I’m 69yo with a 3+4=7 GS; is SBRT a good choice for treatment?

Having that low a Gleason score Can make SBRT or even focal therapy a good choice. My brother did it at 77 with a 4+3.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

How many cores had 3+4 And what percentage of the Core was cancerous and what percentage of it was a four.

How mane cores had 3+3 or 3+4? In some cases, active surveillance can be used if there is a very low percentage of 4, and few Positive cores.

Depends on all of your numbers, including: PSA, what % of that 3+4 was “4”, did MRI or biopsy mention anything about cribriform pattern, extracapsular extension, seminal vesicle invasion, perineural invasion or intraductal carcinoma?

What leads you to strongly consider SBRT?

@jeffmarc
What Jeff notes matches what my physicians explained as well. For me: 6 tumors - 4 are gleason 6 and 2 are gleason (3+4) with cribriform. My decipher score (.72) -age 64 (63 when treatment started). My surgeon/oncologist advised that either surgery or radiation were "equipoise". I opted for radiation re: faster recovery, the same efficacy as surgery, better odds at maintaining continence, bowel, and intimacy function. Second opinions at MSK (Sloan) and Smilow (Yale) confirmed my oncologist's advice - either treatment would yield the same result. I had fully expected to be advised - surgery - however, their explanation and overview (supported by second opinions at top centers) moved me to SBRT. I am all done (radiation was December - finished 120 days of orgovyx (some side effects) a week ago. I have a high decipher and I think that was a very big influence on the advice from my docs and second opinions. As Jeff points out active surveillance is potentially a way forward for you (and I had hoped for this but the decipher ruled that out).

@jonathanack
Thanks for your quick and informative response. I’m still waiting on my decipher score but I presume it won’t be low enough to endorse AS. I’m reassured that SBRT went well for you; it’s still early on my journey but hope to move forward as soon as possible with similar results.

@jeffmarc
Thanks for your quick and helpful response. My urologist didn’t provide details about my biopsy but I reread the report with a greater understanding. Everything was negative except 4 of 15 samples with 40% of the cancerous samples being grade 4. I’m still waiting on my decipher score before moving forward but was glad to hear that your brother had a good response to SBRT.

@brianjarvis
Thanks for your quick response and input. My most recent PSA was 6.1; my biopsy was negative in all areas except 4 of 15 samples which had 40% grade 4. I’m waiting on my decipher results before moving forward; SBRT seems to be the best option offered by my urologist relative to efficacy and potential side effects. Prostatectomy sounds more invasive and provocative from my research and discussions.

Do they use rectal spacers with SBRT?

@dekestet Do they use rectal spacers with SBRT to protect against the high dose each session? (I had 28 sessions of proton beam radiation; used SpaceOAR Vue just in case.)

@dekestet
I was 69 when I discovered my 3+4 Gleason prostate cancer in 2022 and finished my treatment with the Mridian radiation machine which has a built-in MRI, in February 2023. I did not take ADT and did not want active surveillance which one out of the five Radiation oncologists suggested to me. My decipher score was low.

I looked at all types of Radiation machines, including Proton, and based on my discussions across a spectrum of sources, including the mirage randomized trial that compared radiation without a built-in MRI versus radiation with an MRI, I chose the Mridian. There is another machine called the Electa Unity that also has a built-in MRI with similar capabilities. Side effects and quality of life were a big focus for me. The margins used with the Mridian machine were 2 mm which meant that the amount of healthy tissue that was exposed to radiation would be less, 2 mm margins with the Mridian versus 3 to 5 mm margins with every other radiation machine, and therefore side effects would be less.
The opinions from the five Radiation oncologist were either from centers of excellence or from Radiation oncologists that were trained at centers of excellence. I would make the same decision again if I had to do it over again.

@brianjarvis
They are commonly used. It depends on the doctor, Some just don’t like them.