Advanced PCa Treatment Safari without Proton Therapy

Posted by rick137 @rick137, May 18 8:49am

Last week I was at Mayo PHX for preparatory proton therapy appointments, i.e. Carbon Fiducial Marker Implantation followed by CT Simulation Therapy and MR Prostate Imaging. Proton treatment was supposed commence in ten to fourteen days.

However, I received a call from my Radiation Oncologist while at Sky Harbor waiting for the flight home to Eugene Oregon. Bad news. The imaging showed my bowels were abnormally situated. This created, in the words of the Rad Onc, a “challenging situation” for Proton Therapy. Phase One of my treatment safari, Lupron (Eligard) plus proton, was therefore not viable. If the offending tumors could be shrunk, proton therapy was perhaps possible.

I now have a consultation with a Medical Oncologist in ten days. I presume the consultation is to discuss systematic therapy, radioligand therapy and immunotherapy as alternatives to proton therapy or to shirk the tumors making proton therapy possible.
I have constructed the following Phase 1 Treatment Safaris for discussion if anyone wishes to comment or has relevant experience:

TS1-1: Eligard plus six cycles of chemo (Taxotere) at three-week intervals; PSA and PET/CT after three weeks to assess efficacy. Assuming it was effective, the best case scenario, the miracle scenario, would be after the 18 weeks of Eligard and chemo a clear PET/CT scan and undetectable level of PSA. If not effective after three weeks go to TS 1-2.

TS1-2: Kwon’s Delux Package, Eligard plus a 2nd generation hormone therapy plus six cycles of chemo at three-week intervals; PSA and PET/CT after three weeks to assess efficacy. If TS1-2 was not effective, the situation would not be hopeless but dire to say the least. Stronger chemo, radioligand, immunotherapy?

I am not an MD so cannot provide a quantitative definition of effective. Perhaps there is not one, only the obvious qualitative statement of decreasing PSA and tumor volume.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

two months of orgovyx shrunk a tumor by half as measured on by directly prior and directly post PSMA PET. Not sure if that helps.
You might wish to consult with a few other institutions. California is closer and we have radiation oncologists that might interest your case. One is Carlo Rossi at CA Proton. He is the most experiences proton RO in the world and would review your case by phone. Although medicare wouldn't pay for a phone consult unless you crossed into CA. The other possible interest is Amar Kishan at UCLA. It is possible with him to have radiation while under MRI guidance. That could alleviate the worry about the unusual bowel positioning.

While I'm sold on Proton, it must be the side scatter that endangers the bowel.



Thanks for the intel. Always good to have second opinion resources in your pocket.


In comparing situations the staging provides a basis for similarity. My stage is cT3bN1M0.
c:=Clinical assessment of data
T3b:=An extraprostatic tumor that has invaded the seminal vesicles
N1:=Metastases in regional node(s)
M0:=No distant metastases


Although I posted this information elsewhere I think having it here is the most relevant thread.

2023-08-15: Classical urinary symptoms from enlarged prostate
2023-08-21: BestMed Urgent Care
-DRE showed enlarged prostate
2023-08-24: OHSU (Oregon Health Sciences University)
-DRE showed enlarged prostate
2023-09-25: Adventist Hospital
2023-10-21: OHSU MRI (As later interpreted at Mayo Clinic PHX)
-Prostate Volume = 77cc, PSA density=0.21
-Lesion 1: 6.04cc; PI-RADS=5
-Lesion 2: 1.79cc; PI-RADS=5
-Lesion 3: 0.60cc; PI-RADS=3
-Left seminal vesicle invaded
2024-03-28: Sonora Quest Laboratories
2024-04-01: Mayo Clinic PHX Fusion Guided Transperinal 12 Core Biopsy
-ROl#1: Prostatic adenocarcinoma; Gleason score 9 (4+5), grade group 5, 2mm (13% of core, < 5% of the
total tissue)
-ROl#2: Prostatic adenocarcinoma; Gleason score 6 (3+3), grade group 1, 5mm (30% of core, 10% of the
total tissue)
-ROl#3: Prostatic adenocarcinoma; Gleason score 9 (4+5), grade group 5, 3 foci (aggregate length
27mm) involving 3 cores (81% of the most core, 77% of the total tissue)
2024-04-18: Mayo Clinic PHX PSMA Ga68 5.31millicurie PET/CT Scan
-Numerous tracer-avid nodal disease at the following locations:
-Right common illac/presacral region
-Clustered left external iliac nodal disease
-Right external iliac region
-Right pelvic sidewall region
-Right perivesical region anterolaterally
2024-04-25: Mayo Clinic PHX
-Initiated Lupron therapy: 45mg for 6 months
-Testosterone: Free=10.2ng/dL; Total=517ng/dL
2024-05-09: Mayo Clinic PHX
-Informed by RO my stage is cT3bN1M0
2024-05-13/14: Mayo Clinic PHX
-Preparation for Proton Therapy: Insertion of fiducial markers in prostate; CT/Simulation; high resolution
MRI of pelvic region
2024-05-15: Mayo Clinic PHX
-Informed by RO that I am not a candidate for Proton Therapy until certain tumors can be reduced;
because of abnormal bowel geometry, Proton Therapy would be “challenging”
2024-05-17: Quest Diagnostics
-Ordered by MO May Clinic PHX; PSA=24.96ng/mL
2024-05-28: Mayo Clinic PHX
-Consultation with MO


Five years ago I had proton treatment At Mayo PHX, PSA was 11, now 0.1. Dr. Schild Was my RO. Can’t say enough about him, sorry he has retired. My situation wasn’t nearly as challenging as yours. I’m surprised the interference didn’t show up on MRI. Seems a second opinion could be had without travel? Good suggestions by gentle. Best wishes.



I certain it did on the MRI at Mayo. The initial MRI was done at OHSU and the interpreter commented the resolution was degraded by movement. Well, the moment was not by me but the vibrations of the MRI machine. It sounded like a washing machine out-of-balance. For one scan the a resonant frequency of the machine was excited and it felt like an earthquake.

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