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5 dose Radiotherapy ?

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User
Posted 27 Jan 2022 at 00:38

Hi all, 


Having been on active surveillance for about 18 months, the time has now come when I really must be getting some treatment. Gleason 7 (3+4)  T2c and PSA now risen to 19.  Most of the posts I have seen on this site appear to relate to surgery rather than radiotherapy. I have read about a million articles about the pros and cons of the treatment options, and the more I hear , the more confusing it all becomes. 


At the moment I am however leaning towards the SABR  5 dose radiotherapy, and if possible with a rectal spacer. They have also advised 6 months hormone treatment 😕


Is there anybody out there who has recently been down this route?


I am 65yrs old, a bit overweight but active (tennis, swimming etc), I am symptom free, apart from mild ED which came about as a result of the second of my 3 biopsies, and this has been easily managed with tadalafil. I know I am extremely unlikely to escape without any side effects of treatment, but I am looking for the "Least worst" option.


Any help, advice or words of encouragement would be very welcome. Cheers.

User
Posted 28 Jan 2022 at 09:39

Hi Steve


My husband was a similar grading to you (T2C 3+4) with a slightly lower PSA reading.  


He was admitted onto the PACE-A trial at the Royal Marsden and assigned to the SBRT (Cyberknife) route.  This terminology, I think, is the same as you are being offered.  Five days of radiotherapy but no hormone treatment.  We were advised that hormone therapy was not considered necessary with his staging and with the effectiveness and precision of the SBRT.


This was carried out in August 2018 and his last PSA reading was 0.06.   He did have some side effects such as bowel and bladder urgency but these abated. 


Please feel free to ask any questions.


V.


 

User
Posted 27 Jan 2022 at 16:56
All the trial data so far is that 5 fractions causes fewer side effects that 20 or 37 fractions, even though the dose is much higher. The biggest current trial has good outcomes at 2/3 years but doesn't have data for 5+ years, simply because the trial only started in 2018.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Jan 2022 at 18:56
The Christy Manchester is a leading hospital and your clinical team there with have assessed from your scans and biopsy that you are a good candidate for SABR. This way of administering RT uses a tighter beam which means the dose is more highly focused on the tumour, also resulting in less radiation where it is not wanted. (In some cases, there is less certainty about the extent of the cancer and the wider spread of more conventionally delivered RT can be advantageous). The trend has been to reduce the number of fractions over recent years whilst at the same time increasing the actual dose at each fraction. Overall this results in less total radiation tor the patient with fewer attendances and also benefitting the hospital in overall less setting up and treatment time. However, each time the format is changed slightly, these changes are usually considered as part of a trial and ongoing results considered before changes become generally adopted. In some cases results look so promising that changes are made without waiting for long term assessment that can only be known in time.
Barry
User
Posted 28 Jan 2022 at 12:52

Steve


Just to let you know that you don't have to live in the catchment area for the Marsden to join the PACE trial.


I do know that they are still recruiting for both PACE A and the new PACE C.   The PACE C does offer hormone treatment as it is for men who have a slightly higher risk, although my husband was classified as intermediate.  As it is only 5 days of treatment you probably wouldn't find it too onerous travelling to the Marsden on the Fulham Road.  It's very convenient for public transport with a tube station just 5 minutes walk away.  There was the initial discussion, then the planning scans and then the five days of treatment and then follow-up meetings to discuss how things are going etc every three months for the first year and then every six months.  


You could ask your doctor to refer you to the Marsden for the PACE trial.  My husband didn't start off at the Marsden as he was originally referred to the Urology department at Chelsea and Westminster where all the diagnostics were carried out.  He subsequently asked the GP to refer him to the Marsden which she did willingly.


One of the advantages of being on a trial like this is that you really do get superb care.  Any side effects that you may get will be fully investigated and the overall care has been second to none.


Let me know if you need any further info.


Very best wishes.


