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ADT with EBRT and Brachytherapy
Apologies for perhaps asking a redundant question. There are some recent studies that claim that a dose of ADT, when selecting EBRT and a Brachytherapy boost as a therapy method, really doesn’t result in mortality rates (or perhaps, survival rate) differential. I am aware that, just like in any business, changing what has become mantra, is immensely difficult. Given the nefast effecten of testosteron depreciation, is there any further insight on the usefulness or effectiveness of the various pharmaceuticals as a treatment component for prostate cancer (with cribriform)
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ADT has been shown to reduce the size of metastasis making it easier to completely remove them and prevent them from growing any further. I suspect this could make a difference in some of the cases. What study did you see showing that it had no beneficial affects at all to go on ADT Before treatment?
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1 ReactionIt's a YouTube video called "the royal flush" .I unfortunately cannot post the link
I found the Video. It was related to brachytherapy and ADT use not being beneficial, it didn’t seem to include other treatments like SBRT or surgery not benefiting from ADT.
Definitely made a case for using more brachytherapy In the US, where the usage has declined.
Here's a link from the recent ASTRO meeting regarding the addition of EBRT to brachytherapy.
https://www.medscape.com/viewarticle/adding-ebrt-brachytherapy-did-not-improve-higher-risk-2024a1000hzs
The impression that I got from the Royal Flush presentation by Mira Keyes was that the combination therapy was beneficial in high risk patients in that it shortened the length of time on ADT. But, showed no improvement in overall survival.
The link to her presentation is:
All of this begs the question as to how to approach unfavorable intermediate and high risk patients especially when considering higher Gleason scores, high Decipher scores, etc.
Sure, they come out with this stuff after I've completed brachytherapy, IMRT and am on the last legs of ADT!
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4 ReactionsThank you. That is, indeed, the link.
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1 ReactionI’m seeking guidance on how best to proceed if PSA levels remain elevated following HDR brachytherapy and EBRT, after six months of Firmagon treatment. In my case, the standard treatment protocol appears to be yielding suboptimal results, and I am concerned that a strictly dogmatic approach may overlook more individualized or advanced options. I am assuming that cribriform glands have developed a resistance to both ADT as well as Radiation.
What alternative strategies or next steps would be appropriate to consider in this context? I would like to be well-informed so I can advocate effectively for further expert consultation and possibly explore tailored or non-conventional treatment pathways. Any insights or recommendations would be greatly appreciated.
If your PSA is RISING After your treatment, then yes, you may need to do further treatment. Just having a higher PSA, without it rising, may not be consequential.
After having radiation, it can take years for your PSA to reach bottom. If you worry when your PSA starts rising, it really has to have three rises in a row before you need to consider doing something.
Usually the treatment you had will eliminate the cribriform cells.
As for treatment, Get off that Firmagon, It makes people uncomfortable and there is no reason you have to be that way. A Lupron shot causes almost no Side effects, I got them for seven years and never felt anything after getting the shot. Even better get on Orgovyx, much simpler to take a pill then have that shot in your stomach.
If you find your PSA is rising after Continuing ADT, then you need a second drug, an ARSI like Zytiga or a lutamide. That’s because, If your PSA rises with ADT, then you have become castrate resistant. The second drug will almost always reduce your PSA back down to undetectable or at least as low as you can go after having radiation.
The biggest thing to think about is that it is not time to panic. Many people have gone through what you are going through and have lived for more than a decade before treatment has stopped working. You also have to consider the fact that new drugs are coming out all the time, So future treatment may completely resolve your issue.
I’m not sure where you’re being treated, If your cancer does come back, you need to be treated in a center of excellence or by a Genito urinary Oncologist. Those are the ones that can direct your treatment to the Best conclusions. You are beyond a urologist and a radiation oncologist at this point.
Wish you the best outcome.
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7 ReactionsThank you for your comprehensive advice.
If you haven't had germline testing done to look for variants of significance in prostate cancer, that would be something to consider.
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2 ReactionsIf you do need genetic testing
You can get it done free with the below link, if you live in the United States. Do not check the box that you want your doctor involved or they won’t send you the kit. It takes about three weeks to get the results and then a genetic counselor will call you.
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Prostatecancerpromise.org
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