hdr boost + sbrt + prophylactic lymph node irradiation

The HDR/SBRT combo without the prophylactic lymph node radiation is being used at many of the top cancer centers with very good success. I was offered a trial at Univ of Penn, HDR brachy boost, 5 sessions of proton to prostate and whole pelvis region plus short course of ADT. The reason for trial is to see about the side effects, especially for the prophylactic radiation to the pelvis region. I decided not to do trial. Many centers have been doing HDR boost with 23-25 sessions of IMRT with some doing HDR boost before and some after the IMRT for many years now. The last few years some studies have shown 5 sessions of SBRT with the HDR is working just as well as the longer IMRT. Some studies showing SBRT may have less long term side effects. The success rate of HDR & SBRT is around 90% for low/ intermediate risk. Adding short course (4-6 months) of ADT will improve success rate by 5-8% .
Also there is a test called Prostox Ultra that will show chances of long term toxicity to SBRT.

A few guys at Sloan had it done when I was there for my 25 SRT treatments about 2 yrs ago.
Frankly, SBRT or IMRT without radiation to the nodes in a salvage setting is a waste of time; there is a 30%+ failure rate if the nodes are not targeted.
But you are talking about primary treatment; and I personally would want my nodes targeted regardless of a ‘negative’ PET scan - you’re on the frickin table already so just get it done …JMHO
Phil

Not sure but reason they may not always do the nodes if something shows up later in a node you might not be able to zap then again since radiated already? That might leave surgery to remove node the only option at that point?

@copyman very good point with different perspective.

@copyman Yes, that is a distinct possibility; they could then use SBRT to zap the affected node(s).
However, many times in primary treatment using IMRT, they will radiate the nodes as well, especially with a higher Gleason score or other adverse patho features which might indicate ‘local’ spread.
It seems that we are reading more these days about being able to RE radiate after treatment., doesn’t it? The ‘lifetime dose’ has become much more flexible?🤔
Phil

At age 71, I had HDR Brachytherapy + 5 sessions SBRT + rectal spacer + 12 months ADT (Orgovyx) for my Gleason 9 Stage II prostate cancer.

Even though my PSMA scan showed no evidence of spread outside the prostate, I agreed with my radiation oncologist (Dr. Chang at UCLA) to treat my cancer aggressively -- including the entire prostate, local lymph nodes and seminal vesicles.

I feel lucky to have caught the cancer at an early stage.

Thankfully, 2.5 years later, there's no evidence of disease. And so far my PSA the past year is stable in the 0.2's.

Toxicities? No urinary issues. And I'm experiencing no bowel issues.

Results of my colonoscopy last month included "mild erythema of the rectum (likely due to prior radiation therapy)." Hemorroids too. Long-story-short, I was referred to a colorectal specialist to evaluate the findings. Hopefully it's nothing serious.

@retiredboomer71 how bad is "Hemorroids"? how do you handle it? Any treatment?

@benzo
I've had hemorrhoids for years -- at least since my previous colonoscopy in 2021. No pain, no bleeding, no symptoms... so far, no treatment.

Note: I take a stool softener (Metamucil) after every meal. Keeps me regular and bowel movements are easy.