V


 


 

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User
Posted 27 Jan 2022 at 14:03
SABR is not a common method for delivering radiation as a Primary treatment for PCa being more usually used as a salvage treatment, so you may not get a great response from men that have had it. Have you discussed your case with an Oncologist and a Urologist and if so what did they say about the options open to you?
Barry
User
Posted 27 Jan 2022 at 15:32

Thanks Barry, I have already been offered SABR treatment at the Christie in Manchester. I know it is a relatively new option.


The oncologist has advised the radiotherapy (with HT) as I said previously. The urologist I discussed it with does have a surgical history, but to my surprise he also said he would probably advise RT. They did not advise brachytherapy due to my PSA level.


I had a chat with my GP about side effects, and he said in is his experience he sees more patients suffering from the side effects of surgery than he does after RT. I realise that is evidence from a small sample, and it may be that RT side effects tend to build up gradually and therefore patients don't go running to their GPs as a result of a sudden change.

User
Posted 27 Jan 2022 at 16:56
All the trial data so far is that 5 fractions causes fewer side effects that 20 or 37 fractions, even though the dose is much higher. The biggest current trial has good outcomes at 2/3 years but doesn't have data for 5+ years, simply because the trial only started in 2018.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Jan 2022 at 18:56
The Christy Manchester is a leading hospital and your clinical team there with have assessed from your scans and biopsy that you are a good candidate for SABR. This way of administering RT uses a tighter beam which means the dose is more highly focused on the tumour, also resulting in less radiation where it is not wanted. (In some cases, there is less certainty about the extent of the cancer and the wider spread of more conventionally delivered RT can be advantageous). The trend has been to reduce the number of fractions over recent years whilst at the same time increasing the actual dose at each fraction. Overall this results in less total radiation tor the patient with fewer attendances and also benefitting the hospital in overall less setting up and treatment time. However, each time the format is changed slightly, these changes are usually considered as part of a trial and ongoing results considered before changes become generally adopted. In some cases results look so promising that changes are made without waiting for long term assessment that can only be known in time.
Barry
User
Posted 28 Jan 2022 at 09:39

Hi Steve


My husband was a similar grading to you (T2C 3+4) with a slightly lower PSA reading.  


He was admitted onto the PACE-A trial at the Royal Marsden and assigned to the SBRT (Cyberknife) route.  This terminology, I think, is the same as you are being offered.  Five days of radiotherapy but no hormone treatment.  We were advised that hormone therapy was not considered necessary with his staging and with the effectiveness and precision of the SBRT.


This was carried out in August 2018 and his last PSA reading was 0.06.   He did have some side effects such as bowel and bladder urgency but these abated. 


Please feel free to ask any questions.


V.


 

User
Posted 28 Jan 2022 at 10:46
Thanks Vicky.

Your husband was extremely lucky. As I understand it SABR and SBRT are the same thing, but Cyberknife is a specific type of treatment that unfortunately is not being offered to me.😒
User
Posted 28 Jan 2022 at 12:52

Steve


Just to let you know that you don't have to live in the catchment area for the Marsden to join the PACE trial.


I do know that they are still recruiting for both PACE A and the new PACE C.   The PACE C does offer hormone treatment as it is for men who have a slightly higher risk, although my husband was classified as intermediate.  As it is only 5 days of treatment you probably wouldn't find it too onerous travelling to the Marsden on the Fulham Road.  It's very convenient for public transport with a tube station just 5 minutes walk away.  There was the initial discussion, then the planning scans and then the five days of treatment and then follow-up meetings to discuss how things are going etc every three months for the first year and then every six months.  


You could ask your doctor to refer you to the Marsden for the PACE trial.  My husband didn't start off at the Marsden as he was originally referred to the Urology department at Chelsea and Westminster where all the diagnostics were carried out.  He subsequently asked the GP to refer him to the Marsden which she did willingly.


One of the advantages of being on a trial like this is that you really do get superb care.  Any side effects that you may get will be fully investigated and the overall care has been second to none.


Let me know if you need any further info.


Very best wishes.


V


 


 

User
Posted 28 Jan 2022 at 13:59
Hmm, Thanks Vicky. It is a bit of a slog from Manchester, but in the grand scheme of things it may be worth it.

Certainly food for thought!
 
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