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Trying to decide on treatment for prostate cancer
Prostate Cancer | Last Active: Apr 12 10:36am | Replies (38)Comment receiving replies
As I mentioned earlier in this thread the Proton trial I'm considering at Univ of Penn does cover the pelvis region (not sure if it's overkill because MRI or PSMA didn't show anything outside capsule) Both RO's say the PSA of 40 is the game changer. Specifically Penn Trial is Brachytherapy boost first with the SpaceOar gel & fiducial markers put in at same time procedure is being done (3-4) hrs under general anesthesia, then 2 weeks later start 5 HypoFractionated whole pelvis Proton therapy (one session per week for 5 weeks), and 4-6 months of ADT.
Or other option the "proven" treatment with long term data at another top cancer center which also includes brachytherapy but done after 23 sessions of IMRT or VMAT & 4-6 months of ADT. Just having a hard time deciding.
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@copyman
Either of these choices would be good. A 40 PSA is pretty high when it comes to treatment. The NCCN recommends ADT in that situation. The 4+3 isn’t the problem? It’s that PSA. Check out the NCC recommendations below, Just having a PSA of 10-20, they recommend ADT. It might make more sense to go with a second option.
Here are current NCCN Guidelines in 2025. They now suggest 0 (zero) months of ADT for low intermediate (GG2); 4-6 months for high intermediate (GG3), and 18-36 months for high risk (GG4 and 5). Actually, the footnote suggests ADT + abiraterone for T3b with lymph node involvement.
The meta-analysis suggests:
* 0 months for 1 intermediate factor (PSA 10-20, GG2 or 3, T2b-c)
* 6 months for 2 or more intermediate factors (PSA 10-20, GG2 or 3, T2b-c)
* 12 months for NCCN high risk (PSA >20, GG4 or 5, T3 or 4)
* undefined for NCCN very high risk (2 or more PSA >40, GG4 or 5, T3 or 4)