← Return to Possible Extracapsular Extension - How much influence on treatment(s)?

Discussion
charlesprestridge avatar

Possible Extracapsular Extension - How much influence on treatment(s)?

Prostate Cancer | Last Active: Jan 8 11:35am | Replies (18)
Comment receiving replies
Profile picture for wwsmith @wwsmith

Wasn't there a post a while back that mentioned a newer study showing that when a patient has 5 or more positive 3+3 cores that active surveillance is not appropriate? Maybe someone remembers that thread and could post a link to it? And if you combine 5 positive 3+3 cores with an ECE then the situation is all the more dangerous, especially with an intermediate 0.48 Decipher score.

The 3+3 Gleason scores give some pause to treatment but not when considering that biopsies routinely do not reveal the actual maximum Gleason score. But if you want to avoid the harsh side effects of an RP and still have good odds that radiation kills everything (both in the prostate and outside to the extent of lymph nodes) with a minimum chance of recurrence, my lay opinion is that you would have to radiate the entire pelvic region with IMRT and hit the prostate with an SBRT or HDR brachytherapy boost.

Jump to this post

Replies to "Wasn't there a post a while back that mentioned a newer study showing that when a..."
charlesprestridge | @charlesprestridge | Jan 6 4:50pm

@wwsmith

Thanks. I am in agreement with it not being a standard 3+3.

Radiation Oncologist recommends HDR. She is comfortable with two doses of HDR.

I love the possibility of reduced side-effects of HDR vs RP. My concern is the possible return of cancer 5-10 years from now.

Thank you and best wishes.

VIEW AND REPLY
jeff Marchi | @jeffmarc | Jan 6 5:10pm

@wwsmith
I actually posted about that information at one time. If 5 or more were found action was recommended, But there are extenuating factors.

It was discussed during one of the PCRI conferences.

I’ve heard further conferences at which it was not as emphatically recommended something be done immediately.

IMRT with HDR brachytherapy Is a real good way to fully treat the problem, Never seen SBRT being included in that kind of treatment. One person today already talked about the fact that they have multiple metastasis after having that done, so it’s not always the solution but it’s usually a great treatment.

VIEW AND REPLY