That was discouraging to watch. My oncologist said the 5 year remission rate from SBRT+ADT was only 10%. There's a HUGE difference between 10 and 50 percent.
@scottbeammeup my ro told me the same. Also told me brachytherapy was no better than imrt. Hate to say but it appears they are selling us their bag of goods.
@rotate
Sorry for the delay. I forgot I had a dental appointment so as soon as I got home had to leave again.
I found the information on subscription and listed it below my message.
Recently it was our own Colleen Young that referred me to Mayo Health Letter editor for consideration on an upcoming article on heart failure. The contacts I had that I thought were with the health letter subscriptions were from the newsletter editors, writers, and picture program that contacted me about being included in an upcoming article on heart failure.
I have posted below the contact information to get Mayo Clinic Health Letter. As I mentioned I get it free as I am a member of the Mayo Legacy Program.
I hope this information helped. You can go on Mayo web site for more information. I look forward to each months letter. It covers several subjects in each letter. From time to time they do a special editions and recently one was on prostate cancer.
Some interesting ASCO commentary on this topic. Bone metastasis at 10 years is 4% . Puts this in a different light. Even with recurrence it might be a low grade recurrence and treatment not desired or required. Also if radiation is most likely after 70 these patients are now over 80. So take say 40% - low grade occurrence - short life expectancy - with only 4% Mets maybe 10% or so actually need more treatment. https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2023.41.6_suppl.393
Overall rates of BCR were 17.4% at 5 years and 39.4% at 10 years. Rates of BCR were
significantly associated with NCCN risk with high-risk patients having the highest rates of recurrence,
followed by intermediate- and low-risk groups (61.5%, 36.4% and 28.5% respectively at 10 years).
NCCN high vs low clinical risk was significantly associated with likelihood of BCR (HR 4.8, CI 2.5 –
9.2). Rates of salvage treatment, usually ADT, were 16% at 5 years and 19% at 10 years and these were
also significantly associated with NCCN high vs low clinical risk (HR 3.7, CI 2.3 – 6) and concurrent
ADT (HR 1.83, CI 1.2 – 2.7). Overall rates of bone metastases were 2.6% at 5 years and 4% at 10 years.
Overall prostate cancer specific mortality was 3% at 5 years and 7% at 10 years. Conclusions: In this
analysis, rates of BCR were fairly high and consistent with published RTOG studies, but rates of salvage
treatment were relatively low in comparison, indicating that not all patients who recur need, are offered
or want treatment. The limitations of this analysis include incomplete information on radiation dose and
field size. The strengths of this analysis include the size of the cohort and the length of follow-up.
Furthermore, as this cohort largely represents treatment in community settings, the results may be
broadly applicable. Research Sponsor: None
@rotate
Sorry for the delay. I forgot I had a dental appointment so as soon as I got home had to leave again.
I found the information on subscription and listed it below my message.
Recently it was our own Colleen Young that referred me to Mayo Health Letter editor for consideration on an upcoming article on heart failure. The contacts I had that I thought were with the health letter subscriptions were from the newsletter editors, writers, and picture program that contacted me about being included in an upcoming article on heart failure.
I have posted below the contact information to get Mayo Clinic Health Letter. As I mentioned I get it free as I am a member of the Mayo Legacy Program.
I hope this information helped. You can go on Mayo web site for more information. I look forward to each months letter. It covers several subjects in each letter. From time to time they do a special editions and recently one was on prostate cancer.
I would say be careful with what you read and future tripping with it. I am a believer of living in today. Not saying it is easy. We can get hung up in what we read and then suffer from anxiety and paralyzing fear from it and miss the gifts of today. Doc gave me 70-30 chance of never having to revisit this again. Is he right? I don't know and can't hang my hat on it. Finished Orgovyx/rad treatment 2 months ago and my PSA is undetectable with my T at almost normal. Will it hold? I don't know. Next test is in 15 weeks so I can start stressing in 13 lol. Live for today and hope for tomorrow.
Just completed SBRT yesterday for Gleason 9, Grade 4 localized disease. I was told 12-18 mos ADT at initial RO consultation. Recent data (within the last 5 years) endorses disease free survival and mortality equivalent whether RT or RARP are the approach. I am counting on that!
Just completed SBRT yesterday for Gleason 9, Grade 4 localized disease. I was told 12-18 mos ADT at initial RO consultation. Recent data (within the last 5 years) endorses disease free survival and mortality equivalent whether RT or RARP are the approach. I am counting on that!
