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ADT: How long until I can expect the hot flushes to kick in?
Prostate Cancer | Last Active: Dec 15 1:14pm | Replies (31)Comment receiving replies
@climateguy
It is interesting that you bring up the fact that they said you’re not eligible for BT because your prostate is too big. Just last night, I was in a reluctant brotherhood bi-monthly meeting And one of the guys there said he had the same problem. They have to put in the seeds before they do the BT and with a very large prostate the seeds have to be in such a large area that it just doesn’t work. He was definitely frustrated by it.
I’d be real interested in seeing a study like the Trip study where they really did take on advanced cases.
I know in my case stopping ADT after eight years, could be a problem. I have BRCA2, which makes my cancer very aggressive. When I was on Zytiga, I stopped taking one pill out of four for 18 days to see if it would help with the brain fog. In those 18 days my PSA went from .2 to 1. My oncologist is concerned that if I stop ADT and my testosterone rises I’m going to have the same sort of problem. Went back to four pills of my PSA went back down. I wonder if other advanced cases that have things like intraductal, large Cribriform, seminal vesicle invasion, EPE or ECE Could have the same problem.
Replies to "@climateguy It is interesting that you bring up the fact that they said you’re not eligible..."
@jeffmarc regarding your interest in studies of really high risk patients and EBRT + BT boost:
Here is a position paper based on a “comprehensive literature search”, that recommends EBRT + HDR BT boost therapy for men with “localized” intermediate and high risk prostate cancer. Some of the patients in the papers they looked at were T4, or NCCN defined “high risk”.
It starts: "The American Brachytherapy Society convened a task force for addressing key questions concerning prostate HDR brachytherapy boost with EBRT for the primary treatment of localized prostate cancer. "
https://www.sciencedirect.com/science/article/pii/S1538472125001175
There are 90 references.
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@jeffmarc In the European Society for Radiation Therapy and Oncology guidelines
https://www.thegreenjournal.com/action/showPdf
Published 2022
Under a headline “Indications”: “Detailed patient selection criteria have been previously published.. In addition to ensuring that there are no detectable metastases, good urinary function and predicted life expectancy of >10 years several new concepts have emerged:
i) Gland size: previous guidelines have recommended limits of 50–60 ml however for both LDR and HDR, if there is minimal pubic arch interference, there is now published data showing that much larger glands can be successfully implanted with good results for both dosimetry and biochemical control with no excess toxicity [5,6].”
Footnotes 5 and 6:
5. Le, H. ∙ Rojas, A. ∙ Alonzi, R. … The influence of prostate volume on outcome after high-dose-rate brachytherapy alone for localized prostate cancer https://www.redjournal.org/article/S0360-3016(13)00554-3/abstract
“Conclusion: Prostate gland size does not affect dosimetric parameters in HDR-BT assessed by D90 and V100. In patients with larger glands, a significantly higher biochemical control of disease was observed, with no difference in late toxicity. This improvement cannot be attributed to differences in dosimetry. Gland size should not be considered in the selection of patients for HDR-BT.”
6. Stone, N.N. ∙ Stock, R.G. Prostate brachytherapy in men with gland volume of 100cc or greater: technique, cancer control, and morbidity https://www.thegreenjournal.com/servlet/linkout
“Conclusion: This study demonstrates the feasibility of implanting patients with PV100. Very large PV does not influence bFFF. Although urinary retention rates were higher, the long-term urinary symptoms were no different between the two groups. Requirement for transurethral resection of the prostate was no higher in patients with PV100. Radiation proctitis rates were similar for both.”