New Member Seeking Thoughts on Treatment Decision

That sounds like a typical plan of attack, with much data to predict a good outcome.

Alternatives might be SBRT or HDR-BT, but while there are some good small studies, there is less data for those with G8 pathologies.

SpaceOAR is well known, and often used in radiation treatments in recent years. I do think that some SBRT practioners found that it was not helpful with that technique because the focusing was already so precise. That may also apply to HDR BT.

But, it is widely used in many RT practices.

JNF ....nice to hear....

I think it's a terrific plan. Brachy boost has the highest cure rates of any therapy for high risk men. It has a relatively high rate of urinary side effects, so you will probably want to get started on an alpha blocker and daily Cialis sooner rather than later (daily Cialis or Viagra may help prevent ED too).

SpaceOAR is only for late-term rectal side effects (although they make claims for other side effects too). Late term rectal side effects rarely occur (in about 1-2% of patients) with modern day radiation using precise IGRT techniques. There may be some patients who may benefit (e.g., chronic bowel inflammation, low visceral fat, cancer near rectum on biopsy, anatomic abnormality).

Be sure to exercise.

SBRT (CyberKnife) is in clinical trials for the treatment of high risk prostate cancer. Alan Katz (who started the program at Winthrop and now works at his own clinic in Flushing) has reported on 52 high risk cases, but that is probably more than anyone else. In his study (see link in my signature), the 9-year freedom from biochemical failure rate was 66%, which is significantly lower than what we see in most of the trials of brachy boost therapy. The toxicity was quite low, however. It's possible that the success rate may be improved with better patient selection techniques (imaging) that became available since he began that study. Others are treating high risk patients using SBRT with escalated doses, whole pelvic treatment, and adjuvant ADT. I think you should only do it in the context of a clinical trial. Brachy boost therapy has over 25 years of history to back it up.

JGB said...
why is clinical trial superior to the regular treatment.

Good question. When a treatment is new, there are many questions about oncological control, toxicity, and patient selection. in a clinical trial, patients are very closely monitored with examinations and questionnaires. They only allow patients with certain characteristics, and patients are treated according to strict guidelines. Importantly, the patient gets a written document explaining the known risks, and he must acknowledge them before the treatment. The protocol must be approved by an Independent Review Board (IRB) before it can start. As opposed to those very strict treatment and ethical protocols, "regular treatment" is at the doctor's discretion, and the doctor may or may not fully explain the risks.

JGB said...
In my research and conversations it does seem like there may be worse side effects with SBRT.

Quite the opposite. Look at the link in my signature - "SBRT 7-yr QOL results" You have to be careful about "research" on the internet - much of it is pure garbage or hopelessly outdated. The early outcomes of Dr King's high risk trial have shown very low toxicity:

/pcnrv.blogspot.com/2017/03/sbrt-for-high-risk-prostate-cancer.html

That choice is exactly what the ASCENDE-RT randomized clinical trial was done to address.

/pcnrv.blogspot.com/2017/03/brachy-boost-gold-standard-for.html