SRT with HT ?

After much debate with my Doc (director of the Urologic Oncology), he finally said okay I move on to see a Radiation Oncologist for SRT. If I did not have the facts from this site I would be waiting another 3 months or more for tests. Great guy, but Wow his SRT start numbers are much higher than what is on this site and what I read in general. -Scary

He also said not to do SRT with HT due to my low numbers and they will make me feel bad and some other thought... I did not have the counter information or fight left in me to push back. I also thought it would be the RO's call.

Question: if you had SRT did they include HT and if you have any studies I can read up on.

Looks like another research weekend.

Thanks,
Ken

Gear,
My RO put me on Casodex 50mg per day for 3 months starting about 2 weeks before SRT. This is not mainstream in the US, but his reasoning is that it potentially improves results of the SRT and the side-effects are minimal compared to Lupron. Whether that's a good call or not is above my paygrade. But it may be worth asking your RO what he/she thinks. My only side effect was sore nipples by the third month, which returned to normal a month or so after I stopped taking it. On the other hand here I am 6 years later with once again active PCa. Would Lupron during SRT have made a difference? Maybe, but given I had an enlarged lymph node at the time, the horse was probably already out of the barn.
Jim

Thanks guys for the input.... with the link from Tall Allen being spot on. In that article seems to promote HT, but I also found interesting was this thought:

"University of Michigan reported 5-year incidence of distant metastases was 6% if they received more than 12 months of additional ADT after SRT, but 23% if they received less than 12 months of additional ADT. In fact, every month of ADT was associated with a 10% reduction in biochemical failure, distant metastases, and mortality."

This additional ADT concept..... makes me think of the possibility that the extended benefits mentioned could be from ADT alone across the whole body and not necessarily the SRT / ADT combo which "should have" killed the bad cells in the target area. On the other hand, maybe once you got them down in the target area keep your foot on their necks! - Just some random thoughts as I read.

KG

It's usually thought of a a 2-phase approach. The ADT before SRT radiosensitizes the cancer, and the ADT afterwards finishes off any strays. Many ROs give at least 18 months, but there are no rules. I think giving an adequate SRT dose (of about 70 Gy or higher) is even more important.

Ken,

I am afraid with your PSA value of 2.1 a salvage radiation will be of little benefit. You may just suffer form side effects while the PSA value continues to rise.

Here are the probabilities of success as published by Dr. Tendulkar:
71% if PSA value between 0.01 to 0.2 ng/mL
63% if PSA value between 0.21 to 0.50 ng/mL
54% if PSA value between 0.51 to 1.0 ng/mL
43% if PSA value between 1.01 to 2.0 ng/mL
37% if PSA value greater 2.0 ng/mL

I think you may have a metastasis somewhere and that will not be destroyed with standard SRT. You would need a higher dosis for that.

George

Ken -

My initial PSA after Da Vinci was 2.6. Before I would start SRT I wanted to be sure the cancer had not spread outside the local and regional area. If the spread was outside those areas I did not see any value in SRT.

I opted for the 68 Gallium PSMA PET/CT which found uptake in the prostate bed and regional lymph nodes. So I have started SRT with HT.

If I were you, I would want to make sure the cancer has not metastasized to an outside area.

Bobby Mac

Trailguy-

80 Gy for SRT - that sounds very high. How were your SE's? Did they use reduced Gy for the nodes?

I am getting 70 Gy to the prostate bed, 52 Gy to the nodes, and 62 Gy to the nodes found by the PSMA scan.

Bobby Mac

Bobby Mac,

trailguy had RT as primary therapy, not SRT. With IMRT the 80 Gy are SOC.

The SRT doses they plan for you seem to make good sense.

George

Mel,

it is controversial but for EBRT I would recommend starting HT three months before and in case of intermediate risk continue about six months after the radiation.

With SBRT they can use higher doses than IMRT so you may not need HT for treating your lymph node with SBRT. But you just need to follow the recommendation by Dr. King.

George

George -

I reread it and after RP, his primary treatment, Trailguy received SRT. Am I missing something?

Bobby Mac