered at one end of the sample = near the nerve bundles
Cancer cells clustered at the opposite end = near the urethra
Cancer cells clearly visible around the end of the sample = has broken through the gland (T3 / poss T4)
Cancer cells fairly central = T1/T2, good bet for fully contained and possibly suitable for AS

Edited by member 12 May 2021 at 19:56  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 13 May 2021 at 14:17

Hi Don,

Sorry you have joined our club, but you have a decision to make it's yours alone to make.

I was diagnosed 2017 Gleason 3+3 T2A group grade, only 2 cores 1% affected, I opted for AS which I was on for 3years, I read and studied all I could about PC it was my way of dealing with it.

I had 3 MRI, 3BIOPSIES, 1BONE SCAN during that time the only change my PSA had gone from 5.3 to 8.2 and my last MRI showed a nodule had slightly increased in size but my scores were still the same, but given my age 68 I decided it was time to make a decision about treatment while I was still fit and strong I met with an oncologist and a surgeon, I went with surgery because all the studying I had done made me feel it was right for me. I had surgery on 25th November 2020 I was fortunate enough to have bilateral nerve sparing surgery.

I am fully recovered now no incontinence still not fully back Erection wise but work in progress needed a little pill preop sometimes so paintence is a virtue, back at the Gym and cycling, all good, and God forbid if I needed further treatment down the line then Radiotherapy is an option, but not easy to have a prostatectomy after radiation first, also radiotherapy can cause the possible side effects as surgery and yes they are very compatible in achieving a cure, so the choice is yours good luck and good health.

Daily

User
Posted 14 May 2021 at 18:57

Hi

Please have a look at my profile.

Brother decided RT.  What is your staging ?  T? .     I can't add more than Barry, explains it very clearly.

Also into the mix for your decision, are you fit, good BMI and no comorbidities .  Has the cause of episode of UTI been fully resolved.

Is retaining full sexual function a key priority.  Have you been offered other solution ? Ablation if unifocal..I do realise it's 4+4.

Have the probable location of lesions been described, explained to you ?

Surgery has served me well, and had non nerve sparing. However it is a major op.

Regards Gordon

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

User
Posted 21 Jun 2021 at 15:21

Hi don1two,

I'm glad to hear that you have so little cancer, though PSA is moderately high so it clearly needs treating.

Personally I would go for the trial. When they are trialling treatments it would be considered unethical to offer any treatment which was thought to be worse than the current best practice, so I would not be worried about that aspect of things.  If you get selected for the five days arm, then I would say that is probably an advantage as it is only five trips to hospital rather than 20. Whichever arm you get selected for you will probably be closely monitored in follow up for a few years, and the extra monitoring might save your life!

If you go on the trial and get selected for the new treatment and the cancer returns in five years time you may say, I wish I had not gone on the trial. Alternatively if you don't go on the trial and the cancer returns in five years you may say, I wish I had gone on the trail. If it's 50/50 I would try and advance science by going on the trial.

I don't think I would be too concerned about getting a testosterone test. I think the comment about having a testosterone base line was by Andy62, I'm sure Andy won't mind me calling him a "data geek", and he likes to chart every statistic he can. If you can get your GP to do a testosterone test (it is just a simple blood test) then by all means get one. If the GP won't, and you are curious then you can order a kit over the internet, I think they are about £40.

Don't forget these are just my opinions and what I would do, in particular I am comfortable with taking risks, but I don't expect anyone else to be.

Dave

User
Posted 21 Jun 2021 at 23:53
The data suggests that a higher dose over a small number of fractions leads to fewer side effects.

In your case, I can't see any great benefit in knowing your starting testosterone level as you will only be on HT for a very short time but for men on long-term HT for advanced PCa, measuring their testosterone at every PSA test is a useful evidence that the hormones are working.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 22 Jun 2021 at 01:23
It may be of interest to note that the Chief Investigator for the CHHiP trial was at The Royal Marsden which was one of the participating hospitals. This compared men having the standard 37 fractions each of 2gy compared with 19 or 20 fractions at around 3 gy. This showed the fewer number of fractions at higher dose compared well with the standard way of administering. This hypo fractionated dose with advantages for the radiation unit and the patient has been increasingly adopted in hospitals so you could say the Royal Marsden have form for this. This principle now seems to be applying to SRT. Unfortunately, with RT, only time will show whether giving higher doses less often will be more or less successful than current way of administering SRT.
Barry
Show Most Thanked Posts
User
Posted 11 May 2021 at 12:58

Real-world data shows that RT and RP have virtually identical long-term success rates, so there's little or no reason to choose one over the other in terms of the likelihood of a successful outcome. It really is just a question of which set of side-effects you consider less bad.

