Met with the RO today

I met with a RO today to further explore my options outside of surgery, and they were pushing me towards RALP. If I go with them, it would be 4 months HT then 7 weeks IMRT. They have a close association with my urologist, so I don't know if there are any politics involved since they were giving me the same salvage options speech the urologist gave, but they did give me a name for a SBRT consult at a different hospital. I'm in the process of sending my slides to Epstein for a second opinion since my 4x3 precludes me from brachytherapy, and I want to make sure it isn't an option. I guess if the SBRT specialist also pushes surgery, it will look like RALP is in my near future.

Be wary of ORs associated with urology practices. This surfaced as a scandal a few years ago.

/www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2013/NEJM-exposes-overuse-of-radiation-therapy-services-when-urologists-profit-through-self-referral/

Your GS 4+3 certainly does not preclude the use of brachytherapy or SBRT. If it is LDR brachytherapy (seeds) they probably would include a course of external beam with it. If it is HDR brachytherapy, it can probably be done as a monotherapy. You would have to meet with a brachytherapist who practices those to learn about those options.

Make an appointment with a Medical Oncologist who is not associated with any of them and have a nice little talk...MO's have seen it all, they know the landscape better than anyone and at this point they are not trying to sell you anything...I hate to say this but there can be fierce competition for your treatment dollars and this competition is not always in your best interests.....

Look at my signature. I was full of 4+3 and I had HDRBT and seven years later I am cancer free and side effect free. Whoever told you that you can't have brachytherapy is either a quack or a liar. I would not talk to them again.

You are an excellent candidate for brachytherapy and can achieve cancer control and little or no side effects just as I have and so many others that have chosen this treatment method.

They do brachytherapy, but they won't do it for 4+3, only 3+4, is what I was told today. Wheeling is close enough, used to drive up there when my buddy went to school there.

That could be the issue. I met with a MO today. I thought MO/RO were just different names for the same thing.

MO and RO are completely different, please do not confuse them. For us with PCa an MO comes in when we can no longer be cured. They use different chemical based therapies to prolong our remission and survival. They are not experts on either surgery or radiation therapy and should not be used to guide the initial therapy.

In Atlanta we have world class radiation oncologists that use brachytherapy, both permanent seeds and High Dose Rate, that treat both intermediate and high risk men very successfully. Come on down and I will get you with my doctors. Also as TallAllen says the radiation oncologist in Wheeling is one of the best with brachytherapy. If you need a Florida vacation, go to Michael Datolli in Sarasota, world renowned, and your situation is everyday to him. That is what you want. Also go north to Chicago to see Brian Moran for permanent seeds or to Detroit to see Alvarez Martinez one of the very best with HDRBT. Also some great work being done at Vanderbilt in Nashville.

You have many great choices, just doesn't look like you can stay where you are. Keep searching and you will find the best for you. If you want to be treated in Atlanta I will get you with my doctors and you can stay in our guest room upstairs.

You do not need the services of an MO at this point in your journey, maybe I was not clear enough about that in my first post....But consulting with one now might be useful in that they have seen all the failures, had to deal with the side-effects, seen them first hand, so their recommendations are based on observations gathered over a long period of time....Also, they know who the best (and worst) surgeons and RO's are in their area as they have seen the results of their work...The more information you can gather, the better off you will be....

Met with another RO last week. SBRT is an option as well as RALP and IMRT. Brachytherapy isn't recommended because of the small prostate volume. He also told me I would most likely have to receive radiation treatment after RALP because of the possible EPE. I'm heavily leaning towards scheduling SBRT, especially if I will need radiation no matter the course I choose. It doesn't make sense to go through the surgery and still have to be radiated when radiation alone can handle it. I may no longer be leaning. I think I have a call to make.

One of the reasons I chose surgery was that I was very likely to need radiation as a follow-up. I chose to cut to the chase and one directly to radiation.

BTW, I've never heard a small prostate precludes brachytherapy, although I've heard the opposite. Was the doc talking seeds (LDR) or High-Dose brachy?

He was talking seeds and said the smaller prostate would cause difficulties only going after the targeted areas. It could be done, but he didn't recommend it. The urologist said similar, but was more concerned about placement being a bit off or shifting could cause coverage gaps.

Tall Allen said...
.....the problem with a too-small prostate is they can't get in enough seeds for full uniform coverage, and if they try to put in more, it overdoses the urethra.

That is exactly what both my Uro and RO told me.

Am I reading that your prostate size is estimated to be 31.4? That is perfectly normal and by no means too small for brachytherapy. Mine was 38 and I had a month on ADT to reduce the size a bit before starting radiation therapy. Your signature also states a volume of 24 at a later date. Is that correct? Meaning your prostate shrunk 22%. Is that correct? If that is the size it is an the small side of normal, but I would be surprised that it would routinely eliminate brachytherapy.

However, SBRT is a great treatment method. So I would be very pleased to use it if brachytherapy isn't available.