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Treatment Options for Locally Advanced Cancer

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User
Posted 30 Jul 2022 at 14:19

I’ve been following this forum for a while but this my first post…just trying to come to terms with everything and now feel ready to talk about it.

I was diagnosed recently type T3B,  Gleason score 7(4+3)  - there was some debate about exactly whether it was localised or Locally Advanced but I think in the end the conclusion was that it had just started to spread into the seminal vesicles, so the T3B is the official type.

I’ve been on hormone therapy for nearly 6 weeks now, 4 weeks on the tablets(now finished), and after 2 weeks of that my first 3 monthly hormone injection if Prostap3

So now I’m looking at treatments.

I’ve had a meeting with the urology consultant who informed me surgery wasn’t an option because they felt that if they removed the prostate there was a chance that some cancer would be left behind so I would  require secondary treatment anyway. I found the consultant rather disinterested and lacking empathy. Fortunately I have some excellent Specialist nurses who I can turn to for help and support.

I then had an appointment with the oncologist who was thankfully much more forthcoming. However he did kind of throw me with a treatment option of 7 weeks rather than the 4 weeks. He also mentioned a brachytherapy boost(which I had read about) but I am not sure whether this will be feasible because of my flow rate not being good enough….I am going in tomorrow to have this checked again to see if there is any improvement since my first test, which was not long after they took biopsies.

I knew about the 4 week treatment, planting of gold seeds to direct the beams,  and also the brachytherapy boost option but had no knowledge of the 7 week treatment, so I wasn’t prepared with questions.

As I understand it the 7 week treatment is like a preemptive strike in case any micro cancer cells, undetected by the scans, have spread to the area just outside the prostate and will also target the lymph nodes. At each session a smaller dose of radiation is given but covering a wider area, so in total you get the same amount of radiation just over a longer period. I’m not sure whether I will still get the gold seeds planted if I opt for the 7 week treatment.

I’m just wondering what the pros and cons of having the 7 week treatment as opposed to 4 week treatment, apart from having to trail to the hospital every day for 7 weeks, which TBH doesn’t bother me if it’s going to give me the best outcome.

I just feel I want an expert to guide me on the best option for me given my circumstances rather than me trying to make the decision for myself.

Any help and advice people  can give me would be most welcome. I’m also going to speak to the Specialist Nurse tomorrow when I go for my flow test and see if I can make I decision.

Thanks!

 

User
Posted 30 Jul 2022 at 22:21

The traditional external beam radiotherapy dose is 37 x 2Gy fractions (Mon-Fri, so just over 7 weeks). Gy (Gray) is the unit of radiotherapy treatment dose. The number of fractions can vary from 35-40 in different places (usually higher in the US because they charge by the fraction).

There's a hypofractionated (fewer fractions) version of this which is 20 x 3Gy fractions. Although the total dose is less, because it's delivered over a shorter time at higher power, the treatment effect is the same. Although the prostate cancer responds better to the higher power, I'm not sure any other organs (such as lymph nodes) do, so they might want to use the 37 fractions if they're including other areas. (I'm not completely sure on this - you could ask your oncologist.)

I had HDR brachytherapy boost. This was delivered as 23 x 2Gy fractions to prostate, seminal vesicles, and pelvic lymph nodes, plus 1 x 15Gy fraction HDR brachytherapy boost delivered to the prostate only. In your case, the HDR would probably include seminal vesicles too. Including the pelvic lymph nodes with the external beam is optional - I didn't have any known disease in them, but it was belt'n'braces to mop up any micro metastisis there which hadn't shown up on scans. Most places do the brachytherapy first, but Mount Vernon Cancer Centre does the brachytherapy immediately afterwards.

I'm 3 years after the radiotherapy now, and pleased with the choice.

User
Posted 30 Jul 2022 at 23:14
Of one thing you can be sure and that is your Urologist will know about the various way of administering RT. He/she will recommend the best way of doing this in your individual case as he sees it, and using his/her experience.. (This assumes the option of the two types of Brachytherapy is available as a complete or partial treatment as not all hospitals are able to offer it). There are differences some requiring the patient present having taken a certain amount of water and or an enema before each fraction for example but these requirements will be explained before RT is started.
Barry
User
Posted 31 Jul 2022 at 09:42

37 fractions is the norm - 20/19/5 fractions are only used in certain circumstances. My guess is that once your flow rate has been assessed tomorrow, the oncologist will give you a stronger steer based on whether brachy boost is an option. 

Edited by member 31 Jul 2022 at 09:46  | Reason: Not specified

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

User
Posted 31 Jul 2022 at 11:06

Decho, in a different position to you, but slow flow was an issue before  my 33 salvage RT sessions. I had a suprapubic catheter fitted as insurance in case my stricture closed up, I suspect your issue is more to do with and enlarged prostate.

Hope you get sorted soon. 

Thanks Chris 

User
Posted 31 Jul 2022 at 20:40
I had the 'normal' 37 RT sessions to prostate/pelvis/seminals (as mentioned lesser RT to pelvis etc). I only had the RT/HT option given to me so at least didn't worry about choice. Treatment finished summer 2018, all good still.

Prior to treatment I had slow flow etc and had that sorted by urology before RT via Tamsulosin, self catheterization until a TURP (op to slice a bit of prostate off) then all ok. I was told RT may make flow worse, temporarily so the flow rate needed sorting first, for me anyway.

Peter

User
Posted 01 Aug 2022 at 04:58
Yes, I did mean Oncologist in my previous post and think it reasonable that you press him for a recommendation since your treatment seems to be under his aegis.

