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My Turn, Salvage RT Options

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Posted 11/4/2016 5:24 PM (GMT 0)
Latest PSA confirmed the upward trend so I met with the RO to discuss a plan. What's your opinion on this for salvage treatment ?

4 Months Lupron, 6 to 8 weeks later start 25 hypofractionated Tomotherapy @ 2.5 gy/day, 5 days a week for a total of 62.5gy. One tattoo, no fiducials. Full bladder but no change in diet unless needed. Integrated CT scan to confirm positioning, prostate bed "structure", full bladder and reasonably empty bowels at the start of each treatment.

He said he has better results with lower toxicity using this hypofractionated method for SRT over a more traditional 39 session IMRT but also offered the 39 session option if I wanted it.

Jon
Posted 11/4/2016 5:49 PM (GMT 0)
I had 70 gys over 35 treatments with no ADT. Three tattoos for lining up on table, and scan for positioning. Done at MDA in Houston. I was told I didn't need ADT. I would confirm that it's necessary. Maybe the slight SE are worth the added precaution. Ask why not 70 gys and if they're going to do any nodes.
Posted 11/4/2016 5:55 PM (GMT 0)
Thanks JFL -

RO said there is a significant advantage using combo ADT/RT. As much as 15 or 20% better results over RT alone.

The 62.5gy delivered in 25 treatments have been shown to be equal or better than 70gy over 35 or 39 sessions with lower toxicity.

No nodes, none were indicated at surgery.
Posted 11/4/2016 6:13 PM (GMT 0)
Seems like a pretty good plan to me. I would've probably also done ADT for increase in benefit. My doc just didn't suggest it or say it was necessary. I can't imagine the SE would be too difficult to handle. Since my SRT, I haven't had any issues at all. Except, my ED hasn't shown any noticeable improvement. I also didn't have any nodes treated. It seems that those who've had nodes zapped may experience more bowel or stomach issues.

Good luck. It's really nothing to worry about.
Posted 11/4/2016 8:24 PM (GMT 0)
JFL and I went to same place. RT only, mainly because we GS7 only. You might need theADT simply for the 4+3=7. That GS acts more like GS 8. Certainly seems like a good plan. I would also question not having 70gys. That seems to be the magic number in most cases, you RO might have set just right for you. Good luck
Posted 11/4/2016 9:07 PM (GMT 0)
I HAD a similar case - but gleason 4+3. My RO suggested ADT although my urologist said it was optional. I went with ADT for 6 months since nomograms on Sloan Kettering website show much better chance of cure - 50% vs 75%. my pathology was excellent so I was surprised when psa increased after 18 months and I pulled the trigger at psa 0.11
Posted 11/4/2016 10:33 PM (GMT 0)
Sounds good.

You can plug your statistics into the Salvage Radiation nomogram. Do it first without ADT and the second time with ADT to see the difference.



I had 39 treatments at 1.8 each (70.2 grays). The oncology urologist told me that ADT wasn't warranted for GS 7 (3+4).

https://www.mskcc.org/nomograms/prostate/salvage-radiation-therapy
Posted 11/5/2016 12:07 AM (GMT 0)
lapilot
just curious as to what your psa is now, and did it change from when you had the IMRT?

teddy
Posted 11/7/2016 4:53 PM (GMT 0)
Thanks to all that replied. Your thoughts and well wishes are well received.

Tall Allen - Wondering what your thoughts are on this treatment plan ? Especially the 4 months Lupron instead of 6 and is the 62.5 gy delivered at 2.5 per treatment really equivalent to 70gy @ 1.8 ?

Is tomotherapy really a better option than conventional Linac delivery? RO says yes, it's faster and more accurate reducing the chance for toxicity.

My RO is basing this on a study he and others have done at the UW Madison Carbone Cancer center.

Jon
Posted 11/7/2016 5:43 PM (GMT 0)
Jon,
Sounds like a great plan to me. The trend is towards few treatments with higher dosage.

You may need to email TA if you want his input, he's announced he's off writing a novel this month and might not be reading the forum daily for November.

Andrew
Posted 11/7/2016 9:40 PM (GMT 0)
Tomotherapy, also called Cyberknife, can be performed by the same Linacs used to perform conventional IGRT. They just set the machines up differently. Only the newer LINACS can do this..Since you are getting a bigger dose everyday, it is bound to have a greater impact so less radiation is needed overall...

It is starting to become apparent that the traditional 40 dose treatment can be performed just as well with fewer "fractions" ..Since RO's get paid for every fraction, they are looking at a big loss of income so you can expect some push-back from many of them.....
Posted 11/8/2016 2:46 AM (GMT 0)
Jon,

Regarding the ADT part, you didn't mention what your Testosterone level is. I campaigned with me RO for the least amount of radiation and completed 64.8 Gy with few side affects and they did not consider ADT for me in 2012. Your history sounds like a good case for RT. I waited 10 months before I flipped the switch over witch my PSA went from 0.03 to 0.1. It has been hovering around 0.02 after nearly 3 years post-RT except went up to 0.05 after I started TRT last 4 months.My physician is stumped after both RP and RT and said it is unlikely there are any cancer cells left in my abdomen. I hope any PSA is coming form prostatic cells left behind after surgery.

Research is helpful and it helps make an informed decision. You mentioned UW Madison Carbone Center - - I'll bet those fellas do good research! Good luck with your decision and treatment outcome.

Russ
Posted 11/8/2016 1:39 PM (GMT 0)
My radiation oncologist at MD Anderson wouldn't even talk about SRT without doing hormone therapy. I hated the SEs from Lupron, but I appreciate the better odds.
Posted 11/8/2016 3:08 PM (GMT 0)

teddy9 said...
I went with ADT for 6 months since nomograms on Sloan Kettering website show much better chance of cure - 50% vs 75%.

My RO quoted the same numbers, about 75% with the Lupron. Definitely seems like it's worth doing.


Fairwind said...
Tomotherapy, also called Cyberknife, can be performed by the same Linacs used to perform conventional IGRT. They just set the machines up differently. Only the newer LINACS can do this..Since you are getting a bigger dose everyday, it is bound to have a greater impact so less radiation is needed overall...

I think you are correct in the larger daily dose has a greater impact so the 62.5gy @ 2.5 X 25 is "biochemically" equivalent to 70gy @ 1.8 X 39. At least that's what I found in a few published studies. Funny too, my RO is listed as one of the authors of the studies.


Rust said...
Regarding the ADT part, you didn't mention what your Testosterone level is. I campaigned with me RO for the least amount of radiation and completed 64.8 Gy with few side affects and they did not consider ADT for me in 2012.

I haven't started the Lupron yet and don't know what my T level is. I'm guessing there will be a whole bunch of bloodwork once I pull the trigger on this.


John_TX said...
My radiation oncologist at MD Anderson wouldn't even talk about SRT without doing hormone therapy. I hated the SEs from Lupron, but I appreciate the better odds.

I'm not looking forward to the SE's at all. Sounds like the hardest part will be the Lupron, followed by the full bladder and the daily grind to the hospital for treatment. Fortunately I'm fairly close, about a 30 minute drive, so maybe's it's an hour and a half total per day.

So is the Lupron a shot in your rump? Is it anything like the antibiotic shot prior to the biopsy? That one stung pretty good and was sore for a couple of days. Maybe I should take my pharmacist daughters advice and take two Norco's before the appointment. "...why suffer Dad..."
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