Best wishes,

Chris

User
Posted 11 May 2021 at 15:31

Hi 

It is very difficult to decide on the best option when confronted by decisions that will change the rest of your life good or bad and possible side affects.

I had the choice of robotic surgery or Brachytherapy and i believe both the specialist believed his option was the best for me in his own way but neither of them could guarantee any of the side affects i may have to contend with.

I had a private medical to renew my 7.5 ton licence at 70 and microscopic blood was picked up in my urine so doctor asked  for further tests and found a slightly raised PSA of 2.19 and after MRI and other tests i had Gleason of 3+4=7 and 5 of 20 samples positive.

I had Brachytherapy in September 2016 at Mount Vernon and was in and out in two days and put on Tamsulosin and a few pain killers.Four and a half years on my PSA is 0.08 and was signed off in January 2021.

If you click my Avatar you can see my journey so far.

Good Luck John.

Edited by member 11 May 2021 at 15:34  | Reason: Not specified

User
Posted 11 May 2021 at 17:03

Originally Posted by: Online Community Member

 

So it seems 'safer' in my rather simple mind to throw the kitchen sink at it by removing the offending body part and cleaning up with RT if anything is left behind.

 

Where is my thinking going wrong?

Personally I would absolutely not consider this as an option. Worst of both worlds. What staging have they given you? Is nerve sparing an option? 

User
Posted 11 May 2021 at 22:16

Chris,

I have received that message several times and I get it. As a 'position' it has to be an average outcome I suspect, so I do wonder if it's a coin toss as to which way we all choose to go.

It seems to me from reading loads of profiles on here that each man has his own prostate cancer journey, each one is different and there is no single, right answer. All we can do is take a stab at it from the available collective experience based on our own set of circumstances.

I of course read about your journey and am glad it's working out for you......thanks for your support.

User
Posted 11 May 2021 at 22:31

Thanks John,

Brachytherapy sounded a good option when I spoke 2 or 3 years ago with a relative from Canada who went that route. This was well before my eventual diagnosis of cancer last week.

I asked the lead surgeon on my case about it and he said he wasn't a fan (for what that's worth), wasn't appropriate to my case and the MDT has given me the two options of RT/HT or Surgery. I feel unqualified to disagree with their conclusions so it's one of those two as far as I can see.

Thanks for your support and continued good health.

User
Posted 11 May 2021 at 22:59

Thanks Mike,

I hope I haven't misled you. I am not saying to have both treatments one after the other. I mean if you opt for the RP, you still have the RT/HT to fall back on if necessary down the road for salvage, etc.

I am not staged fully yet as they couldn't see any tumour on both MRIs I have had (pirads 2). It was only the recent Transperineal biopsy (69 samples taken!) that showed any sign of cancer. 6 of the 69 were cancer, 5 were Gleason 3+3, and, drat it, 1 was Gleason 4+4. Yesterday, my specialist nurse said I was T0 N0, don't fully undertand the system yet.

Just had the bone scan, also yesterday and maybe the staging is clearer after that?

My surgeon told me if I went the RP choice, he may be able to spare the nerves on the one side.

Thanks for your concern....pleased to read your encouraging progress.

User
Posted 11 May 2021 at 23:06
After bone scan about 6 weeks ago and starting HT that will progress to RT in 6 months I am awaiting CT scan to confirm staging. I'm not sure yet what it all means!
User
Posted 11 May 2021 at 23:22

Thanks,

Best wishes for your treatment....I have to decide the path I'm going to take in the next couple of weeks.

Such a lot to take in and understand!

User
Posted 12 May 2021 at 02:31
Make sure you see both a surgeon and and oncologist before you make your choice. You could also ask for a further second opinion from two more.

Have you ordered the comprehensive information folder “Tool Kit” from the publications section of this website?

Best of luck,

Cheers, John.

