Radiation @ 82 yrs old - 5 day or 5 week treatments?

@ghansonsmoker
You have to make up your own mind of what is best for you. The success rates of a low dose over extended time and the success rate of high dose lower numbers of treatments are the same per my R/Os at Mayo and UFHPTI (not my opinion).

I had the extended 30 rounds (six weeks, 5 days a week) of low dose proton radiation versus the short term high dose course 5 times over 1 week and usually a day. Both Mayo and UFHPTI recommend to me the low dose over extended time not the high dose short treatment times.

My PCP who sees hundreds of patients who have gone through both says he is seeing a more increase in the high dose shorter treatment side affects. It would make sense side affects would come earlier, and more intense with the high dose radiation damage to prostrate, and surrounding organs and tissues versus the low dose. But most likely you will still (per my Mayo urologist) to have side affects with both. We are all different and some had little side affects and others more severe.

I did not see if you mentioned hormone treatments. Are you getting them? That treatment is going (normally) to cause more side affects than radiation. I did not have hormone treatments so others that did can be better sources of information on side affects of hormone treatments.

Bottom line you make the decision, get it over quickly with high dose, or extended treatment plan with low dose. There is definitely the convenience of just doing the 5 day high dose over 5-6 days versus going for 20-30 dose over 4-5-6 weeks. I had to drive one hour each way to UFHPTI and was over 6 weeks for a 10 minute treatment.

The shorter high dose would be the only thing I would considered changing (would still stay with proton) if had to make decision again. With the 30 dose treatment I had, I had very mild side affects. The R/Os I saw did not recommend to me the shorter dose course. I was 76 when I had treatments and have heart failure so that could have been a significant reason they recommended the high dose to me.

A useful tile in the decision mosaic of external beam radiation (EBRT) choice should include a ProsTOX test. It is done with
a mouth swab sent to the lab. It genetically compares you to thousands of others with their known subsequent side effects. ACUTE effects are about the same and self resolve and short term symptomatic treatment is enough. Their report: HIGH risk of DELAYED urinary tract symptoms (>15%) or LOW risk (<5%). SBRT may be HIGH or LOW as are the traditional multi week smaller dose techniques. ( ...should also be done: BRCA, and a DECIPHER, bx slide genetic test for 5, 10, 15 yrs prognosis of metastatic RISK along with ARTERRA an artificial intelligence bx slide review will add another chink in the prognosis that can help balance 'quality of life' versus 'biological' ideal outcomes.

In philosophy and External Beam Radiation Providers the 'Black and White' fallacy may be operative. There is a third (maybe in your case absent more details) called brachytherapy (Internal 'beam' rate therapy). I would pose the question to 'Helpline' counselors at the Prostate Cancer Research Institute (PCRI.org) and see their video on YOU-Tube video with the subject Cribriform Prostate cancer. Considering the remaining sand in the longevity hourglass 'quality of life' might be the paramount consideration. May be a focal high dose rate (HDR) brachytherapy 'one and done' followed by regular surveillance thereafter MAY be an option.

Let us not descend into pecuniary bean counting to assess clinician motivation for treatment advice. Nonetheless: if LDR-B or Low dose brachytherapy ['LDR-B'] is $, and High dose brachytherapy ('HDR-B') is $$, and SBRT is $$$, and Conventional EBRT is $$$$ might one's salaried tenure at even prestigious institutions subconsciously complicate matters. The clinician's dilemma increases when an equally effective treatment with potential or where actual 'quality of life' is superior is not on the house menu of services.

BTW: July 1st is when new residents begin. Medicare pays for their salary. Good attendings would never let a newbie work on a patient 'over his skis'. Medicare permits you to decline any care from a new 'earn while you learn' resident if you have any concerns.

ww.youtube.com/watch?v=HEAEmFDOlfQ

This article "Trial Results Support SBRT as a Standard Option for Some Prostate Cancers" describes the situation after the results of PACE-B on intermediate risk and low risk patients were published.
https://www.cancer.gov/news-events/cancer-currents-blog/2024/prostate-cancer-sbrt-effective-safe
The thing is, 3Tb cancer, that I believe you are saying your case is classified as, is classified as high, or very high risk. My RO calls my 3Tb case "at least high risk".

The PACE-B study excluded such high risk cases, according to the article: "About 92% of participants had intermediate-risk prostate cancer and 8% low-risk, and none received hormone therapy in addition to radiation therapy."

The article continued: "Another ongoing trial, called PACE-C, is testing SBRT with hormone therapy versus standard hypofractionation with hormone therapy in men with higher risk of disease recurrence, but no results have been released to date."

At some point, when I was considering what to do, I decided that since I believed in and trusted my RO, I'd accept his choice of external beam treatment for me. I'm about to be treated with a 20 session 4 week course of treatment.

@alangjonesrs999

My pain level was way above the nuisance level. It felt like I was dying a gruesome death. I firmly believe that one more Lupron shot would have killed me, yet my doctor was still eager to do it. I have had kidney stones, gall bladder attacks and open-heart surgery but their pain paled compared to my Lupron pain level. I felt like I had the flu for 14 months in a row.

Thank you for taking the time for sharing! God Bless...

@alangjonesrs999
Thank you for taking the time for sharing! God Bless...

@pesquallie

Thank you for taking the time for sharing! God Bless...

@ghansonsmoker
Forty years as a doctor and Consultant Surgeon
My life here was to try and help people. Only do to a patient what you would do to your wife, children and yourself😊

At age 73 for SRT following RP, I had 37 txs at 1.8 gy for a total of 66.6 gy

I would choose "low and slow" for radiation.

Best wishes.

I am currently doing the 38 IMRT for BCR and have had 20 sessions. It is quick to get it done, I am there less than a half hour. The big problem for me so far is to keep my bowels empty even though I have started to get diarrhea. While I have had no problems, I do think if I had gone for sbrt I would have been done. I just want this to be over. In the end I will get through it and really the key thing is if I get a cure for the BCr or not. That is the long term and what are the long term side affects. While given the choice I picked IMRT because using SBRT for BCR is realatively new and does not have long term results. It I was getting it just for the prostate I would definitely have gone with the 5 sbrt sessions, getting it behind me is important. Best wishes to you and wishing you happiness always