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Prostate Cancer
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Posted 1/12/2012 10:02 AM (GMT 0)
Hello,
I am trying to make a decision as to whether to have my treatment at The Christie in Manchester UK, a world class hospital or the Dattoli Centre in Sarrasota, a specialised prostate hospital.
In the UK I would have 19 doses IMRT followed by 2 years HT.
At Dattoli I would probably have similar treatment followed by Bracytherapy, however I am told that the Radiation at Dattoli is far advanced.
The English Doctors are telling me it is all hype. I really do not know what to do.
I want a cure but I am also concerned that after the loss of my wife 18 months ago I have a new girlfriend and the HT is not compatible with my idea of our relationship.
Can anyone give me any advice or knowledge of Dattoli Centre or other US centres - I would much appreciate it. I am 74.
Posted 1/12/2012 1:14 PM (GMT 0)
The radiation at Dattoli is most likely more advanced and the doctors are most likely more skilled in that they only do prostate cancer. Your psa of 29 is the concern because it is indicative if the cancer being outside the capsule and if so the HT must be added to any treatment regardless of the locaton.
A PAP test should be taken as it is indicative of spread beyound the prostate and also a PCA3 to determine the aressivness of the cancer. If the cancer was found in your transition zone this could explain the high psa if not then some type of sofisticated MRI to the prostate should be done to determne probability of spread. a diffusion MRI or MRIS
19 doses of IMRT does not appear to be sufficient as the usual treatment is 45 sessions totalling a dose of 81 gy. How many Gy are they giving in 19 doses? The older doses of 65 gy just don't cut it anymore and are more apt to fail. You want the highest does possible and combo seeds and IMRT can get to 150 gy.
Dattoli is a very well respected prostate cance center with very good published results. They are also a heavy marketing organization so you have to seperate the marketing hype from the real results.
JohnT
Posted 1/12/2012 1:27 PM (GMT 0)
Thanks for your helpful reply. I will find out how many Gy they are giving, when I asked he said if I perfered I could have 37 doses but the Gy would be the same over 19 or 37 doses.
My UK Doctor also questioned the published results from Dattoli as they were from what appeared to be a small number of patients and look like they have been selected. I have been unable to find any published results online myself but will have another look.
Thanks
Tom
Posted 1/12/2012 6:54 PM (GMT 0)
Tom,

Has your doctor published his results? If so, on what basis and how do they compare to Datolli? I found a few doctors running down a large brachytherapy center in Atlanta questioning the results only to find the doctors being critical didn't publish results. It ktook away the argument.

I would question getting the same radiation externally with only half the fractions. I don't know of any of the leading centers doing that in the US. There is generally a Gy limit to each fraction with external beam before it starts doing a lot of damage to the benign tissue and organs; that is why they divide the treatment over time. Be careful on that. Typically the standard I have seen is less than 2 Gy per fraction for prostate. If you are getting 80 Gy in only 19 fractions that is nearly 4 Gy per fraction and that looks like a very large dose.
Posted 1/13/2012 2:18 AM (GMT 0)
Tom,

Welcome aboard friend. You have already been given some good advice.

I am very concerned about the 19 dose radiation plan. I have been through major radiation twice in the past 12 years,
the first was 70 gys spread over 35 treatments, the most recent, had 72 gys spread over 39 treatments.

Either, you wouldn't be getting enough radiation with the 19 gys, or they would be giving you way too much per dose.
The body can only safely tolerate x amount of radiation per day, that is why its not uncommon to have 35-45 days of
treatments. If they are trying to force a high amount of gys into 19 days of treatments, I would be very worried for you and how it might effect you, possibly increasing the likelihood of serious side effects. I believe you answered above, that you did not
know how many gys of radiation would be given total. This would be most important to know.

You state that you are 74 years old, so that would be more of a reason to make sure that your daily radiation limit wasn't
considered to be excessive.

Good luck as you sort this out. Please keep us well posted.

David in SC
Posted 1/13/2012 3:54 PM (GMT 0)
Hi Tom Welcome (I'm a Brit but I live in Holland)

19 sessions sounds odd. I've never heard of anyone having 19 sessions.
I think you need to check on the total dose they want to give you rather than the number of sessions.
The total dose should be around 70-80Gy, which if you only do 19 sessions eman they are wanted to give you about 4Gy each day, which is a big whack in one go. I had 66Gy of SRT which was 33 sessions of 2Gy eqach day, when asked why 2Gy per day (instead of say 11 sessions of 6Gy each day or 66 sessions of 1Gy they said that 1Gy per day would not be enough, but that anything much above 2Gy a day is difficult for the patient to cope with. (Same as they only liked to do RT Mondays to Fridays as you need a bit of time to recover each week.)

Personally I'd not have liked to add so much travelling jetlag etc to the RT equation. I also feel very comfortable having my check-ups post RT with the same people who planned it and carried it out.

Alf
Posted 1/21/2012 1:59 PM (GMT 0)
Thanks for all the useful replies.

My Doctor here in the UK is proposing giving me 19 fractions of 3Gy.

I am concerned about this and I am going to ask him if he could give me 37 treatments of 2Gy.

I will keep you posted.

Thanks

Tom
Posted 1/21/2012 2:52 PM (GMT 0)
Tom you also need to ask if the radiation fractions will focus on pelvic lymph nodes. With your high PSA it is quite possible that hitting area lymph nodes will be beneficial...

Tony
Posted 1/21/2012 7:36 PM (GMT 0)
Hi Tom,
The use of higher dose fractions in less time is called hypofractionation. It is a convenient way to reduce the number of treatments. The higher dose fractions usually result in a lower total dose. This is done based on an equivalency formula. Your proposed hypofractionation dose of 57 Gy total dose is equivalent to a 74 Gy total dose done with lower fractions. The use of hypofractionation is a still fairly recent development although similar toxicity results have been reported when compared to normal fractions.

I know that the Dattoli operation is first class and has the latest available equipment. I cannot rate the operation at The Christie for lack of information. In reading your signature, you seem to already be on androgen deprivation (or have been) although you report a rather high current PSA level. Can you clarify that?

RalphV
Posted 1/23/2012 9:26 AM (GMT 0)
Thanks Ralph and Tony ,

Yes my PSA was last taken before I started the hormone treatment. They have not taken it since I have been on the treatment.

I am asking my Doctor if I can have the treatment of 37 fractions of 2 Gy as I think I would prefer it.

I am also asking him if the radiation fractions will focus on pelvic lymph nodes.

Thanks for your help

Tom
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