Feels good to have a plan!

We have a plan with dates attached and everything. I can't really describe the relief...

Casodex started about a month ago, Lupron a week later. So far, my husband seems to be tolerating them ok.

HDR Brachytherapy is scheduled for 5/23 at UCLA with Dr. Demanes.

IMRT (25 sessions) will begin 2 weeks later down here in OC with Dr. Ash at St. Joes. We really, really liked Dr. King at UCLA and wanted to try and have him handle the IMRT, but the long commute (plus nightmare LA traffic) just made it too overwhelming. We were relieved to find an RO down here that we liked almost as much, and it's a hop skip and jump from my husband's office, so the convenience will allow him much more time to take better care of himself (exercise/rest/etc)...I worried that the commute would cause him to ditch his self-care on the freeway.

Still up in the air: Length of HT and whether or not to add a chemotherapy boost to the mix later in the year. It's a guessing game, to a degree, deciding how to balance killing all the cancer with toxicity. We've decided that at the one year point with the HT, we'll evaluate how he's tolerating it, and if he's doing ok, we'll try to get to 18 months and reevaluate again.

Chemo: We aren't sure how to weigh the likelihood of microscopic spread against the toxicity. Given the clean bone/PET scans and his relatively low PSA (even though all 12 cores were positive for cancer and he's a Gleason 9), I'm tempted to skip the chemo...we don't have to make this decision now, but we really won't have any further data to help us make it later either. If anyone has any thoughts on adding a chemo boost and how to determine the need for it, I'd love to hear it.

Congratulations on making the decision. I know all the work you did that went into it, and you should feel really good about that.

To my knowledge, chemo has never been used with brachy boost therapy. The results are too good without it. I don't really understand why you would even consider it outside of a clinical trial, since there is no evidence to support such a thing.

Optimum timing for adjuvant hormone therapy after brachy boost is very much a judgment call. Most seem to use 6 months or a year. Demanes believed that adjuvant ADT conferred no additional advantage when used with HDR-BT (see link below), and the study with the lowest utilization of adjuvant ADT in high-risk patients (Zamboglou et al., at 60 percent) actually had the best oncological outcomes (see below).

Similarly, Alan Katz found that adjuvant ADT did not improve outcomes among high-risk patients treated with SBRT (which also has a high biologically effective dose), and Chris King makes 9 months of ADT optional in his SBRT high-risk protocol. It’s possible that there is an as yet undiscovered quality about extreme hypofractionation that obviates the need for adjuvant ADT, or it may just be the higher biologically effective dose. Men to be treated with LDR-BT are sometimes given a longer duration of ADT pre-treatment in order to shrink their prostates — we do know that seeds are more effective on smaller prostates.
Until we have data from a randomized clinical trial, adjuvant ADT duration is a matter of judgment.

Excellent Results From High Dose Rate Brachytherapy and External Beam for Prostate Cancer are Not Improved by Androgen Deprivation

/pcnrv.blogspot.com/2016/08/hdr-brachy-boost-and-monotherapy-for.html

Great! There's a tremendous sense of relief to having a plan in place. You move from "how are we going to handle this" to "all right, let's kick some cancer butt and get this done." Hope the HT is going as good as it can.

Congratulations on the decision. It must take a lot off your mind now knowing the direction your lives are taking. Best of luck. I'm about a step away myself from a final decision on my treatment plan.

The relief most feel when the plan starts to take shape is about the first time we can take a breath. That's how I felt. You have a plan and schedule. Most importantly as others have said, you have done your homework. You've talked to many Drs and have received suggestions from all.
We live in a smaller community so I thought it best to go to a larger city(Seattle) . As my plan began to develop we realized that the RO at our reginal cancer center was well qualified and the machine they have is better than in Virginia Mason (SEATTLE) Anyways, we decided to have my IMRT at home.

My plan was the triple play and my Dx is very close to yours with exception of the volume. As we reached time for BRACHY my RO with consultation with my RO in Seattle decided not to do the BRACHY because of SE I had before IMRT and fear it would get worse.

The only reason I did chemo was because I didn't have BRACHY.
The triple play you have planned is the best treatment for your Dx.

Congratulations on moving forward

Mark

Thank you all so much for the input over the past couple months since diagnosis. This has been a really exhausting journey, but having access on here to the experience of you all (and I was able to read lots of old threads for further info as well) made a MASSIVE difference. I still am grateful for the relief I saw on my husband's face when I showed him that there were far more hopeful options than the original diagnosing doc presented (we have a special name for that guy...one I can't post on the forum without fear of being banned ;) )

Anyway, I'm grateful for all of you for the information, hope and humor. I will definitely be sticking around through the journey, and I look forward to the date when I get to be the one to reach out and offer hope to someone in my shoes...and tell them it will all be OK.