User
Posted 12 May 2021 at 08:39

don1two,

A little like you I wasn't keen on RT and although I really didn't want treatment ( and went on AS for a couple of years) surgery was my preferred choice. But for me it was really important that the surgeon was aiming for full nerve sparing. I'm not clear why your surgeon says he may be able to spare nerves only on one side- might be worth exploring further. It really depends on what is important to you and whether ED is a major concern or something you could deal with. I did a fair amount of research to find the best surgeon I could and was fortunate I had private healthcare. If nerve sparing had been in doubt I'd have probably held off a little bit then gone down the RT route.

Good luck with whatever choice you make. It's not easy

User
Posted 12 May 2021 at 18:39

Hi John,

Thanks. Yes, I am waiting to see the oncologist having already seen the surgeon and I did order the toolkit..... should arrive in the next day or two. Am still leaning towards surgery with a Gleason 4+4 and PSA probably now over 20.

Cheers, Don

User
Posted 12 May 2021 at 18:48

Thanks Mike,

No, not easy. He said the biopsy suggested it may not be safe to spare one side. I don't know how they make these decisions, but I am inclined to take their advice......it is a very experienced team and they have done 1100 Robotic Prostatectomies...he seems like one of the best from what I have read along with his colleague. I will wait until I have spoken with the Oncologist before deciding, although I will need convincing as I don't fancy HT/RT downsides.

I agree, I don't want treatment, but feel I have no choice for peace of mind.

I appreciate your interest and reading everyone's stories is an education in itself!

Cheers, Don

User
Posted 12 May 2021 at 19:54

As well as looking at how much cancer there appears to be in the prostate (using the MRI plus the number of positive cores), they also look at what % of each core is cancerous, the position of the positive core within the grand and the position of the cancerous cells within each core. In your case, they can presumably see that some of the cancer is towards or at the edge of the gland near the nerve bundles, rather than settled centrally. Imagine they stuck a straw into a melon and pulled it out carefully to inspect the thin tube of melon flesh:-
Cancer cells clustered at one end of the sample = near the nerve bundles
Cancer cells clustered at the opposite end = near the urethra
Cancer cells clearly visible around the end of the sample = has broken through the gland (T3 / poss T4)
Cancer cells fairly central = T1/T2, good bet for fully contained and possibly suitable for AS

Edited by member 12 May 2021 at 19:56  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 13 May 2021 at 14:17

Hi Don,

Sorry you have joined our club, but you have a decision to make it's yours alone to make.

I was diagnosed 2017 Gleason 3+3 T2A group grade, only 2 cores 1% affected, I opted for AS which I was on for 3years, I read and studied all I could about PC it was my way of dealing with it.

I had 3 MRI, 3BIOPSIES, 1BONE SCAN during that time the only change my PSA had gone from 5.3 to 8.2 and my last MRI showed a nodule had slightly increased in size but my scores were still the same, but given my age 68 I decided it was time to make a decision about treatment while I was still fit and strong I met with an oncologist and a surgeon, I went with surgery because all the studying I had done made me feel it was right for me. I had surgery on 25th November 2020 I was fortunate enough to have bilateral nerve sparing surgery.

I am fully recovered now no incontinence still not fully back Erection wise but work in progress needed a little pill preop sometimes so paintence is a virtue, back at the Gym and cycling, all good, and God forbid if I needed further treatment down the line then Radiotherapy is an option, but not easy to have a prostatectomy after radiation first, also radiotherapy can cause the possible side effects as surgery and yes they are very compatible in achieving a cure, so the choice is yours good luck and good health.

Daily

User
Posted 13 May 2021 at 16:56
You can look at this a number of ways because although there are similarities, each case is different medically and his assessment to risk and various treatments differ. My view is that if the cancer is well contained and nerve sparing achieved surgery is a very good option or without nerve sparing if this is not of great concern to you or any partner. You then have to accept the risk of some incontinence for a time or for a very few permanently. You also have to accept the risk that once on the operating table it may be found necessary to remove more nerve bundles than originally thought. Where the cancer is found closer to the edge of the gland, with the possibility that some is outside it, the change towards towards External Beam which can go further than the knife or modern equivalent can be used. You come to a point where putting yourself through surgery and all that that entails plus additional radiation means you may think you will just go straight to radiation anyway. This was my situation with a T3A. The surgeon said he would remove my Prostate if this is what I wanted but he had strong doubts he could remove all borderline cancer, so it was his view and that of the MDT that I would be best going for radiation which I had. And yes, to answer a question made at the beginning of this thread, there is a chance while you still have a Prostate that cancer will grow in it again (as happened to me) or that in maybe in 20 or so years time there is a smaller risk of the RT initiating another form of cancer. It has to be considered as part of your risk and treatment assessment.

