You haven't got the full diagnosis yet, so any suggestions require some speculation which might turn out to be invalid.
You haven't mentioned lymph nodes or that any further scan awaited for those (such as waiting for an abdominal CT scan), so presumably they think they're clear (N0)?
If the lymph nodes are clear and the bone scan is clear, i.e. T3bN0M0, I think a good treatment for that staging is HDR boost, which is radiotherapy delivered half as external beam, and half as high dose rate brachytherapy. This gives you the advantage of brachytherpy which is a high dose into the known cancer, combined with the advantage of external beam which is spill of external beam outside the prostate which can mop up any nearby micro-mets (mets too small to show on scans). An option with this treatment is to also treat the pelvic lymph nodes prophylactically at a lower dose with the external beam, which I took. The basis for this is the next place the cancer is likely to go is pelvic lymph nodes, and including them in the dose will wipe out any micro-mets which have already got there and might cause recurrence otherwise. Cribriform and lymphovascular involvement increases that risk. (I would ask if they think treating lymph nodes at a higher dose in the light of this might be advisable, but that probably increases risk of side effects afterwards.) This treatment is combined with hormone therapy, probably for 2-3 years. HDR Boost is only available at the main treatment centres, so if you wanted it you might have to be referred to a different hospital. (You don't have to only accept treatments your local hospital does, but you will probably only be offered those unless you ask to be assessed for a different treatment, which you can do.)
Very few surgeons offer prostatectomy for T3b. It seems to be difficult to catch all the cancer in the seminal vesicles, so it has a higher recurrence rate than is the case for lower staging.
If there is spread to bone, then treatment options will be different and depend on the extent and location of this.
Wishing him all the best with the bone scan for a clear result.
Edited by member 12 Mar 2024 at 20:28
| Reason: Not specified