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@copyman

My diagnosis is cT3b. My RO has prescribed one session of HDR, with 20 or so sessions of EBRT. Although he has said "protons or photons" in the past, I believe this prescription is photons. He has access to both types of EBRT. He's been critical of protons for PCa in the past, saying his whole prostate department at the NCI designated cancer center where he works is skeptical that protons are superior when used to treat PCa. He is the chief of the BT program there.

My RO was only going to prescribe HDR boost, as opposed to LDR, if his evaluation indicated I would be a good candidate for BT, he said, because my seminal vesicles are involved. I have no idea what his stance on LDR is.

I presented my case to Western Radiation Oncology in S.F. for a 2nd opinion They claim to be the highest volume LDR center in the US. The doc there said they would not accept me as a patient because their recommendation was HDR boost and they are not tooled up to do HDR there. He pointed to the seminal vesicle involvement.

I asked my RO about his 5 session EBRT clinical study, as he had mentioned he might offer this in the past. He was definite that my best course was the longer 20 session EBRT, because of the BT HDR boost.

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Replies to "@copyman My diagnosis is cT3b. My RO has prescribed one session of HDR, with 20 or..."

@climateguy I agree that your best option is HDR-B used as a boost combined with 20 sessions of EBRT. When fewer high dose sessions of radiation (usually SBRT) are used for the lymph nodes and greater pelvic region, there are high risks of toxicity from that protocol. I was almost entered into a trial like that and later found out the trial was aborted early due to radiation toxicity issues. See my bio for more details.