After Brachytherapy, ADT and EBRT
I’m seeking guidance on how best to proceed if PSA levels remain elevated following HDR brachytherapy and EBRT, after six months of Firmagon treatment. In my case, the standard treatment protocol appears to be yielding suboptimal results, and I am concerned that a strictly dogmatic approach may overlook more individualized or advanced options. I am assuming that cribriform glands have developed a resistance to both ADT as well as Radiation.
What alternative strategies or next steps would be appropriate to consider in this context? I would like to be well-informed so I can advocate effectively for further expert consultation and possibly explore tailored or non-conventional treatment pathways. Any insights or recommendations would be greatly appreciated.
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Don’t be a Guinea pig- could be hazardous sir.
An excellent point—why bother with lifeboats until the ship actually sinks? Let’s just keep rearranging deck chairs and hope the iceberg was a metaphor.
As for my proposed course of action, I was thinking something bold, like using evidence, judgment, and a dash of foresight—radical, I know.
If dogma gets us there eventually, I suppose we can always circle back after the slow-motion train wreck concludes.
I can’t help but suspect that this is only the beginning
I suppose unless there’s nothing to lose…
BOLD how? What would YOU have done if your particular case and set of circumstances presented itself to YOUR urology/oncology office? Procedures, treatments and drug therapies all at your disposal?
I am truly curious to hear your unorthodox treatment plan.
Best,
Phil
True statement agree
My thoughts; each of us react differently to the cancer within our bodies. I was diagnosed at age 57 and had HDR break Therapy and ADT therapy continuous. I have had some chemo and lots of different pills and changed my diet. I am currently undergoing Pluvicto treatments., which is what I would recommend. If Medicare doesn’t cover them hopefully your insurance will pick up part of the tab. Each treatment and there are six and the program is approximately $44,000. One treatment every six weeks.
It reduced my pain levels by more than half and I was only nauseous and sick for the first three or four days and then I started feeling good enough to resume living my life. It did not cure me nor did it bring my PSA down but I do feel better and I look forward to some radiation on an Aggressive spot of cancer on my vertebrae. My PSA is 377 and going up about one point per day, which is my greatest concern and also something I cannot get answered from any of my doctors.
Radiation has been the best and effective treatment for the bone cancer, which followed the prostate cancer chemotherapy was mostly just money for the hospital and illness for me. I’m not sure at the most effective path to cure this; but that is something I surely wish I knew.
If your PSA continues to climb perhaps you have become castrate resistant? Perhaps genetic testing may be in order as well? Best,
Phil
To summarize, it’s your way or the highway- to H__ with protocol. Have at it. I know I m not as smart as researchers so I follows proven plans of treatment. I m not an Ivermectin junkie . I hope your not either. Take care and keep us informed with your experimentations.
I appreciate your response, but I think you may have missed the point of the discussion. It’s not about rejecting protocol or claiming to be smarter than researchers—it’s about recognizing that protocols evolve, and patient-specific factors sometimes call for individualized approaches within or alongside evidence-based frameworks.
No one mentioned Ivermectin or conspiracy theories here. I’m simply advocating for thoughtful, informed choices—not blind adherence or reckless experimentation or established dogma that serves most, but not all. If one is part of the "not all" crowd, then dogma might not be right, or might accelerate progress. . That said, I do appreciate the exchange, and I’ll definitely keep sharing updates. Take care.
I totally understand your thoughts and I can see how you might feel that a different course of action is appropriate in your case. But I have to ask again:
WHAT exactly do you think should be done? No ADT?
Supplemental T? No treatment?
You believe that since your T is inherently low, your cancer must have already become castrate resistant and ADT is starving it of nothing, since it never depended on T to begin with…correct so far?
IF that is the case, how on earth could anyone know this UNLESS they first applied the “gold standard” and saw that it failed…right? Doctors cannot simply hypothesize without any evidence whatsoever that your cancer is different from the thousands they’ve treated. IT MIGHT BE - but they need evidence of that since in North America we practice evidence based medicine.
How would you feel months from now if you learned that your doctor completely deviated from accepted practices and instituted therapy and treatment that was detrimental and possibly lethal? WTF, right?
So, Your radiation treatment is half over; once it’s done it will be many months before you know if it was totally successful because you’ll still be on ADT and many times PSA fluctuates and goes higher before dropping to the nadir; this is NOT failure of treatment.
IF - after the ADT is out of your system and you’ve reached the nadir - your PSA starts to rise, then PERHAPS your theory might be valid OR more likely, you are one of those individuals who can never be off ADT.
I don’t know if you’ve had any of the genetic testing that @jeffmarc suggests, but those results would certainly prove beneficial should the “gold standard” fail and it is determined that genetic factors are making your cancer unresponsive to treatment. Best,
Phil