Treatment plan for my T3b?

Sounds sensible to me. It's a lot like my treatments. I have a much higher Gleason score (4+5=9) but you have the SVI so our risks may be comparable (or not -- I dunno).

When I used to be an employee of FSU (back in the day) it was improper to use the full name without including the article "The" in front.

It's a tough decision -- the old adjuvant vs salvage RT dilemma rears its ugly head again. Treating recurrences early and with sufficient radiation is certainly an advantage if there is really a recurrence going on. Your focal positives, SVI and detectable PSA are all adverse features. The HT should slow it down and give you time to get some more opinions.

The standard of care is localized IMRT, perhaps with HT, and it may be all you need to clean up the cancer. Because there is no evidence of lymph node involvement, irradiating the entire pelvis may not buy you anything but SEs, or it might kill off as yet undetectable cancer cells that have traveled there. I don't really understand what the proton boost to the prostate bed buys you, other than greatly increased cost. If it is in the bed, then you'll want to treat widely and deeply (IMRT) rather than with razor-edged margins that protons may provide -- so what is the advantage of adding protons there? I haven't seen any data that salvage RT with a proton boost is any better than without it.

The HT pre-treatment gives you a couple of months to get other opinions from Moffitt or Dattoli. I always like hearing expert opinions before making up my mind.

- Allen

did you ever say what your original PSA was? 

ed

 

Have you gone to or considered going to a second doctor for a second opinion and to compare opinions?

49yrsold,

less than .01 is a whole lot better than .01. That little "<" makes a big difference.

But it's still a hard decision, especially because you have a few high risk features. Recent evidence is that adjuvant treatment is better than salvage (i.e., waiting for PSA to rise to .2), but Dr. King has found that as long as the radiation dose is sufficient - around 70 Gy - and the PSA doesn't get up above .2, salvage results may be just as good.

The timing of salvage radiotherapy after radical prostatectomy: a systematic review.

The hormone therapy may slow it down while you seek second opinions. There's little agreement on how long to use it. Some believe that only 2 months pre-treatment is necessary to sensitize the cancer to radiation. Others think 6 months is better. Then after treatment, some believe it should be continued for 6 months and some continue it for as long as 2 years. There is some evidence that it is of no benefit with Gleason 3+4. It is also debatable whether it is really needed with dose-escalated (70 Gy) of radiation -- there's a clinical trial now to help solve that.

I'm sorry if I've only added to your very warranted confusion about this. I wish there were clearer answers.

- Allen