There are of course a lot of men where the options are more clear cut but there are other aspects that can influence a treatment decision, age, aversion to either form of treatment and or potential side effects among them. Regardless of what treatment a man opts for, there is a chance of PCa coming back if not in the Prostate, somewhere else. Of course better results for surgery can be expected from better more highly experienced surgeons or where very good radiologists have cutting edge linacs, but regardless there will still be some failures. It's not surprising when all things are considered that men can come to different conclusions.

Barry
User
Posted 14 May 2021 at 18:57

Hi

Please have a look at my profile.

Brother decided RT.  What is your staging ?  T? .     I can't add more than Barry, explains it very clearly.

Also into the mix for your decision, are you fit, good BMI and no comorbidities .  Has the cause of episode of UTI been fully resolved.

Is retaining full sexual function a key priority.  Have you been offered other solution ? Ablation if unifocal..I do realise it's 4+4.

Have the probable location of lesions been described, explained to you ?

Surgery has served me well, and had non nerve sparing. However it is a major op.

Regards Gordon

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

User
Posted 17 May 2021 at 23:17

Hi everyone,

I just re-discovered I need to tick the box below a thread to be notified of new posts. Apologies to those posting several days ago and thanks to you for your continued support and input.

Lyn - I have only so far received the categorisation of Grade 4 and 1 Gleason 4+4 sample reported, with 6/69 positive and 5 of them Gleason 3+3. The TNM system was not discussed by the Urological Consultant and I didn't think to ask. I still need that system clarifying. 

Quizzing the MacMillan Support worker assigned to me subsequently, she said that they could not see a tumor on both my MRIs, so she said currently it was T0 N0 (if that makes any sense). Maybe in my case, it would come from postoperative pathology of the excised gland? I plan to drill down, chapter and verse, on this with the Oncologist when I see them. Your description is very illuminating ...thanks.

------------------------------------------------

Daily - at 69 I am still sufficiently interested to want the nerve-sparing, even if only one side is safe....but not if it presents a high risk...another question for the Urologist/Oncologist. It is on the job sheet for my robotic prostatectomy if I go that route, which I currently favour. This is because, I feel the G4+4, although not pervasive it seems, and with a PSA knocking around 20 now, sounds safer with a later RT/HT backup plan. Glad to hear of your current good health and general well-being. Long may it continue...thanks.

------------------------------------------------

Barry - I appreciate your balanced and thoughtful views, you make some great points. I have not dismissed the RT, but it's not just that, my MDT has said it's RT with HT and I fear that's two lots of treatment regimes with two lots of side effects. Also, I have had a history of bladder issues and lower back pain issues (arthritis) and I do wonder if the RT/HT route might, given also my age, raise the risk of adverse side effects.

Thanks for your tips on further stuff I need to ask. Hope you're keeping well...you've had a long journey and I'm so pleased for you.

------------------------------------------------

Gordon - please see above, still awaiting a TNM staging explanation/confirmation. Yes, reasonable fitness and BMI and I believe my earlier 2017 bladder issues are resolved and behind me.......but they 'thankfully' led to my first PSA test and possibly saved my life!

I believe the options I am being offered from the MDT expert assessments, are either Surgery or RT/HT. I'm happy to choose one of those. The jury is still out on the final decision.

Pleased to hear of your good outcome. Thanks and continued good health.

User
Posted 21 Jun 2021 at 10:49
Morning all,

Had a telephone consultation with the Oncologist Consultant. He said the amount of cancer found from the biopsy was clearly on the low side and only 1 of 69 samples was high risk. The treatment proposed is EBRT sandwiched between 6 months of Hormone Therapy by LHRH agonist injection.

