Treatment choice

Sumary:

First Biopsy 12 cores:

Left Lateral base = Benign Prostatic Tissue
Left Lateral Middle = Benign Prostatic Tissue
Left Lateral Apex = Benign Prostatic Tissue
Left Base = Benign Prostatic Tissue
Left Middle = Benign Prostatic Tissue
Left Apex = Benign Prostatic Tissue
Right Base = Benign Prostatic Tissue
Right middle = Minute Focus of Atypical Small Acinar Proliferation, Suspicion for Adenocarcinoma
Right Apex = Benign Prostatic Tissue
Right Lateral Base = Benign Prostatic Tissue
Right Lateral Middle = Benign Prostatic Tissue
Right Lateral Apex = Benign Prostatic Tissue
​

Second Biopsy 21 cores only 1 positive:
​
M. Left transtion Zone: ADENOCARCINOMA GLEASON SCORE: 4+3 = 7, INVOLVING 40% GRADE GROUP: 3 GLEASON SCORE4: 95%


Age: 60
PSA: 7.93
Decipher 0.49
Clinical Stage: T1C
Prostate volume: 36cc
Oncologist: T2A

Treatment offered: Hormone (6 months) / Brachy Therapy HDR / 33 IGRT w/ Space OAR

After much research from this forum and others, I decided to go with this treatment due to numbers of reasons into consideration such of quality of life, incontinence and ED.. e.t.c

My question:

Am I making the right choice of the treatments for my situation?

Anyone with similar treatment and diagnostic, I would love to hear your thoughts & inputs.

Greatly appreciated.!!!

Post Edited (davie1803) : 5/3/2023 1:49:57 PM (GMT-8)

F8 said...
yes i believe you made a great decision. my treatment was similar except i had much more cancer. all cores were positive and at least one at 70%. good luck to you!

Thanks for replied!
What is your experience with this pack of treatment? any side effects or anything along the way?

For a case like yours, the alternatives are Active Surveillance and treatment of some kind.
You have chosen to treat; a good decision in my opinion.
Now let's dig a bit further:
For a case such as yours, there are many treatment options and you have chosen a 'heavy duty' triple play one:
HDR brachy + IMRT (33 sessions) + ADT.
That appears to me to be a bit of overkill, but I could be wrong on that issue. Do note though that side effects are accumulative.
Personally, I would have chosen SBRT (only five sessions; maybe with ADT), but I would only recommend that option if an expert SBRT center is available to you.

Welcome Davie. I used the same basic combination 12 years ago very successfully. I am cancer free with undetectable PSA and have no treatment induced negative side effects. Everything works just fine.

You will see that I had a boatload of cancer like F8 and was treated close to the same time and this treatment worked wonders. Great choice.

You have chosen the treatment I would have.

hey Dave -- at least no one thinks you should have surgery! two things i'm against in most cases are 1) surgery for the primary treatment and 2) incremental thinking. i've seen too many guys that didn't take their best shot but rather believed the doctor when he said "we got it all". or didn't do ADT against their doctor's recommendations. or dragged their feet on follow-up treatment, doing test after test when BCR was obvious

i don't know if you've read the story of andy grove's treatment of prostate cancer. it seems to align with your doctor's thinking as well as yours -- you have one chance to beat the beast; hit it with the kitchen sink. btw, i had 9 months of ADT and that was the worst part of treatment. i never quit going to the gym and i kept working even though at times my capacity was diminished.

also, i have never once been incontinent and sexually i am fully functioning with the aid of cialis!

anyhow here's the link:

https://fortune.com/1996/05/13/andy-grove-prostate-cancer-cover-story/

F8 said...
hey Dave -- at least no one thinks you should have surgery! two things i'm against in most cases are 1) surgery for the primary treatment and 2) incremental thinking. i've seen too many guys that didn't take their best shot but rather believed the doctor when he said "we got it all". or didn't do ADT against their doctor's recommendations. or dragged their feet on follow-up treatment, doing test after test when BCR was obvious

i don't know if you've read the story of andy grove's treatment of prostate cancer. it seems to align with your doctor's thinking as well as yours -- you have one chance to beat the beast; hit it with the kitchen sink. btw, i had 9 months of ADT and that was the worst part of treatment. i never quit going to the gym and i kept working even though at times my capacity was diminished.

