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ADT: How long until I can expect the hot flushes to kick in?
Prostate Cancer | Last Active: Dec 15, 2025 | Replies (31)Comment receiving replies
@climateguy
interesting study. I’ve heard the combination of IMRT/EBRT and brachytherapy is really the ideal for advanced prostate cancer. I’ve heard of a number of people getting it, but never seen a study (now the Trip study) that showed that it was the optimal way to do it. Interesting thing is the study did brachytherapy first and EBRT second, Something I’ve never heard of anybody having. It’s always been the other way around.
I wonder if it would make a difference.
The study didn’t seem to take into account, very advanced cases, however. The criteria was T2c-3a, or a prostate-specific antigen (PSA) >20 ng/ml or a Gleason score >7.
Why didn’t they include T3b it T4?
I sure would be interested in seeing the results of a trial that worked with more advanced cases. These were just somewhat advanced.
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@jeffmarc Dr. Stone claims in the talk that he controlled when the brachytherapy was administered for all the centers in the TRIP study. He taught or advised all the participating centers in Japan on how to administer BT. But he didn't set up the study. The Japanese researchers apparently are the ones that decided T3a.
Keep in mind that he has been a pioneer in figuring out the way to compare different RT treatments, i.e. this Biologically Effective Dose concept, or BED he talks about. So he had seen that most BT studies were not publishing their actual delivered dose figures, rather, they published the dose they planned to administer. He was emphatic saying BT practitioners all know that the planned dose doesn't always get achieved. He felt that the external beam people were going to be able to deliver what they planned more than the BT people, so he had the BT people administer their planned dose, then calculate what they actually delivered, then he had the EBRT people administer more or less of what they planned so the BED of all study participants would be as nearly the same as possible. He feels this is a weakness of the Ascende-RT trial, i.e. more total dose than planned because of inexperienced practitioners, which resulted in the high number of grade 3 complications they reported, giving BT a bad name.
Dr. Stone is about as eminent in the BT and RO field as they come, so I don't think this BT first approach is anything that controversial.
I am very interested in getting EBRT with a BT boost. I am c3Tb. My RO says he runs the BT at the NCI facility he works at, and that I am not a candidate because of a 62 cc prostate and a too high IPSS score.
So I'm tracking down research that indicates there is no problem with larger prostates and BT. I found a European document that states they changed their previous limit and now allow much larger prostates due to new research published by Dr. Stone among others.
I'm looking for studies that allow BT on patients who have had recent corrective "outlet" therapy. It appears that in Europe, I would be a candidate for EBRT + BT boost. I like the RO who says I'm not a candidate, but if I can't convince him I will probably be looking for a clinical study or a practitioner who will consider my case more favorably.
If I find a study of >pT3b I'll let you know. Dr. John Sylvester, another proponent of BT, said in a talk I've been studying that high risk cases benefit the most from BT.