Difficulty In Deciding on IMRT or Proton Therapy

Hey toolbelt,
Great to hear all went good with your journey! Thanks for explaining your good results with the SBRT. I have an upcoming appointment with my doc and will bring it up as a possible option. Also good to know you id well on Orgovyx. I hear it has less chance of heart attack than Lupron and your testosterone rebounds back quicker when done.

Hey jc76,
Thank you very much for explaining your proton therapy success story and where to go! I am definitely going to ask my doc about the decipher test! Were you put on hormone therapy, and if so what meds?....

Hey heavyphil,
Great to hear how well you did on IMRT! As mentioned my doc feels thats the right treatment for my condition. But I will ask him about the Decipher score test. And thanks for your explanation of how you did on Orgovyx, as I would prefer that over the older Lupron shots. And yup, understood I definitely have to put more time and emphasis on exercise!
Thanks again pal!

daveinflorida,
Thanks for sharing your story and decisions! I'm having such a hard time deciding between Photon and Proton treatment.....
Both seem to have equally good results except for the extra radiation and side effects past the prostate....

I do not know which hormone I received but I had a shot that was for 6 months and it was given approximately 3 months before I began my radiation therapy. The side effects from the hormone therapy and the radiation therapy combined was very exhausting for me as I continued to work outside in my lawn service business. Coupled with the summer heat and the work pulse near daily radiation, left me completely exhausted by weeks end. It took me all weekend to recover only to begin it all over again on Monday morning. I started the lawn service after I retired from my regular line of employment. I have now been completely retired for 3+ years. I'm 81 and still on a wait and see for my 3rd time of increasing PSA scores. Four PET scans have produced no visible cancers.

You are spot on with the cardiotoxicity of Orgovyx. No matter what hormone therapy you choose, and with a 4 + 3, it is very likely you will be taking that route, please make sure to exercise vigorously and watch your calories and likely take calcium and vitamin d supplement.

@jseabass
I agree with @gently
I had 5 sessions with the MRIdian which has a built in MRI. This is really important. Most radiation treatments use a margin of radiation exposure around the prostate that ranges from 3-5 mm, including Proton therapy. The MRIdian (and Elekta Unity) use 2 mm. The built in MRI, vs fused images, means that less healthy tissue is exposed because of the real time mri accuracy. This affects side effects and toxicity. Here is a link to information regarding the Mirage randomized trial which talked about the results of the trial:
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

Most welcome! I forgot to add - most importantly! - why I had IMRT. My prostate had already been removed 5 yrs ago so I HAD to have IMRT since it has to cover a very wide area - prostate bed to pelvic nodes; they really don’t know where the surviving cancer really is so they carpet-bomb….
The guys talking about 5 dose SBRT is for patients like you who are getting your primary treatment for PCa; IMO it is the preferred way to go if there is no spread; especially the MRI guided system.
So please ask these RO’s specifically WHY they are not recommending this treatment over many, many sessions of IMRT. THEY “might” suspect a breached or broken prostatic capsule even though your PSMA is clear. FWIW, “clear” doesn’t always mean CLEAR - some cancer could be present and not show; sorry, but that’s the state of the art, such as it is… Best
Phil

@jseabass
Your welcome. That is why MCC is here to share our experience.

Regarding the Decipher. Most of the time they use the same biospies to do the Decipher. The Decipher will come back with specific determination if your cancer is low risk, intermediate or high risk. Some poster have had numbers given to them but my R/O (Mayo) use the low, intermediate, high. Mine came back low risk.

I mentioned it again because you asked about hormone therapy. I did not have it. When I got my orignal diagnosis at Mayo Jacksonville the R/O said recommendation was radiation treatment with 20 rounds of photon (SBRT) AND hormone treatment.

My Mayo R/O recommended doing a Decipher test. I did not know about what that was (I had not been a member of MCC back then) but said yes anything that helps with diagnosis. I had it done and it came back low risk. My diagnosis was changed from intermediate risk to low risk. Mayo R/O then changed his treatment recommendations to radiation only no hormone.

I did not find out about MCC until after I started my radiation treatments at UFHPTI. I was invited to a prostate seminar at Mayo Jacksonville and MCC came up during discussion.

Similarly, at 65y I had a localized, Gleason 7(4+3), and PSA of 7.9. I had been on active surveillance for 9 years, and had much time to get referrals and evaluate all treatment options. Ultimately, I chose 28 sessions of proton radiation (at 2.5 grays per session; had treatments during April-May 2021), 6 months (two 3-month injections) of Eligard, and SpaceOAR Vue.
I did not go with the shorter 5-sessions of proton due to the reported higher risk of urinary bother with the higher radiation dose each session.
Just like someone would do when choosing a surgeon for a prostatectomy (with lots of robotic experience), ask questions and choose a radiation oncology team that has significant experience with proton radiation hitting small targets.
If you have the chance, look up the Bragg-Peak as it relates to proton radiation treatment of the prostate.