ADT with EBRT and Brachytherapy

I’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.

Most often I have net zero cognitive content.

Glad the treatment hasn’t altered your personality, Hans. How many more sessions until you’re done?
Phil

I just attended our local prostate cancer support group meeting with a Nano knife surgeon (an academic with a large personal series of experiences). If I understood correctly, rising PSA after radiotherapy, MRI is recommended. Nanoknife treatment could be an option if there is localized tumour not extending beyond prostate capsule. Good luck.

I am assuming that “nano” applies to the knife, and not the surgeon? I’d be very happy if we had some “Borg” technology, where micro drones with micro knives cut micro pieces of this uninvited guest until extinction of that guest. Not the host. Even though I keep advocating for a more pragmatic and dramatic intervention, the local radiation gnomes insist on following treatment dogma.

I’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.

I am assuming that “nano” applies to the knife, and not the surgeon? I’d be very happy if we had some “Borg” technology, where micro drones with micro knives cut micro pieces of this uninvited guest until extinction of that guest. Not the host. Even though I keep advocating for a more pragmatic and dramatic intervention, the local radiation gnomes insist on following treatment dogma.

Out of curiosity, what dramatic and pragmatic course of action are you proposing?
I know you are concerned about innate castrate resistance but how can you know what to do until after the dogmatic approach fails?? How can the doctors know??
Phil

Don’t be a Guinea pig- could be hazardous sir.

An excellent point—why bother with lifeboats until the ship actually sinks? Let’s just keep rearranging deck chairs and hope the iceberg was a metaphor.

As for my proposed course of action, I was thinking something bold, like using evidence, judgment, and a dash of foresight—radical, I know.

If dogma gets us there eventually, I suppose we can always circle back after the slow-motion train wreck concludes.

I can’t help but suspect that this is only the beginning