Posted 6/3/2016 5:28 PM (GMT 0)
Many thanks to Tall Allen - many questions come from his previous posts-
If anyone sees something I left out - Please inform Me -
1. MSKCC Nomogram predicts, based upon my cancer specifics, that I have a 96% chance of 15 years of cancer specific survival. Why should I have adjuvant/salvage treatment now, instead of waiting and using ADT way down the road?
2. RT, with or without ADT, shows a benefit of remaining recurrence free over a period of time. Does that translate into a cancer specific survival time period benefit?
3. Do you recommend adjuvant or salvage radiation? Why?
4. How large a dose do you propose for the prostate bed? > 70 Gy
5. For the first time, a randomized clinical trial (GETUG-AFU 16) has proved that adding a short course of androgen deprivation therapy (ADT) to salvage radiation therapy (sRT) improves the progression-free survival over sRT alone.
6. Can I assume this also applies to adjuvant treatment?
7. Do I need adjuvant/salvage ADT
8. Should ADT be started before RT and concurrently?
9. Short term ~ 6 months okay? Is the optimum duration of ADT use related to the patient’s pathological findings – pre-treatment PSA, Gleason score, stage, and positive margins?
10. Would stronger forms of androgen deprivation (e.g., Zytiga or Xtandi) improve outcomes?
11. Would immune enhancement (e.g., Provenge, Leukine, Yervoy, Keytruda) improve outcomes?
12. Are there biochemical markers (e.g., Decipher™ or CellSearch™) that may be used to identify patients more likely to benefit?
13. What dose lymph nodes (50 Gy)
14. How do you plan to prevent bowel toxicity? How will you account for the separate movement of that area and the prostate bed?
15. What kind of machine do you use? (e.g., Truebeam/RapidArc, Tomotherapy, Vero, etc.)
16. What kind of image guidance do you propose? fiducials/Calypso transponders in the prostate bed (best answer)? Using the fixed bones or soft tissue only?
17. How will prostate bed motion be compensated for? Cone beam CT? Moveable bed?
18. What measures do you propose to spare the bladder and rectum? What dose constraints do you set?
19. What side effects can I reasonably expect? How should I deal with them?
20. How will we monitor my progress afterwards, both oncological and quality of life?
21. How many salvage/adjuvant radiation procedures have you done?
22. What's the best way for us to communicate if I have a question or issue?
23. Should I ask for bone/abdominal scans or are my numbers too low to pick up? 68 Ga PSMA(Germany/Australia) –Choline 11 (Mayo)-