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ADT, maybe not? Anyone opted out of ADT?
Prostate Cancer | Last Active: 1 day ago | Replies (162)Comment receiving replies
@jeffmarc How do you get a description of current NCCN guidelines this specific? I go to the NCCN site, log in, and can't access anything like as easy to understand as what you've laid out.
One thing I'm trying to track down at the moment is exactly what the NCCN guidelines say about brachytherapy.
I can get a general AI generated "2025 NCCN guidelines recommend a combination of treatments such as surgery, radiation therapy (sometimes with a boost from brachytherapy), and hormone therapy, tailored to the individual patient's risk factors and age".
But I would like to see details, such as NCCN guidelines for something similar to my "PSA 7.7, cT3b, GGIII (4+3), 5 of 12 cores, biopsy indicated seminal vesicle involvement but no PNI or EPE, "no evidence of metastasis" on PET but "no prostate uptake" of the radioactive indicator seen by the PET, case. My doctors agree my case could be described as "localized", and they call it "high risk".
Doctors advocating a brachytherapy "boost" for high risk cases say less time or no time on ADT is required when a brachytherapy boost is added to standard EBRT, for a superior result, compared to EBRT + ADT without such a boost.
They point to a major advantage of brachytherapy boost, which is less or no time on ADT. Less time on ADT for a superior result interests me quite a bit.
Replies to "@jeffmarc How do you get a description of current NCCN guidelines this specific? I go to..."
@climateguy You have defined the question I want answered when I see a brachy expert in two weeks
@climateguy
The brachytherapy boost you refer to isn’t real common but is a real good way to treat your cancer so that is unlikely to come back. I see 157 references to it in the NCCN guidelines I have.
The summary I posted was something that Rick Davis over at ancan.org put together.
Interesting that they say six or more cores as when you do something in certain combination of cases.
I downloaded the following file from NCCN, you could go there and get the same document.
The basic guidelines referred to other pages that have more detailed breakdowns of what should be done with certain combinations of problems.
@climateguy To get what you’re looking for in the NCCN Guidelines for Prostate Cancer you really have to get a copy of it and review it page-by-page for your diagnosis.
At a high level, here’s what it shows for GG3 treatment options (see attached chart).
But, once you start digging into it, in the 16 April 2025 version, there are 150 references to “brachytherapy.” Some of those might provide the details you’re looking for.
(For a GG3, I had 28 sessions of proton radiation + SpaceOAR Vue + 6 months of Eligard.)
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@climateguy
My biopsy and PET were almost identical to yours and I was given 44 radiation treatments and was recommended to have 18 months of Lupron. I had only 4 months of Lupron as the side effects were so serious that I thought I was going to die. Sweating, severe headaches, brain fog joint pain, frequent urination, numbing of fingers and hands, and muscle cramps. I am now 7 months after 4 months of Lupron and I am just starting to see some reduction in side effects, but I still have no libido and cannot sleep with any bed covers or I am soaking wet.