Anyone have iliac nodes treated?

Woody-

Because you have detected it in a bone, you know that the cancer is systemic - what is the point of treating the mets you can see, if it puts you in danger of incurring toxicity? Systemic treatments (hormone therapy) work and have been shown to cut mortality in half.

Read CaliJR's recent thread about radiation-induced enteritis.

Woody... I agree with TA, you have mets and systemic treatment is what you should shoot for. As your doctor mentioned, zapping those lymph nodes could cause issues and trust me, small bowel issues suck. I know it doesn't happen to everyone, maybe George didn't have any side effects and got lucky, but yet again he doesn't have bone mets. Whack-a-mole with RT should only be used for relief of bone pain. I think TA posted something recently about starting HT sooner is better for overall survival which is the real goal. Good luck to you. Take care.
-JR

Don't know if this is applicable to your case. I was originally diagnosed with suspicious iliac and obturator nodes. My primary treatment was IGRT/IMRT with the Varian Truebeam. I had a combined pelvic and prostate gland treatment. The first 25 were of this type. Called full pelvic. The remaining 20 were to the prostate only. (25 to pelvic. 45 to prostate.) Years later, at NIH trial, I asked if there was any evidence of activity in the original treatment area. There was none. I have never had a side effect from the RT other that diarrhea and some skin irritation on by rear end at the top of my butt crack. Both were gone within two weeks of completion of treatment. My rad onc said that I would be at higher risk for colon cancer due to the radiation of the pelvic area.

I had a colonoscopy shortly after treatment and had some radiation damage but it was noted as not significant. Last colonoscopy about 18 months ago removed seven polyps all precancerous. Scheduled to go back in six months.

Good luck.

Don

Woody,

you write: „I am aware my case is considered systemic...“ You can consider it systematic because of the bone met. But there are two mets only and this is oligometastatic. This is more favorable than widespread mets.

Further: „this is my last shot at remission and to delay the start of hormones..“ Not necessarily. You can repeat the SBRT radiation if new mets appear. See these studies:
Berkovic: Salvage Stereotactic Body Radiotherapy for Patients With Limited Prostate Cancer
Decaestecker: Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence
Pasqualetti: 18F Choline PET/CT and stereotactic body radiotherapy on treatment decision making of oligometastatic prostate cancer patients: preliminary results

I have pointed out before that many researchers are regarding the TOAD study as underpowered and therefore the results as questionable. You might as well look at the study by Garcia-Albeniz: Immediate vs. deferred initiation of androgen deprivation therapy in prostate cancer patients with PSA-only relapse . This study is not randomized but it is not underpowered. In this study they could not determine a survival benefit for immediate ADT initiation within three months after PSA-only relapse compared to deferred ADT initiation.

I do not know if your RO offers SBRT radiation himself and has as much experience with it as Dr. King. Yes, I would not treat the lymph node met with IMRT. However, SBRT is a very targeted radiation so I would not expect side effects. At least I had none.

George

For what it is worth, after RP and salvage I had IMRT to common iliac and para-aorta nodes. No side effects, but not much help with the PSA either. I agree, and did before doing this, that whatck-a-node is unlikely to be much benefit, but I agree with you as to why not try it.

George-

Non-randomized clinical trials are not "powered" at all - you apparently don't understand what the word means. Let me explain to you. "Power" means that a certain sample size was pre-judged to significantly detect an effect of a certain size, based on certain assumptions. It's a calculation researchers make to determine how large a sample size is needed for a clinical trial to detect a given size effect. Nevertheless, even with a lower sample size than anticipated, TOAD did detect a significant effect of starting HT early on survival. The effect was larger than anyone would have guessed - it cut 5 year mortality in half. There are actually very few oncologists who doubt its findings. And older data analyses, which are lower levels of evidence, like the ones you keep posting won't make it go away. They are just not as reliable.

I know you don't like the findings - neither do I. But no amount of hunting for criticisms on the internet is going to make it go away. You are just exhibiting very understandable confirmation bias. Only another large randomized clinical trial with contradictory findings could do that. There are none. And it may be many years before there is one. Like it or not, it's the best info we have.

I also had imrt via dart to ALL pelvic lymph nodes after failed rp and SRT but I had no PCA in bones or other soft tissue. No toxicity because I was treated by an RO team that treats ONLY PCa: Dattoli.
Bob

George-

The study is older because it was superseded by the newer RCT, the TOAD clinical trial.

The TOAD study certainly did show that 5-year mortality was cut in half. That's what a hazard ratio of 0.55 means. I suggest you think about what that means for you, before you decide to ignore it.

I agree with her that every patient must make the decision for himself based on his own circumstances. A man in my support group suffers from CV disease, and is struggling with this decision because of it. It is a difficult decision, but to advocate ignoring the best evidence we have so far can be disastrous for yourself and others.

Once again, you do not understand what Level 1 evidence means. It is fact and not subject to opinion. I suggest you read about it on your own - I've tried to explain it several times. Perhaps there is a language barrier.

Woody, I am kind of late coming into this discussion, but I can offer you the following from my experience.

My PSA had been rising over 3 years following surgery and SRT. And during that 3 years I participated in multiple diagnostic clinical trials where nothing was found. I was of the mindset that before I started down the path of HT I needed a target to shoot at. Something that would show the efficacy of HT in my case. There was no doubt that my Pca was systemic.

January of 2014 two lymph nodes finally showed up during regular CT scans. Dr. Kupelian, the Vice Chair of Radiation Oncology at UCLA was my original RO for SRT at MD Anderson, Orlando. I reached out to him about zapping my two lymph nodes.

So I made the trip to UCLA to see him. At the time they were also doing the C11 Acetate scans, so I suggested that we do the scan to really pinpoint my two infected nodes for SBRT planning purposes.

Unfortunately the C11 scan found two more nodes. At that point DR. Kupelian said that SBRT was off the table. He said that the risk of SBRT overlapping my original radiation was too great a risk for side effects that would be most certainly QoL affecting.

I did a year of HT (2014) and was able to take an HT break (2015) and beginning 2016 my rising PSA has put me back on HT once again.

I certainly recognize your desire for reaching long term remission. But there is always the other side of the equation and that is the one where you trade Quality of Life against Quantity of Life. My personal goal has never been to just be able to see the sun come up in the morning, but rather to see the sun come up and be able to totally enjoy the fullness of the day.

Just my two cents on this discussion for what its worth. Good luck and my best to you,

Sonny

Post Edited (Sonny3) : 10/23/2016 12:10:01 PM (GMT-6)