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Why some one only need 5 sessions? Other need dozens of therapy?
I am 74 years old. In February of this year, a biopsy revealed two 4mm and one 1mm adenocarcinoma in one side of my prostate, with Gleason scores of 8, 7, and 4, respectively. My urologist informed me that surgery is not suitable for radical treatment due to my age (74). I am now scheduled for a PET/CT Prostate CA PSMA scan, and the treatment plan will depend on the results. The doctor mentioned that if there is no metastasis, radiation therapy alone will suffice, but if there is metastasis, it will require radiation combined with hormone therapy. My questions are: Is proton therapy the best radiation method? Why do some people require dozens of proton therapy sessions while others only need 5 sessions (completed in one week)? Is this difference based on the severity of the condition, or have treatment protocols improved to allow completion in just 5 sessions? Could someone with knowledge of this situation help explain?
Thank you!
Tyler
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@lifutang, I am a 74 year old prostate cancer patient sorting through the same decisions as you. It sounds like you have an excellent care team that is collecting the necessary information to help you make treatment decisions. You still have a very important diagnostic puzzle piece to collect and consider: metastasis. Your doctors have ordered exactly the right test - a PSMA. Then your treatment team will make definite recommendations. You may or may not choose to get a second opinion at that point, depending on whether you think a second opinion will make you feel more confident in the treatment decisions you need to make to move forward.
My diagnosis came to me December 12th. Like you, once I received the diagnosis of PCa, I wanted to plow ahead as quickly as possible to educate myself and make a treatment decisions ASAP. I found out that most prostate cancers, including mine, progress slowly and I had time to gather information, get second opinions, and educate myself about my treatment options. My educational path led me to explore RARP, all variations of external beam radiation therapy, and combination treatments using some form of EBRT with ADT (Androgen Deprivation Therapy) or brachytherapy. Your post made me count the number of clinical trial reports I've downloaded and reviewed: 62. I've also viewed most every relevant video posted on PCRI.com (Prostate Cancer Research Institute) and read Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. My point is you have time to consider your options.
Until you have the results of the PMSA, what helped me most at your discovery point was Dr. Walsh's book (if you don't already have it) and mixing in some PCRI videos on diagnosis and treatment options for your Gleason stage (8).
After you get your PMSA results, if you're still interested in pros, cons , and side effects of different fractionation schedules of external beam radiation treatment for PCa, check back in on this forum. I've got enough information to put you to sleep and many others on this forum are incredible resources.
Most importantly, know that you have support! There are many people on this forum that have your best interest at heart! God bless!
Tyler, the five fraction treatment is with fairly new technology that combines MRI with Radiation. Because the prostate moves during treatment having imaging concurrent with teatment allows a closer margin. The five is more intense radiation per treatment.
Proton equipmet is not compatible with MRI. If you decide on Proton, you probably have 28 treatments or fractions as they are called.
Most institutions don't have the Linac or MRIdian equipment.
Hormone treatment can dramatically shrink the tumor. And it makes the tumor more susceptible to radiation.
It is often recommended without metastasis.
The case I'm most familiar with was similar to yours. Hormone treatment was two months before 5 fractions with the MRIdian and 2 months following.
You should meet with at least 1 radiation oncologist and one proton radiation oncologist before deciding.
In my opinion the advantages of the five fraction outweighs the advantage of proton. You may have a completely different opinion. Bless your choice with luck.
Ask your urologist to order Decipher or one of the other somatic testing of the dna of the tumor.
https://www.veracyte.com/decipher-prostate/
I had proton radiation therapy at Loma Linda Hospital in Loma Linda, California (near Riverside). This was in 2010. I had radiation each weekday morning for 2.5 months. I understand now, the treatment period is much less. I was Gleason 3+3; PSA: 6.47 with localized slow-growth cancer. There are not that many proton radiation facilities in the US, perhaps eight or 10 at this writing.
If you have the choice both with full coverage insurance or other, I would strongly suggest proton radiation therapy over photon (x-ray) type radiation. Do your research and you will agree. Good luck. RH/Florida