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Intermediate cancer treatment. Reduced radiotherapy.

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User
Posted 24 May 2024 at 10:02

I know this has been discussed in various conversations but thought it was worthy of one of it's own.


Last September the Beeb reported that visits for radiotherapy for intermediate prostate cancer could be safely reduced from 20 down to five.


https://www-bbc-co-uk.cdn.ampproject.org/v/s/www.bbc.co.uk/news/health-66946336.amp?amp_gsa=1&amp_js_v=a9&usqp=mq331AQIUAKwASCAAgM%3D#amp_tf=From%20%251%24s&aoh=17165403388933&referrer=https%3A%2F%2Fwww.google.com


Does anyone know if this has been implemented?


Does it eliminate the need for HT?


 


 


 


 

User
Posted 26 May 2024 at 15:16

That seems unlikely.


What's made this treatment possible is the aiming/targeting accuracy of getting it just in to the prostate, and not spilling outside. After a prostatectomy, that tissue is gone, and what you're doing for salvage radiotherapy is targeting the tissue you would have been trying to miss had you been doing radiotherapy in the first place. That tissue isn't as good as the prostate at handling high doses, so I suspect that will remain a treatment of more lower power doses.


Having said that, salvage radiotherapy to the prostate bed has slowly been changing from 33-35 fractions down to 20 fractions at some treatment centres. It isn't always given with HT either, although I've never worked out what the rules of using HT or not is for salvage RT.


If they are treating a known met somewhere else, than SABR has been used for that for some years, often without HT.

Edited by member 26 May 2024 at 15:17  | Reason: Not specified

User
Posted 27 May 2024 at 14:45

A clinician is forbidden to mention private treatment options during an NHS consultation, unless you explicitly ask, as you did, and then they can.


I did the same. In my case, the consultant said, "You can choose where you have it done, when you have it done, you get a private room, and I get paid more, but the treatment is identical". I stuck with the NHS.


I think the 5 treatment regime is available on the NHS now at all the treatment centres which took part in the trial, which was quite a lot of the main treatment centres capable of doing SABR.

Edited by member 27 May 2024 at 14:49  | Reason: Not specified

User
Posted 27 May 2024 at 18:16

I was invited to apply for a place on 5 fraction treatment for high risk Pca, the randomised element was additional prophylactic zapping of lymph nodes.


I think the NHS are very keen on moving to 5 fraction for obvious reasons.






 




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User
Posted 26 May 2024 at 07:32

Yes, two members of one of my support groups have had this just recently at Mount Vernon Cancer Centre. It's not done with HT. In both cases, they were considering brachytherapy but were also offered this, and decided to switch treatment.


 

User
Posted 26 May 2024 at 07:48
Does anyone know if it's going to be an option for salvage treatment post RARP recurance?

Cheers
Bill
User
Posted 26 May 2024 at 15:16

That seems unlikely.


What's made this treatment possible is the aiming/targeting accuracy of getting it just in to the prostate, and not spilling outside. After a prostatectomy, that tissue is gone, and what you're doing for salvage radiotherapy is targeting the tissue you would have been trying to miss had you been doing radiotherapy in the first place. That tissue isn't as good as the prostate at handling high doses, so I suspect that will remain a treatment of more lower power doses.


Having said that, salvage radiotherapy to the prostate bed has slowly been changing from 33-35 fractions down to 20 fractions at some treatment centres. It isn't always given with HT either, although I've never worked out what the rules of using HT or not is for salvage RT.


If they are treating a known met somewhere else, than SABR has been used for that for some years, often without HT.

Edited by member 26 May 2024 at 15:17  | Reason: Not specified

User
Posted 26 May 2024 at 20:12
That's a useful explanation Andy,

There was a paper (I've referenced it in another thread, so won't try to replicate my search for it) that described a trial which concluded that HT could be avoided for SRT as long as PSA was <0.5 and doubling time greater than 8 months (figures from memory).
User
Posted 27 May 2024 at 11:29

Hi. I had a RP and seem to have come out well on the other end - and was a Gleason 7 so not perhaps entirely apt here. NONETHELESS, at my so called 'information meetings' at a major London hospital in January of this year - during the one with the oncologist - totally chaotic it was too - he said that although the NHS did officially sponsor the clinical trial with the five fraction treatment it (i.e, the NHS) has not yet officially approved/adopted that treatment path for use in the NHS system itself and consequently it is not currently (or at least it wasn't at that time) available ON THE NHS. You may be amused to know that the oncologist I met with in that major London NHS hospital was ALL TOO eager to tell me 'what he could do for me privately'. Go figure!

Edited by member 27 May 2024 at 11:31  | Reason: Not specified

User
Posted 27 May 2024 at 11:47

Originally Posted by: Online Community Member
 although the NHS did officially sponsor the clinical trial with the five fraction treatment it (i.e, the NHS) has not yet officially approved/adopted that treatment path for use in the NHS system itself and consequently it is not currently (or at least it wasn't at that time) available ON THE NHS.


Hello mate. I think they have just started it as a treatment plan.


https://www.royalsurrey.nhs.uk/news/royal-surrey-joins-new-radiotherapy-trial-to-reduce-treatment-time-for-prostate-cancer-10626/#:~:text=A%20new%20clinical%20trial%20led,a%20quarter%20of%20the%20time.


 

User
Posted 27 May 2024 at 11:51

Meunier, I have swapped to the private sector for my treatment. My oncologist didn't mention that there were additional treatments available privately until I asked the question, "is there anything better privately". 


I think it is frowned upon for NHS staff to try and sell the private sector. 


Thanks Chris 

User
Posted 27 May 2024 at 14:45

A clinician is forbidden to mention private treatment options during an NHS consultation, unless you explicitly ask, as you did, and then they can.


I did the same. In my case, the consultant said, "You can choose where you have it done, when you have it done, you get a private room, and I get paid more, but the treatment is identical". I stuck with the NHS.


I think the 5 treatment regime is available on the NHS now at all the treatment centres which took part in the trial, which was quite a lot of the main treatment centres capable of doing SABR.

Edited by member 27 May 2024 at 14:49  | Reason: Not specified

User
Posted 27 May 2024 at 16:46

Andy , I did think not allowed was more appropriate than frowned upon but wasn't 100 percent certain.


I came across this article, it is only a trial and in the USA.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10828884/


Thanks Chris 

User
Posted 27 May 2024 at 18:16

I was invited to apply for a place on 5 fraction treatment for high risk Pca, the randomised element was additional prophylactic zapping of lymph nodes.


I think the NHS are very keen on moving to 5 fraction for obvious reasons.






 




 
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