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gleason 9 loma linda says 20 proton and 25 treatments of 3 D conformal radiation

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Prostate Cancer
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Posted 2/23/2013 10:14 PM (GMT 0)
this is an interesting approach?
they are guessing there is a percentage that can't be seen and has escaped the pod.
even though CT scan, bone scan, MRI is negative.
Loma Linda has not mentioned ADT yet?

MD Anderson is saying for a 9
2 years of ADT Lupron, starting with a 3 month shot.
then down to MDA for the 2nd shot and the simulation then into
the up to 8 weeks of protons.
and at MDA IMRT of the Lymph is an option that has not been proven.
The added risk is damage to the colon requiring surgery to correct.

Christus st Michael says ADT and IMRT and capping with Brachy.

he surgeon says he can get it? But the partain tables say no.
what a gamble life is in PC world.
Posted 2/24/2013 3:22 AM (GMT 0)
In the end it will be your decision. Nobody here is a doctor. And even your doctors don't get to decide. It is all up to you... and (unless you are Donald Trump) your insurance. We can just tell you what we think.

If your life were a movie you would choose the surgeon. A cocky young surgeon with more confidence than experience, who is sure he can do what all the other doctors say he can't. What screenwriter could resist that?

I kind of like the ADT / IMRT / Brachy option. You might see if you can negotiate the ADT down to 18 months or even a year. There have been studies lately that got really good results with 18 months.

But the other choices you mentioned are also fine.
Posted 2/24/2013 10:16 AM (GMT 0)
When I was at UFPTI (3 years ago), there were several patients with more aggressive PCa that received Proton + IMRT.

...Jerry
Posted 2/24/2013 1:19 PM (GMT 0)
MDA mentioned that it is controversial to add IMRT to Protons. as it has not been proven that there is a benefit. and because they radiate so close to the rectum there is a high probability of colon damage requiring surgery. Probably a really good surgeon would remove nerves, lympf, prostate and all and anything that even looked suspecious. But it is still gonna be there somewhere in that nest of body parts. Partain says 43% on a gleason 9 psa 10
Posted 2/24/2013 1:50 PM (GMT 0)
I had a really good surgeon. He carefully took out all the stuff you mentioned and then, because my path report came back with a high-volume GS9 we immediately went back with IMRT and toasted all the stuff he left behind. And I am on ADT for two years to make it stick.

The advantage that protons offer, as opposed to other forms of external beam radiation, is that it allows radiation to be applied very precisely to just the area to be treated while sparing nearby tissues on the order of 1 or 2 mm away. It's a bit like surgery in that regard but doesn't require poking holes in the patient. For more aggressive cancers, where you need to treat those surrounding tissues too I start to lose track of the value of protons in the picture. But that's just me.
Posted 2/24/2013 6:24 PM (GMT 0)
To add to Peter's thoughts. The idea that photons must be used to boost the dose received by protons only is revealing. One of the tenets in radiation is that higher doses are needed to kill larger volume tumors and more aggressive tumors. Proton alone has never been able to deliver these doses safely and higher grades usually need a boost from some other forms of radiation. The cure rates for Proton alone decrease significantly when used to treat higher grade cancers.
Protons have been very successful in treating low grade cancer, but have failed in the higher grades compared to more conventional treatments. There has yet to be data published that shows Proton is more effective than other forms of radiation in treating PC.
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