Prostate Cancer Treatment Options

Proton can be given with less intensity over a longer period of time. Not a five treatment therapy but it can be dependent on doctor recommendations and capabilities of the facility . It is flexible

I just finished 29 treatments with Proton Therapy last Friday at UFHPTI in Jacksonville. Yes, while it is a little inconvenient, you can be confident in receiving it this way. We stayed at Third and Main, a secure apartment complex a 5 minute drive from the treatment facility. Third & Main has gated parking for only $1600/mo. My wife and I even took the two dogs with us. I believe I read where UFHPTI looked at (studied) reducing the number of Proton treatments, but discovered some universal urethral discomfort and so they don't offer the shorter regimen at this time. While there waiting for treatment in the beautiful and peaceful atrium lobby on at least two occasions I had men come up to me who had been treated a decade earlier. They introduced themselves, saying they were back for an annual checkup and wanted me and the other men being treated there to know how much they recommended the treatment and assured us we had chosen wisely. No cancer treatment is perfect, but so far I have no complaints and would highly recommend Proton Therapy at UFHPTI in Jacksonville. Contact them and they will Fedex you a free information packet.

Proton can be given in as few as 5 fractions, known as Proton SBRT. Dr. Rossi talks about Proton SBRT (starting at 4:30:45) in the Q&A portion of his 2023 Mid-Year PCRI presentation: https://www.youtube.com/live/WTqPnSRYtW4?feature=share

(I had 28 fractions of proton radiation + 6 months (two 3-month injections) of Eligard + SpaceOAR Vue.)

I have looked at options to treat prostate cancer. My local urologist gave me two options RP or beam radiation. My VA urologist suggested brachytherapy 70 miles away. I have discovered TULSA PRO and am going to OU Medical Center in OKC (3+ hrs away) for another MRI. The hospitals don't trust another hospital's MRI results. TULSA PRO looks to have the least side effects with no radiation or surgery. They use ultrasound to ablate the cancer. The catch is that insurance doesn't cover it until 2025. My VA Community Care person told me it was covered but I'm skeptical.

@kugrad1975
Proton radiation does not have to be done with the 5 high dose treatments. I had proton radiation done last year at UFHPTI and I had 30 rounds of low dose protron radiation. Several others on MCC have had the lower dose radiation not just the high dose.

There is information that most are moving to high dose 5 treatments but UFHPTI is not one of them. Some research shows increased side affects with high dose and probably common sense since it is a higher dose.

I had almost no side affects other than dribilling and increased urgency to urniate that came about half way through treatment that slowly improved after treatments were finished. In one year after I have gone from 3.75 PSA to .60 PSA.

First of all, best wishes for success on your journey.

Whatever treatment direction you choose now will directly affect what treatment options are available to you in the future should your cancer return. I know this firsthand because I was originally diagnosed in 2020 with low-grade prostate cancer that returned aggressively in 2023. Because it was believed that my cancer was low-grade and preserving my sexual health was of prime importance to me, I elected to have focal LDR brachytherapy. I was told that if the cancer returned, they could just implant more LDR seeds and life would go on. Unfortunately, the biopsy I had in 2020 missed significant and aggressive prostate cancer. My current doctors believe that I was under diagnosed and under treated. When the cancer returned, it did so with a vengeance and further LDR brachytherapy was out of the question as a cure; Gleason 9 with positive margin, extracapular extension and lymph node involvement. The first opinion I got planned 40 sessions of radiation to be followed by a brachytherapy HDR boost along with 2 years of first and second generation ADT. Removing the prostate was not an option. I wasn’t comfortable with this because I knew that the prostate bed had already received radiation from the LDR brachytherapy and further radiation might result in serious bowel and urinary incontinence problems. I sought a second opinion.

The second opinion confirmed my concerns and added an additional concern that the planned radiation would have resulted in a stricture requiring a urinary diversion ostomy. All because my primary treatment was not what was needed. Sad deal. Luckily I was qualified, if only barely, for a salvage radical prostatectomy. These are almost never done because of prior radiation damage to the bladder neck and prostate bed. The surgeon also removed every pelvic lymph node he could safely reach leaving just one cancerous lymph node behind which was confirmed with a post-RP PET-PSMA test. I’ve started 2 years of 1st and 2nd gen ADT and will require 33 sessions of IMRT to the lymph node basin. The odds of a permanent remission are good and I have a positive attitude.

So what does this have to do with your situation? The most important thing I can suggest is that you be your own advocate. I was my own advocate to a point but certainly not far enough. I wanted genetic testing done on my 2020 biopsy. My urologist/radiologist said it wasn’t necessary and he was mistaken. The pathology on my tumor revealed a high risk, aggressive mutation. Had I been aware of it in 2020 I would’ve opted for a radical prostatectomy (RP) then and lived with ED. I have forgiven myself for not being a stronger advocate for myself and the decision I made but I still regret it as my life will never be the same.

Besides being your own advocate, I strongly suggest that you get genetic testing done on your biopsy samples. Do some research and you’ll find that Gleason scores typically are higher post RP than Gleason scores from biopsy samples. Also, make certain that whatever treatment you decide on you go to a center of excellence with a great reputation for care and success.

Again, good luck on your journey.

Robert - Thank you for this insightful summary of your personal and continuing journey with PC. My husband is currently researching treatment options based on a steady and progressive rise in his PSA and subsequent results of an MRI. Your recommendation for getting a 2nd opinion is good and will be valuable in the days of decision ahead.
LMJ

My urologist at the local hospital, and most of the medical community, have an age bias. When I asked how the PC treatment, beam radiation or RP, would affect my sex life the dr. looked at me and said, "I'm surprised you even care about sex."
I decided to investigate treatment out of town at an oncology center with more treatment options.

@bobbygene
If my urologist had said that to me I would have walked out and gone to someone who cared.

I am lucky my original urologist was at Mayo even though my treatments were at UFHPTI (World reknown treatment center in Jacksonville Fl.) as they had proton radiation where Mayo did not at Jacksonville. Mayo Jacksonville is building an new cancer center that will have proton radiation treatments.

I am 77 years old and my R/O is still having me to long questionares on my sex life to go over at next meeting so can address best ways to improve it. Very in depth questions and goes not only into this but other quality of life issues and insights.

@ljohnson1001, how are you and your husband doing with the treatment decision making? What options are you contemplating? And, most of all, how are you doing?