Failures wth IMRT Seeds & ADT as Primary Treatment?

I read post after post of recurrence after surgery, but don't recall reading any, with the type of primary treatment I've had.

I've noticed the same thing. It does happen, we just don't hear about it as much. Any reason for I would give would just be a wild guess.

My fear about having done IMRT has always been, "what it all the PC cells weren't in the target zone?"

Andrew

Don't remember the exact measurement but there was a concern about the PC being in the margins so the RO targeted an area just slightly bigger than the prostate itself. I remember asking him to open the beam up enough to hit any suspicious areas around the prostate.

I am sure that's one of the reasons my treatment worked so well. It just my speculation based on the pathology report and the doc's reading of it, but I've often thought that if I went with surgery first, I would have ended back in for SRT.

So far my PSA dropped fast and low enough that we aren't talking about any further treatments.

Andrew

Ed - yup, that PSA test is still an anxiety generator. So much rides on that number. Don't recall but I think it was a 30% chance of being out the capsule for me - each time the nurse calls to remind me it's PSA time, my brain goes into worry mode for awhile.

At first I did a lot of second guessing about my treatment choice but the more low PSA numbers I get the better I feel about what I did.

Andrew

divo, not sure where you're located, but Vanderbilt Hospital (Nashville, TN) has a large urology oncology group.  They are a referral center for people with complications from prostate cancer treatments.  You may want to contact them to see if they can be of help.

I had that discussion with them while debating my treatment options, and some choices they discouraged because of the resulting complications they are asked to fix.

I had IGRT by IMRT as my primary treatment, due to the G9 (5+4), high involvement, and 3T MRI showing extraprostatic extension.  Surgery was possible, but likely not curative.  So, radiation and HT it was (and is).

The RO had the plan created with a 6mm margin around the prostate, with 4mm in the area next to the rectum.  The lymph nodes were treated too, and they gave them a 7mm margin since they're a little more mobile and they wanted to cover them due to an over 40% risk of lymph node involvment.

Blessedly, at almost 5 months post-radiation I have no symptoms from it at all.  Well, I get up at night usually once due to urinary urgency which didn't happen before, but that's not unusual and not too bothersome.  Still on HT for 2 1/2 more years, but doing great with undetectable PSA.

My RO said he has not seen local recurrence with this treatment plan.  It's always been systemic.

In 2004 I had a Lupron shot, 25 beam radiation treatments, another Lupron shot and seed implants.
The PC came back in 2008.

Still enjoying life and looking forward to many more years.

Sam

I've been looking into this a lot lately because someone in my support group is high risk and is pursuing combo therapy. The variables include the type and dose of boost to the prostate & prostate bed, whether the pelvic lymph nodes are treated, and whether and how long ADT is used. In my friend's case (GS9, PSA40, T1c), his nomogram showed a probability of LN invasion of >40%, so even though his CT showed no suspicious enlargement, we decided to treat those anyway. He had to go on ADT because of a trip that delayed treatment, so we could not do a PET scan (his PSA is too low now).

Combo therapies - external beam radiation with a boost to the prostate - have produced 5-yr biochemical control rates ranging from 69% to about 90%. Although it's better than the stats on high risk RP treatment, as John T pointed out, it's still a wide range of outcomes.

Rather than have a brachy boost to the prostate, my friend will have an SBRT boost (5 x 8 Gy) with treatment out to 5mm on the anterior side. His pelvic lymph nodes will be treated with 5 doses of 5 Gy each. (A total of 5 treatments altogether). His ADT will be continued for 9 months

ADT has never been proven to be beneficial with hypofractionated radiation when comparing patients who did and did not receive it. However, it's hard to ignore a recent study in at Kitasato U. that used moderate hypofractionation to the pelvis and an HDR brachy boost and 3 yrs of adjuvant ADT. They achieved 91% biochemical success rate after 5 yrs. Of course, it was not a randomized trial, so they might have achieved that without the ADT. We all felt more comfortable with at least some adjuvant ADT afterwards to clean up any systemic micromets that may be susceptible.

- Allen