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Trying to decide on treatment for prostate cancer
Prostate Cancer | Last Active: 3 days ago | Replies (38)Comment receiving replies
@jeffmarc @heavyphil
im a high risk guy, about to start orgovyx and then apalutamide (Luminal B cancer), which seems right based on my research. Im debating on the type of radition. Would like the convenience of 5 dose SBRT, but is there is enough data to justify this? Ive seen some promising info, but dont think it is standard care. Because of my risk factors, I need to radiate the pelvic lymph nodes as well as pelvic bed. i have read the larger the area, the more you should spread out the sessions. And the whole proton debate continues with competing arguments.
Your input would be appreciated. PS Decipher .93 (.75 post surgery), cribiform, EPE. no vesicles, nodes (but only 3 dissected). Pre surgery PSA 5, post uPSA .069, .039. .036, .056, .051 every 6-8 weeks. Apprehensive!
Last, looking for a experienced high risk RO for second opinion. Any references would be great! Currently working with Dr. Daniel Song at JHU.
Replies to "@jeffmarc @heavyphil im a high risk guy, about to start orgovyx and then apalutamide (Luminal B..."
@mlabus3 I must defer to Jeff Marchi on this one - he always ‘knows a guy’ since he is plugged into a few organizations.
As for your radiation question, I had SRT of 25 sessions to the bed and nodes with no long term SE’s to date…that can always change.
But as a practical matter, you do have a more aggressive PCa and a wide area approach makes sense to me so that would involve a form of EBRT.
I do not know if an SBRT approach is really ideal - or if it can be tweaked- to accomplish SRT.
By definition it is a much higher dose and sensitive tissues (bladder esp) can be damaged.
My 25 sessions was a marked reduction from the standard 39; they might even be able to go with even less in the future if they run another study.
Proton vs Photon will probably be debated for the next couple of decades so I wouldn’t focus too much on that myself.
But if you are in a situation to get salvage therapy with proton beam radiation, and it seems better to you, well why not?
Outcome-wise, however, there’s no difference.
Phil
@mlabus3
I was presented with the same options for a very similar diagnosis - 28 sessions of EBRT given at a local clinic and after a second opinion at a center of excellence 5 sessions of SBRT. The RO recommending the SBRT said he could give me 28 sessions but the outcomes would be the same. I had SpaceOAR inserted along with fiducials and 5 months post-treatment I'm feeling fine. I would recommend finding a center that has the equipment to perform SBRT, go there and get a second opinion. I went to MSK but could have gone to UVA.
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@mlabus3
Here’s a list of some really great doctors at JHU
Bethesda Maryland
Sibley memorial hospital
Johns Hopkins, school of medicine
GU Oncologist
Dr. Channing Paller GU Oncologist
Dr. Mark C. Markowski GU Oncology
Dr Deville RO
Is your cribriform Large or small. Makes a big difference if you have large cribriform.
With such a high decipher score, I would want to speak to one of the GU oncologist for recommendations.