Brachy + EBRT TREATMENT

DjinTonic said...
Perhaps RT gurus can answer this question I have. The dynamics of PSA trends after RT confirm there are some healthly or damaged prostate cells that remain viable for some period. Has it been excluded that some RT failure stems not from PCa cells already outside the irradiation zone, but relatively cells remaining in the prostate that proliferate and undergo ex novo lesion formation? I have in mind, for example, a boost that missed an area that needed it.

Thanks,

Djin

wouldn't that give radiation a higher failure rate than removing the cells through surgery?

DjinTonic said...
Not if it was a relatively uncommon event. Just as new lesion formation from remaining healthy tissue after a RP could happen. We don't know e.g. if those who have recurrence say 15 years after RP are slow-growing micromets or new lesions from remaining healthy cells.

It's remarkable how many basic PCa questions remain even after decades of research.

Djin

who knows. most of what I believe is based on the 10 years I've been here and I know back then I would have sold my soul to the devil to be alive in 10 years.

What are the recourses in treatment if PCa returns after RT therapy as a first treatment? More RT , chemo, ADT ?

Thanks for the reply ASA

JNF

Thank you so much for this easy to read explanation. I had a recent consult with a local oncologist and he recommended EBRT with seeds. However he seemed concerned about seed procedure risk with me as my ct scan shows a renal aortic aneurism: He mentioned risk using drugs that put you to sleep during procedure. He also thought my hemmoriods and past perianal abscess could interfere with seed procedure. Actually he said he would treat me but felt he would prefer to transfer risk due to aneurysm. I had a consult with another urologist a few days later and he said my aneursym does not increase complication risks with use of anasthesia. Tend to agree with surgeon here. I am concerned about rectum damage. Onco uses spaceoar gel to move rectum away from prostate. Ithis onco specializes in brachy therapy. I was also considering proton therapy as there is a local center at a nearby university. Havent met anyone who did prtin but everything i read indicates it stops at tumor and does not pass all the way thru body like EBRT does. I am leaning towards radiation treatment But am concerned as my hemmeroids do cause slight incontinence when they are aggravated. Easy to manage with advil and sanitary wipes. Sorry if this TMI. 🥴

Newbie,

Proton has not proven to be better in any way for PCa. It is excellent in many pediatric and head and neck cancers, just not PCa. The Bragg Peak effect you mention is somewhat theoretical. Two big problems with Proton are cost, most insurance and a Medicare will not fully reimburse, and Radiation deflection or scatter. This means the radiation is more inclined to scatter or bounce around to areas you don’t want radiated. While theoretically the Proton has less that exits, it has more power that enters. This may offset the supposed exit advantage. A few years ago the Radiation Oncology Society ruled that for PCa that Proton should only be used in clinical studies and trials as it had not been proven to be better that IMRT/IGRT and comes at some three times the financial cost.

Of course brachytherapy radiation does not exit or go through. EBRT does, but IMRT limits the effect. plus the circular movement of the delivery gantry makes it that the prostate essentially gets about 85-90% of the radiation with only a small amount actually going through.

Regarding the other conditions you mention, I can’t help. you just have to talk to several different specialists to draw some consensus. In my case, I spoke to three different surgeons and all said no to surgery due to my risk profile. I am sure I could have found a surgeon to operate, but the consensus would have overridden it. That one radiation oncologist isn’t confident, I suggest you seek a few other assessments. If all or most share the same concern, then you have better direction. If not, you will find your preferred doctor.

Importantly, seek the best specialist. As an example my wife has been treated twice for breast cancer in the same breast, though unrelated incidents. The first time she received radiation. Most ROs would say she could not be radiated again. Her second bout the surgeon wanted some spot radiation to an area she couldn’t get a significant surgical margin. She directed us to one RO in Atlanta as the best for such a situation. He performed a complete study relying on the precise radiation of the initial treatment 14 years earlier and his team including the physicist and dosemetrist developed a specific treatment plan for my wife. Nine years later it remains that it worked well and he is still considered to be the best in Atlanta. In my opinion, there is no substitute for finding the best doctor possible. It can be difficult to do so, however.

Wait for Epstein. He and Bostwick are the best and should be the arbiter.

You always look only at the highest grade and treat to that. A lot of G3 and a little G4 does not allow you to ignore the G4. It means you disregard the G3 and deal with the G4. The G3 will not hurt you, the G4 will. Don’t let the preponderance of G3 lull you into a false sense of security. If you have only a very little bit of G4 you may pursue AS, but many in that situation end up treating to eradicate the PCa. Usually just a matter of time. AS is every bit a treatment routine as eradication and control and should be seriously pursued. No more watchful waiting.

Steve Strum and others have written that G3 is not true cancer as it can not spread and live in other areas of the body and harm you. It is generally accepted that G3 does not become G4or5. So many hold that G3 is a benign tumor. It can cause problems with tumor volume in the prostate area so it sometimes needs to be treated. Even your lightest bx indicates some G4, so take it seriously.

Yes i understand what you saying. I Guess I am still in denial. I feel i am in a special place be cause Prior to receiving my diagnosis I was on a medical weight loss program that included testosterone therapy. The dr treating me was overdosing me on testosterone without My knowledge until 6 months into this program I had symptoms of PCa . I had blood test for T level and psa . My T level was too high (over 1200) PSA 4.2 -( psa before treatment was 1.6 T level 500 . I believe this weight loss program fueled the PCa and higher Psa #. I immediately stopped T treatment and after two months of stopping treatment my psa dropped to 2.2. This psa test result was a few days before my biopsy. I cant seem to come to grips with the fact I need immediate radical surgery that messes you up forever or the other radiation crap sandwich solution. as a novice I am thinking stop feeding the PCa with testosterone and give me time to think this through without over treating.

More than four positive cores, even if all G(3+3) would rule out AS at all but Klotz' program in Toronto. In other words, you need to be thinking about some type of treatment.

My two book recommendation are Surviving Prostate Cancer (4th ed) by Patrick Walsh; and
The Key to Prostate Cancer by Mark Scholz.

Do not buy one without the other, as together they cover both the cancer, and all its possible treatments.

When looking at radiation, avoid any studies where the men were treated before about 2005, as that equipment wasn't that good, and is no longer used.. The two advanced types of RT, SBRT/Cyberknife and protons are posting highly impressive non-recurrence rates. Be sure to research them.