Looking for opinions and update after seeing local Radiation Oncologist (first consultation)

Hi,

So I went to see the local Radiation Oncologist. I'm going to go to Boston to talk to a few Doctors in the coming weeks. The local Doctor was very thorough and seemed to have genuine concern. Here is what he suggested as treatment.

IMRT - Photon 8 weeks X 5 days a week for 40 total treatments.
4-6 months of Hormone treatments. I'm leaning towards 4 but would love to hear what others have to say about that.

He said I was "T1C", which is the first time I had specifics on that. He also said I was considered stage-2.

My friend at Brigham and Womans said I should look into proton treatment. She is going to set me up with a Doctor at Mass. General to discuss this possibility.

I want to do what is best for long term recovery. But if it means going to Boston 40 times (will end up being a 4-6 hour round-trip with the traffic and treatment time) versus having IMRT here on Cape Cod... well I'm going to be biased towards Cape Cod, which is 15 minutes away.

So... does anybody have opinions on all of this.

Oh... and at this point I'm not even considering surgery... should I not give up on that? I had a real bad outcome from back surgery and I want to avoid the knife like the plague. But if it is the right thing to do, I don't want to write it off completely.

Thank you all for your ideas and knowledge.
Tim

Hi Andrew,

Thanks for the feedback. I had a feeling Proton would not be covered as my Doctor here mentioned that it is much more expensive. It gives me concern that IMRT isn't as focused as I would have liked though. I asked him about that and why they don't just try to knock out the cancer. He said that the technology simply isn't good enough to do that. So it hits the whole organ and some neighboring "items" as well.

Thank you,
Tim

Tim-

2-3 hours each way is going to be tough to do.

I had Salvage RT, 35 fractions, with an hour commute each way - Luckily i had a number of places to stop along the way home to urinate. Almost always had to stop.

From what I have read Proton is not any better than IMRT- Others will have more info on that!

Bobby Mac

The long drive would be a killer for me.

I had salvage radiotherapy 39 treatments (70.2 grays) 5 days a week for 8 weeks, and I can tell you for me it was a nonevent! If I had any side I really didn't notice any. I never changed my diet nor my habit prior to or during the radiotherapy. My commute is 30 to 40 minutes each way and the radiation center was located between my house and the office. So I would put in a full day and then stop at the radiation center for the IMRT/IGRT. I was in and out usually in 15 minutes, actual time on the table was probably at most 5 minutes with actual beam time of less than 2 minutes.

The RO, radiation nurse, and radiation techs were fantastic!

Hi OlderNH,

Thank you for the information...

What type of radiation treatment did you receive?

Thank you,
Tim

Hi Tim
It was described to me as External Radiation. Treatment Site: Prostate/Base SVs Dosage: 7,920 cGy
Modality PROTON-6
I had to drink at least 30 Ounces of Water so that the Prostate would be identified readily. My lifespan without treatment was suggested as 3-5 years. The Radiologist suggested that Primary Radiation with Hormone Therapy yields 85-90% cure Rate.

sheepguy said...
Well, it depends.My local RO in consultation with Roswell Park recommends the standard IGRT of 40 treatments but is willing to do hypofractionation if I insisted..he hasn't done it but sees nothing wrong with it other than lack of convincing data in his opinion. I 'm not sure that I would insist on it based on TA's opinion though. By the same token you might convince me. My Uro hates brachytherapy of any sort having seen a plethora of urinary strictures over the years no matter who does it. He's had patients from MSK, Cleveland Clinic and Mayo clinic have problems that he has to deal with...his patients could not go back to NY, Cleveland or chicago for emergency relief.

Oh man, where's the popcorn? This discussion always ends up rather contentious. Having argued this back and forth for myself 4 years ago, I'll just comment what I heard then.

Urinary strictures were the main BT side effect of concern noted by my RO back in 2013 at Vanderbilt, and were the main reason Vanderbilt's Cancer Center didn't favor the EBRT+BT concept. They didn't see enough benefit for the BT with today's 79.2+ Gy radiation dosing capability to be worth the side effect risk. Vanderbilt (in Nashville) is a regional referral center for urology, and are all too familiar with the problems of urinary strictures. They too have to do a lot of repair for that problem coming from other places that did BT.

EBRT+BT does seem to do a very good job indeed of oncological control based on multiple studies. There's really no arguing that. I'm even ok with calling it the "gold standard". At the same time, I don't know that it really means other methods aren't as good, or nearly so, with less side effect risk. Studies comparing EBRT vs EBRT+BT always have quirks that raise an eyebrow for me. Lots of selection games are possible with large data sets, and I'm skeptical of all studies due to the enormous commercial pressures in medicine.

Hypofractionation seems attractive. TA has posted study links that show that to be a good method, it's not just his opinion. 44 sessions is really a marathon, and if that could be reduced to 25 or less it would be great! Again, commercial pressures resist implementing cost reductions, though it seems that radiation suites will be fully booked either way. I know Vanderbilt's machines ran continuously morning to night, and cutting from 44 to 25 treatments would likely just mean they could treat more people. It's unlikely it would hurt their cash flow, since it's unlikely to result in idle time for their equipment!

Hi Allen,

This was from a local (Cape Cod) RO. But I'm not sure what it is you disagree with. Is it the IMRT or the number of visits, or something else completely that you disagree with?

I haven't made it up to Boston yet but I'm going to be going to talk to both an RO and a surgeon at Brigham and Woman's in the coming weeks.

Thank you,
Tim

Tim -

You may want to check if Mass General, Brigham's or any of the bigger hospitals have satellite radiology centers in Plymouth, Quincy etc, for a much shorter commute.

Bobby Mac

Tim- Dana Farber has a satellite in South Weymouth - there may be others !!

www.southshorehospital.org/cancer-care-services

Bobby Mac

Hi Bobby,

Great. A friend in Quincy said he thought there was such a place. Thank you for confirming.

Tim