After Brachytherapy, ADT and EBRT

Thank you. Appreciate the link and I'll ask about this after my today's visit to the zap machine.

An additional link to Cancer Care Ontario's page of guidelines. At the center of the page is a link to their specific guidelines by cancer type.
"Hereditary Prostate Cancer
Prostate cancer is a common malignancy that is frequently associated with hereditary cancer
syndromes, particularly when individuals present with advanced and/or metastatic disease. Evidence of
high risk, invasive disease may be found in pathology reports, operative reports, urology notes and/or
oncology notes. A history of systemic chemotherapy, distant metastasis and/or death due to disease
can be considered sufficient evidence to confirm metastatic prostate cancer in a patient or family
member. Hereditary cancer testing can be considered for individuals with a:
1. Personal history of metastatic prostate cancer.
2. Documented personal history of high risk, locally advanced, prostate cancer.
• High risk prostate cancer can be confirmed with evidence of one or more of the following
features:
• T3 (or higher) staging11, Grade Group 4 or 5 (Gleason Score 8 to 10)
12, lymph node
involvement, PSA ≥20.
3. Personal history of prostate cancer with ≥1 close relatives with prostate cancer.
• One relative must have evidence of high risk or metastatic disease.
4. Personal history of prostate cancer with ≥2 close relatives13 with prostate, pancreas, ovarian and/or
breast cancer regardless of age or stage.
Note: There is currently conflicting evidence for prostate tumours with intraductal/ductal pathology and
this feature is not considered to be independently sufficient to confirm eligibility for genetic testing at
this time. The evidence will be reviewed periodically and this criteria will be amended if needed."
https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/70161

I don't know if you have had a post-treatment PSA, but I can warn you that my 9.0 PSA spiked to 11.96 after SBRT.
It has since declined, but seeing a post treatment jump is not unheard of. Radiation can be quite a rollercoaster ride.

Most often I have net zero cognitive content.

I just attended our local prostate cancer support group meeting with a Nano knife surgeon (an academic with a large personal series of experiences). If I understood correctly, rising PSA after radiotherapy, MRI is recommended. Nanoknife treatment could be an option if there is localized tumour not extending beyond prostate capsule. Good luck.

Glad the treatment hasn’t altered your personality, Hans. How many more sessions until you’re done?
Phil

Hi Phil,
Thirteen to go. So, nearly there—if one considers "nearly" in the same spirit the Belgians consider summer: technically coming, rarely enjoyable, and always slightly disappointing when it arrives.

I am assuming that “nano” applies to the knife, and not the surgeon? I’d be very happy if we had some “Borg” technology, where micro drones with micro knives cut micro pieces of this uninvited guest until extinction of that guest. Not the host. Even though I keep advocating for a more pragmatic and dramatic intervention, the local radiation gnomes insist on following treatment dogma.

Out of curiosity, what dramatic and pragmatic course of action are you proposing?
I know you are concerned about innate castrate resistance but how can you know what to do until after the dogmatic approach fails?? How can the doctors know??
Phil

I believe nano knife is a focal therapy using electricity, cryotherapy uses extreme cold, HIFU uses high intensity
ultrasound waves and HDR (high intensity radiotherapy) uses probes which cover 'radioactive' skinny needles. ( a temporary brachytherapy.) They are principally for one lesion in one area.