He explained I was eligible for the PACE C trial, which assessed standard conventional radiotherapy given over 4 weeks versus stereotactic radiotherapy targeting the prostate given over 5 alternate days. It is a randomised control trial run by the Royal Marsden Hospital who have published their early data showing comparable early side-effects between standard radiotherapy and stereotactic radiotherapy. He said, however, we await the long-term outcomes data. However, I would need to have an up-to-date MRI scan to participate in this trial as I have not had one recently.

Not sure I will opt for the trial as it seems a bit risky as no evidence to say it is better or worse than the standard treatment. What do people think, am I being sensible?

I have asked for a fresh PSA test to get a pre-treatment baseline, as last one was 22 Nov 20 and was 18.9.

Can someone explain the advisability/necessity or otherwise of having a testosterone level test before starting HT treatment. I thought I read someone on here saying they wish they had a baseline before they started their treatment. How is it tested for anyway?

Once again, thanks for your help and support.

Don

User
Posted 21 Jun 2021 at 15:21

Hi don1two,

I'm glad to hear that you have so little cancer, though PSA is moderately high so it clearly needs treating.

Personally I would go for the trial. When they are trialling treatments it would be considered unethical to offer any treatment which was thought to be worse than the current best practice, so I would not be worried about that aspect of things.  If you get selected for the five days arm, then I would say that is probably an advantage as it is only five trips to hospital rather than 20. Whichever arm you get selected for you will probably be closely monitored in follow up for a few years, and the extra monitoring might save your life!

If you go on the trial and get selected for the new treatment and the cancer returns in five years time you may say, I wish I had not gone on the trial. Alternatively if you don't go on the trial and the cancer returns in five years you may say, I wish I had gone on the trail. If it's 50/50 I would try and advance science by going on the trial.

I don't think I would be too concerned about getting a testosterone test. I think the comment about having a testosterone base line was by Andy62, I'm sure Andy won't mind me calling him a "data geek", and he likes to chart every statistic he can. If you can get your GP to do a testosterone test (it is just a simple blood test) then by all means get one. If the GP won't, and you are curious then you can order a kit over the internet, I think they are about £40.

Don't forget these are just my opinions and what I would do, in particular I am comfortable with taking risks, but I don't expect anyone else to be.

Dave

User
Posted 21 Jun 2021 at 23:39

Thanks Dave,

That's a great perspective, you've given me much food for thought and I am spurred on to research a little deeper into the PACE trials.

I see my Oncologist again next week and will have the chance to question him further.

One question that has come up listening to the PCRI is whether the higher dose of SBRT together with a larger than average prostate gland would lead to a significant increase in the risk of damage to other healthy tissues.

I would welcome other's views that have considered or taken part in SBRT treatment.

Thanks for any help, Don

User
Posted 21 Jun 2021 at 23:53
The data suggests that a higher dose over a small number of fractions leads to fewer side effects.

In your case, I can't see any great benefit in knowing your starting testosterone level as you will only be on HT for a very short time but for men on long-term HT for advanced PCa, measuring their testosterone at every PSA test is a useful evidence that the hormones are working.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 22 Jun 2021 at 01:10

Hi Lyn,

Yes, I noted that. I think the PCRI guy was trying to say that where the prostate has a larger volume, the beam would need to cast a wider net and thus irradiate more tissue. I certainly doubt that PACE B would have stratified their results on this variable by now or even ever. Seems a mute point, but I'll raise it with the Onco anyway.

Yep, seems like I'm barking up the wrong tree on the testosterone test thing.

Thanks a lot for your advice.

Don

User
Posted 22 Jun 2021 at 01:23
It may be of interest to note that the Chief Investigator for the CHHiP trial was at The Royal Marsden which was one of the participating hospitals. This compared men having the standard 37 fractions each of 2gy compared with 19 or 20 fractions at around 3 gy. This showed the fewer number of fractions at higher dose compared well with the standard way of administering. This hypo fractionated dose with advantages for the radiation unit and the patient has been increasingly adopted in hospitals so you could say the Royal Marsden have form for this. This principle now seems to be applying to SRT. Unfortunately, with RT, only time will show whether giving higher doses less often will be more or less successful than current way of administering SRT.
Barry
User
Posted 22 Jun 2021 at 02:17

Hi Barry,

Thanks for drawing my attention to that trial...I wasn't aware of it. Bedtime now, but I will read around that a bit tomorrow.

Cheers, Don

 
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