Third SBRT Opinion Worth It?

The answer to your question is “what do you want?” You’ve probably reviewed all treatment options, success rates, side-effects, quality-of-life expectations during and after treatments, etc. What is your treatment preference?

With prostate cancer, the choice of treatments is totally up to the patient (& the insurance company, of course!). Prostate cancer treatment is one of self-advocacy and shared-decision-making. You are the one driving this vehicle; doctors are there to provide medical advice and recommendations. They’re not likely to give you a firm, absolute decision like “That treatment method is best and will work.”

This is yours; you have to live with the results; you know yourself better than anyone else; you will have to make the final call. (You say that you’re leading towards radiation. Why? Understanding that will help you come to a final treatment decision.)

(With a localized, 7(3+4), PSA of 7.976. I had all the same options and after a thorough and in-depth analysis, I chose radiation and informed my urologist of my decision. Working with my radiologist, I chose 28 sessions of proton radiation. Prior to starting treatment, a second opinion on the biopsy slides increased the Gleason to 7(4+3), so we added 6 months of Eligard (and brought on a medical oncologist to manage that). I had treatments during April-May 2021. PSA now hovers between 0.35-0.55.)

@brianjarvis Your numbers are very close to mine Gleason 3+4, PSA 7.67, prostate size 103 cc. Decipher was .045. I'm 78 and otherwise in good health. Glad you had a good outcome. Based on the decipher score which puts me at the top of the "low risk" area, my urologist is suggesting we consider another biopsy in 5 months (instead of a year), as part of active surveillance. I'm thinking about how to proceed.

Has the doctor discussed giving you an MRI, Or did you already get one? That at least can see whether or not there are any growth(s) inside the prostate, And also target where to do the biopsy. A transrectal biopsy can’t get to as much of the prostate as a transperennial biopsy.

At 78 SBRT radiation will probably kill it off, surgery usually wouldn’t make sense.

My brother at 76, with a 4+3 had SBRT and it seemed to have killed it off, with six months of ADT included. You could find yourself an MRI guided SBRT machine, Much more accurate less tissue damaged.

Brian, thanks for contributing your experience! It's always helpful to listen to someone that has experienced a treatment you are considering. If you don't mind me asking, where was your treatment delivered and did you experience any side-effects during the treatment or 3 years after the treatment?

Thanks and best wishes!

Guy

I don't recall either RO using the exact "grade 3 late stage GU toxicity reaction" language. However, they both expressed concern that SBRT specifically could greatly exacerbate my existing urinary issues, up to and including catheterization. The first recommended 45 RT sessions and the second 20 RT sessions.

I'm pretty sure I'd forgotten to mention the post-cystoscopy Oxybutynin prescription to the second RO, so I did follow up with him to ask if my outlook for Cyberknife would change if I see positive effects from the medicine. He replied, "if you have a significant, sustained improvement in your urinary symptoms, we could consider CyberKnife SBRT. It may take a couple weeks to notice a difference. If you do not experience any benefit with the Oxybutynin, then I would still prefer the 20 treatment course."

@brianjarvis Given that the expected outcomes for RP and RT are essentially the same, my main concern is immediate and long-term quality of life, especially incontinence, although long-term salvage options are also fairly important.

RT seems favorable for incontinence whereas RP leaves more salvage options open. RP recovery would have a more immediate disruption to my active lifestyle (the surgeon said 6 weeks lifting no more than 10lbs - not sure how that's even possible). RT doesn't really have any physical restrictions but the concurrent hormone therapy will likely result in at least some limitations based on fatigue, etc. So I'm basically doing what everyone else has to do - weighing knows vs. kinda knows vs. unknowns.

Based on everyone's feedback, I'm going to keep the MD Anderson appointments. They are going to re-analyze my biopsy slides, which could result in a different recommendation. No harm, no foul if not. That also gives me several weeks to gauge Oxybutynin effects.

That was my thinking as well. There are many long-term treatment options with RT, depending on the nature of the recurrence. The recurrence may be distant from or very near the prostate, for which there are many treatment options; the recurrence may be local to the prostate, bringing treatment options like focal therapies (because the dose can be specifically targeted), brachytherapy, SBRT, and sometimes even re-radiation. (There is rarely a medically-necessary reason for surgery. Most men do surgery only because they “can’t bear the thought of….”)

Side-effects from hormone therapy have been demonstrated to be minimized by rigorous resistance-training exercise. Following what I read and heard about resistance-training exercise, I hit the gym immediately after every radiation session (and for as long as I was on ADT) for weightlifting, as well as alternating days of running 5Ks or swimming laps for 35-45 minutes. I never experienced fatigue; my only side-effects from the hormone therapy were mild warm flashes, muscle atrophy, and zero libido (but never experienced ED).

My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. The short amount of time that I was gone each day for treatment were no different than any other time when I simply left to go shopping or to the gym.

Today, almost 4 years later, everything has gone as hoped. We’ll see what the future brings…….

Brian I like your post. It is very inspiring. I to did radiation 2 years ago & hormone therapy for 18 months. I do worry about a recurrence. I don’t know if that is on your mind or not.
If not what is your secret ? lol also, do you still have dry ejaculations after 4 years ?
I don’t think it’s really a hugh deal. Just wondering.
Nice post.
Bob

That was my thinking as well. There are many long-term treatment options with RT, depending on the nature of the recurrence. The recurrence may be distant from or very near the prostate, for which there are many treatment options; the recurrence may be local to the prostate, bringing treatment options like focal therapies (because the dose can be specifically targeted), brachytherapy, SBRT, and sometimes even re-radiation. (There is rarely a medically-necessary reason for surgery. Most men do surgery only because they “can’t bear the thought of….”)

Side-effects from hormone therapy have been demonstrated to be minimized by rigorous resistance-training exercise. Following what I read and heard about resistance-training exercise, I hit the gym immediately after every radiation session (and for as long as I was on ADT) for weightlifting, as well as alternating days of running 5Ks or swimming laps for 35-45 minutes. I never experienced fatigue; my only side-effects from the hormone therapy were mild warm flashes, muscle atrophy, and zero libido (but never experienced ED).

My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. The short amount of time that I was gone each day for treatment were no different than any other time when I simply left to go shopping or to the gym.

Today, almost 4 years later, everything has gone as hoped. We’ll see what the future brings…….