also, i have never once been incontinent and sexually i am fully functioning with the aid of cialis!

anyhow here's the link:

https://fortune.com/1996/05/13/andy-grove-prostate-cancer-cover-story/

Thank for the input,
Before agreed to hire the UCLA team to go this route, i am virtually read all the story from this site: http://www.yananow.org/query_stories.php#topoflist
also ran into the story of Andy Grove, so I don't know for sure this route is the best possible for me but I trusted the long track record of Brachytherapy and the folks at UCLA

And with 4 times the radiation, you will have 110% chance for success… Be careful where this logic leads or you will want surgery plus radiation plus years of ADT to remove all doubt.

Your plan is fine and we’ll researched so just go ahead with it. Second guessing decisions or having treatment regrets will just mess with your mind forever. You are getting good medical advice from a respected institution or you can trust someone on the internet… or maybe AI…

Three important aspects of HDR-BT;

First, UCLA use of HDR-BT was developed by the father of HDR, Dr. Jeffrey Demanes. He pioneered it in 1981 and in his later career he headed the radiation department at UCLA. So you are truly at a specialist center.

Second, SBRT was developed based on HDR-BT. SBRT is external beam and HDR is interstitial. Both capitalize on the factor of prostate cancer that it is more radio sensitive to high doses of radiation. Most cancers are more susceptible to numerous low doses, but PCa is different as a few high doses are actually more lethal than many low doses.

Third, HDR-BT uses the best technology to deliver the most conformal treatment method. This is both conformal to the prostate and the cancer in and around the prostate. No other method (surgery, IMRT, permanent seeds, etc.) is as accurate or specifically conformal to the intended treatment area. This supports your concern regarding the tumor location.

When I was researching treatment methods, my medical oncologist was strongly in favor of HDR-BT due to the better technology. He commented that “permanent seeds is last century technology, HDR is 21st century technology”. In my opinion, knowledge, and personal experience you have made an excellent and very well informed treatment decision. It will serve you well and you should be confident. Now, I suggest you focus on overall health and fitness (physical and mental) to make you the strongest to deal with the rigors and short term side effects of the treatments you are employing. Best wishes for success.

Hello davie1803, this is the treatment that I had and I also was treated at UCLA. The docs in the HDR brachy program have changed since I was treated, but as JNF has said, the program was put together by the father of HDR brachy and it's a top notch program.

That said, I'm a *touch* surprised that they're recommending brachy in conjunction with external beam radiation--I was under the impression that they would have used HDR brachy by itself for a G7. (I had a G9 diagnosis.) I assume that the parameters for using the combo treatment have been refined over the years.

BTW, ever since my treatment, I have been doing GREAT, with a low and steady PSA. My only lingering SE is that I don't pee quite as well as I used to, but I take an occasional Rapaflo for that and I'm fine. Very pleased with my outcome.

Michael_T said...
Hello davie1803, this is the treatment that I had and I also was treated at UCLA. The docs in the HDR brachy program have changed since I was treated, but as JNF has said, the program was put together by the father of HDR brachy and it's a top notch program.

That said, I'm a *touch* surprised that they're recommending brachy in conjunction with external beam radiation--I was under the impression that they would have used HDR brachy by itself for a G7. (I had a G9 diagnosis.) I assume that the parameters for using the combo treatment have been refined over the years.

BTW, ever since my treatment, I have been doing GREAT, with a low and steady PSA. My only lingering SE is that I don't pee quite as well as I used to, but I take an occasional Rapaflo for that and I'm fine. Very pleased with my outcome.

the beam radiation also treats the prostate bed, which i think is wise

Thanks davie for providing a lot of background info. You have certainly 'done your homework'. I agree that the proposed path makes a lot of sense.
Considering that your prostate will see a lot of photons, be prepared for some urinary problems. There are drugs to help with that.

Davie, at the end of the day, you did your research, consulted with some of the best in the business, and they recommend a course of action particular to your case.

Sounds like you dotted all the I's and crossed all the T's. Now, get on the schedule and get it done.

Vaya Con Dios