Difficulty In Deciding on IMRT or Proton Therapy

I am 65 with 3+4, PSA around 5 (varies with every test), PSMA negative for spread outside capsule, but MRI showed possible extracapsular extension, so more aggressive than 3+4 usually is. My RO recommend the Artera test which showed significant risk reduction in distant metastasis with short term (6 month) ADT, so I started Orgovyx 3 weeks ago. No side effects so far. I am also very active, running 5 times/week and lifting 2-3 times. This seems to be key to controlling side effects. I just met with my RO yesterday and start proton therapy in about 3 weeks. I also consulted with UFHPTI and would have gone there if closer. I didn't really want to move to JAX for 6 weeks. Good luck with your decision and treatment!

Similarly, at 65y I had a localized, Gleason 7(4+3), and PSA of 7.9. I had been on active surveillance for 9 years, and had much time to get referrals and evaluate all treatment options. Ultimately, I chose 28 sessions of proton radiation (at 2.5 grays per session; had treatments during April-May 2021), 6 months (two 3-month injections) of Eligard, and SpaceOAR Vue.
I did not go with the shorter 5-sessions of proton due to the reported higher risk of urinary bother with the higher radiation dose each session.
Just like someone would do when choosing a surgeon for a prostatectomy (with lots of robotic experience), ask questions and choose a radiation oncology team that has significant experience with proton radiation hitting small targets.
If you have the chance, look up the Bragg-Peak as it relates to proton radiation treatment of the prostate.

Most welcome! I forgot to add - most importantly! - why I had IMRT. My prostate had already been removed 5 yrs ago so I HAD to have IMRT since it has to cover a very wide area - prostate bed to pelvic nodes; they really don’t know where the surviving cancer really is so they carpet-bomb….
The guys talking about 5 dose SBRT is for patients like you who are getting your primary treatment for PCa; IMO it is the preferred way to go if there is no spread; especially the MRI guided system.
So please ask these RO’s specifically WHY they are not recommending this treatment over many, many sessions of IMRT. THEY “might” suspect a breached or broken prostatic capsule even though your PSMA is clear. FWIW, “clear” doesn’t always mean CLEAR - some cancer could be present and not show; sorry, but that’s the state of the art, such as it is… Best
Phil

@jseabass
Your welcome. That is why MCC is here to share our experience.

Regarding the Decipher. Most of the time they use the same biospies to do the Decipher. The Decipher will come back with specific determination if your cancer is low risk, intermediate or high risk. Some poster have had numbers given to them but my R/O (Mayo) use the low, intermediate, high. Mine came back low risk.

I mentioned it again because you asked about hormone therapy. I did not have it. When I got my orignal diagnosis at Mayo Jacksonville the R/O said recommendation was radiation treatment with 20 rounds of photon (SBRT) AND hormone treatment.

My Mayo R/O recommended doing a Decipher test. I did not know about what that was (I had not been a member of MCC back then) but said yes anything that helps with diagnosis. I had it done and it came back low risk. My diagnosis was changed from intermediate risk to low risk. Mayo R/O then changed his treatment recommendations to radiation only no hormone.

I did not find out about MCC until after I started my radiation treatments at UFHPTI. I was invited to a prostate seminar at Mayo Jacksonville and MCC came up during discussion.

Hey brianjarvis,
Thanks for sharing your PC history and treatment planning! It's all helping me come up with new questions for my RO and hopefully start treatment soon. And suggesting use of the SpaceOAR is greatly helping reduce my anxiety over rectal burns etc.
Thanks and stay well!

If you search for the “2023 mid-year #Prostate Cancer Patient Conference" - This Dr. (Rossi) has a lot of information about proton in his portion of this 2023 Mid-Year PCRI presentation:
—> Starting at 3:38:45

There’s a Proton Q&A session at the end of his presentation with these topics:
—> 4:25:00: Proton & Insurance
—> 4:30:45: Proton SBRT
—> 4:34:30: Proton & ADT
—> 4:36:55 Proton & Supplements
—> 4:39:00: Proton & Diet
—> 4:40:00: Proton & Repurposed Drugs (Statins; Metformin)
—> 4:42:00: Proton & Post-Treatment Side-Effects Urinary
—> 4:46:00: Proton & Hyperbaric Therapy
—> 4:48:15: Proton & Pre-Existing Bowel Issues
—> 4:49:30: Proton & Hydrogel
—> 4:53:00: Proton & Re-radiation
==========