Posted 10/28/2016 4:15 AM (GMT 0)
My consultation phase is now over, and have decided to go with the combination therapy of IM/IGRT with Brachy boost at MSK. Here is the abridged version of how I got there - First procedure ruled out was surgery, since a) that possibility scared me, b) even my urologist didn't recommend it, and c) a lot of what I read said that radiation therapies were at least as effective. Second procedure ruled out was SBRT - I spoke with a specialist in SBRT and he did not think it was appropriate in my particular case. Both my urologist and the SBRT specialist recommended conventional EBRT with hormone therapy, with the chances of success estimated to be about 70-75%. My urologist also warned me against high dose radiation therapies, as he had several patients where he had to repair damage done by high dose therapies. And the numbers on late term toxicity did seem to be significantly higher for high dose therapies.
That sort of naturally led to low dose combination therapies, and the next look was into therapies involving brachytherapy and possibly hormone therapy, since the material I read indicated that even in high intermediate risk cases like mine the long term progression free rate was 90% or better with such therapies, although toxicity figures were a bit higher as well. My main hope was that in capable hands I could retain the high progression free rate of the combination therapy and minimize the additional side effects. Since I'm in the NYC vicinity, I tried to contact Dr. Zelefsky at MSK, but he had nearly a three month wait for an appointment (and I'd guess another decent wait to get on his surgical calendar), and I didn't want to wait that long. I then contacted Dr. Richard Stock at Mt. Sinai - this was a very comfortable and informative consultation. His proposed treatment plan was for a 5 week course of EBRT plus low dose brachytherapy, and no hormone therapy (I liked that part). I liked Dr. Stock and might have gone with him had there been a convenient place to get the EBRT done. Mt. Sinai has no branch facilities near me (southern CT), and getting the EBRT done in the city, and then trying to get to work and back home would have involved an immense amount of driving (at least 4 hours daily, probably closer to 5). I asked at two cancer centers in Connecticut if they would split the therapy (Dr. Stock was ok with that) but neither would consider it.
The only large cancer center with a branch near me is MSK. I researched associates of Dr. Zelefsky, and decided that Dr. Marisa Kollmeier would be good to talk to. She has experience treating a variety of cancers with a variety of therapies, currently has a clinical study underway involving prostate cancer treated with a combination of brachytherapy and SBRT, and has done over 500 prostate seed implant procedures. With her experience, I wanted to make sure I wasn't missing any viable treatment options. She is very knowledgeable with a warm personal style, and was probably the best consultation I had. Her recommendation was basically the same as Dr. Stock's, a 5 week course of EBRT plus low dose brachytherapy, and no hormone therapy, but with two small differences: MSK has a definite preference for the seed implant surgery to be done before the EBRT, whereas Dr. Stock was mostly indifferent, but personally preferred the have the EBRT done first. Secondly, at the time of the seed implant, Dr. Kollmeier would insert a gel spacer, which would provide additional protection during the EBRT. It was this level of detail, along with the improved convenience of the EBRT (which would cut my driving time to about 2.5 hours a day) that most influenced the decision to have the work done at MSK. The seed implant procedure will be next month, with the EBRT beginning about a month later in December.
Several people have said that their anxieties eased after they made a treatment decision. I didn't get that. Reading, making phone calls, and talking to people are relatively easy. Now comes the hard cold reality of executing the treatment plan. I suppose it's just fear of the unknown. As with everything else, there is lots of information available about what may happen short and long term, but regardless of treatment plan, you don't know what specifically is going to happen to you until it does, and I find that a bit scary.
As always I would appreciate your input and comments, especially from guys who have been through similar treatment plans. Thanks again to the members of this forum for your advice and support.
CK