Barry
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User
Posted 30 Jul 2022 at 22:21

The traditional external beam radiotherapy dose is 37 x 2Gy fractions (Mon-Fri, so just over 7 weeks). Gy (Gray) is the unit of radiotherapy treatment dose. The number of fractions can vary from 35-40 in different places (usually higher in the US because they charge by the fraction).

There's a hypofractionated (fewer fractions) version of this which is 20 x 3Gy fractions. Although the total dose is less, because it's delivered over a shorter time at higher power, the treatment effect is the same. Although the prostate cancer responds better to the higher power, I'm not sure any other organs (such as lymph nodes) do, so they might want to use the 37 fractions if they're including other areas. (I'm not completely sure on this - you could ask your oncologist.)

I had HDR brachytherapy boost. This was delivered as 23 x 2Gy fractions to prostate, seminal vesicles, and pelvic lymph nodes, plus 1 x 15Gy fraction HDR brachytherapy boost delivered to the prostate only. In your case, the HDR would probably include seminal vesicles too. Including the pelvic lymph nodes with the external beam is optional - I didn't have any known disease in them, but it was belt'n'braces to mop up any micro metastisis there which hadn't shown up on scans. Most places do the brachytherapy first, but Mount Vernon Cancer Centre does the brachytherapy immediately afterwards.

I'm 3 years after the radiotherapy now, and pleased with the choice.

User
Posted 30 Jul 2022 at 23:14
Of one thing you can be sure and that is your Urologist will know about the various way of administering RT. He/she will recommend the best way of doing this in your individual case as he sees it, and using his/her experience.. (This assumes the option of the two types of Brachytherapy is available as a complete or partial treatment as not all hospitals are able to offer it). There are differences some requiring the patient present having taken a certain amount of water and or an enema before each fraction for example but these requirements will be explained before RT is started.
Barry
User
Posted 31 Jul 2022 at 08:37

Originally Posted by: Online Community Member
Of one thing you can be sure and that is your Urologist will know about the various way of administering RT. He/she will recommend the best way of doing this in your individual case as he sees it, and using his/her experience.. (This assumes the option of the two types of Brachytherapy is available as a complete or partial treatment as not all hospitals are able to offer it). There are differences some requiring the patient present having taken a certain amount of water and or an enema before each fraction for example but these requirements will be explained before RT is started.

Sadly the Urologist wasn’t interested in discussing anything to do with RT, he said the oncologist would go through this with me. The oncologist did go through the options but didn’t really give any indication which would be best for me given my circumstances.

User
Posted 31 Jul 2022 at 09:42

37 fractions is the norm - 20/19/5 fractions are only used in certain circumstances. My guess is that once your flow rate has been assessed tomorrow, the oncologist will give you a stronger steer based on whether brachy boost is an option. 

Edited by member 31 Jul 2022 at 09:46  | Reason: Not specified

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

User
Posted 31 Jul 2022 at 11:06

Decho, in a different position to you, but slow flow was an issue before  my 33 salvage RT sessions. I had a suprapubic catheter fitted as insurance in case my stricture closed up, I suspect your issue is more to do with and enlarged prostate.

Hope you get sorted soon. 

Thanks Chris 

User
Posted 31 Jul 2022 at 20:40
I had the 'normal' 37 RT sessions to prostate/pelvis/seminals (as mentioned lesser RT to pelvis etc). I only had the RT/HT option given to me so at least didn't worry about choice. Treatment finished summer 2018, all good still.

Prior to treatment I had slow flow etc and had that sorted by urology before RT via Tamsulosin, self catheterization until a TURP (op to slice a bit of prostate off) then all ok. I was told RT may make flow worse, temporarily so the flow rate needed sorting first, for me anyway.

Peter

User
Posted 01 Aug 2022 at 04:58
Yes, I did mean Oncologist in my previous post and think it reasonable that you press him for a recommendation since your treatment seems to be under his aegis.

Barry
User
Posted 01 Aug 2022 at 19:42

Originally Posted by: Online Community Member
Yes, I did mean Oncologist in my previous post and think it reasonable that you press him for a recommendation since your treatment seems to be under his aegis.
Spoke to one of the Specialist Nurse on Sunday(yes, she even works on a Sunday!😊) when she checked my flow rate and she said that once the oncologist had my flow rate results he would make a recommendation. She is then going to phone me. I can’t speak highly enough of these nurses, they are so helpful and empathetic.













User
Posted 01 Aug 2022 at 19:47

Originally Posted by: Online Community Member
I had the 'normal' 37 RT sessions to prostate/pelvis/seminals (as mentioned lesser RT to pelvis etc). I only had the RT/HT option given to me so at least didn't worry about choice. Treatment finished summer 2018, all good still.
Prior to treatment I had slow flow etc and had that sorted by urology before RT via Tamsulosin, self catheterization until a TURP (op to slice a bit of prostate off) then all ok. I was told RT may make flow worse, temporarily so the flow rate needed sorting first, for me anyway.
Peter

Thanks for sharing your story, I have a feeling that will be my best treatment option. I am waiting to hear back from the Oncologist - once he has my flow rate tests I am hoping he makes a recommendation.

User
Posted 01 Aug 2022 at 19:49

Originally Posted by: Online Community Member

37 fractions is the norm - 20/19/5 fractions are only used in certain circumstances. My guess is that once your flow rate has been assessed tomorrow, the oncologist will give you a stronger steer based on whether brachy boost is an option. 

 

Thanks, this is what the Specialist Nurse old me when I went for my Flow Test.

 
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