@rbtsch1951 As you can see in the attached NCCN guidelines, your treatment regimen falls within the RT + 12-36 month guidelines for a Grade Group 4 (high risk).
@scottbeammeup Six month duration of ADT for me too. And congratulations too on a PSA of 0.04 at the 18-month mark - so excellent!
As a side note, I inquired into the amount of radiation (measured in units of Gy) I received from my SBRT. They told me I received 37.5 Gy.
When I met with my Mayo radiation oncologist I inquired into whether SBRT plus a brachytherapy boost would be beneficial. She replied "no", although she was open to doing brachy on me. I passed because there was a 45 day extra wait for brachy and I needed to complete the treatment and get back to work. The radiation oncologist also asserted her belief that SBRT and brachy typically had the same level of favorable results for my Gleason 4+3 situation
Finally, I should probably add that as soon as the six-month ADT period (Mayo only recommended a four month period, but I decided on six because seemed a bit safer) was over I re-started my TRT. I had reached a PSA of 0.1 one month after completing my five SBRT fractions (i.e., at the four-month ADT point). I needed to restart my TRT because I'm unable to work when I'm at castrate level testosterone. I don't know if this will be a mistake for me, but I take a degree of comfort in the generally promising, encouraging results from Harvard-trained urologist Dr. Abraham Morgantaler's three-decade of work where he's seen many patients on TRT after prostate cancer treatment do well.
@kenk1962 My treatment was similar but I got 40 Gy. My testosterone hasn't recovered much a year after stopping Orgovyx (220 vs. ~550 pre-treatment) so next month I have a meeting with my oncologist. I'm starting to develop metabolic syndrome from low T (osteoporosis, high cholesterol, pre-diabetes) plus all the negative mental stuff from while I was on ADT is returning.
Oncologist, sexual health doctor and endocrinologist are recommending raising my T to 400-450 to help me feel better, get cholesterol under control, etc. My GP and urologist are dead set against this saying it's unproven whether this is safe.
I have a month to decide. I'm leaning towards doing this because my PSA is low enough that I have some wiggle room so that if it starts to rise I can stop, but I have mixed feelings. It would be GREAT to finally start to feel normal again but I also don't want to cause the cancer to start growing again. I know what you mean about needing T to work--I had to quit my job as a data analyst and can barely concentrate on anything anymore, though going on meds has helped.
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@scottbeammeup my ro told me the same. Also told me brachytherapy was no better than imrt. Hate to say but it appears they are selling us their bag of goods.
@rotate
Sorry for the delay. I forgot I had a dental appointment so as soon as I got home had to leave again.
I found the information on subscription and listed it below my message.
Recently it was our own Colleen Young that referred me to Mayo Health Letter editor for consideration on an upcoming article on heart failure. The contacts I had that I thought were with the health letter subscriptions were from the newsletter editors, writers, and picture program that contacted me about being included in an upcoming article on heart failure.
I have posted below the contact information to get Mayo Clinic Health Letter. As I mentioned I get it free as I am a member of the Mayo Legacy Program.
I hope this information helped. You can go on Mayo web site for more information. I look forward to each months letter. It covers several subjects in each letter. From time to time they do a special editions and recently one was on prostate cancer.
Mayo Clinic Health Letter
PO Box 9302
Big Sandy, TX 75755-9302
You may also call 1-866-516-4974 or email
customerservice@mayopublications.com
Some interesting ASCO commentary on this topic. Bone metastasis at 10 years is 4% . Puts this in a different light. Even with recurrence it might be a low grade recurrence and treatment not desired or required. Also if radiation is most likely after 70 these patients are now over 80. So take say 40% - low grade occurrence - short life expectancy - with only 4% Mets maybe 10% or so actually need more treatment.
https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2023.41.6_suppl.393
Overall rates of BCR were 17.4% at 5 years and 39.4% at 10 years. Rates of BCR were
significantly associated with NCCN risk with high-risk patients having the highest rates of recurrence,
followed by intermediate- and low-risk groups (61.5%, 36.4% and 28.5% respectively at 10 years).
NCCN high vs low clinical risk was significantly associated with likelihood of BCR (HR 4.8, CI 2.5 –
9.2). Rates of salvage treatment, usually ADT, were 16% at 5 years and 19% at 10 years and these were
also significantly associated with NCCN high vs low clinical risk (HR 3.7, CI 2.3 – 6) and concurrent
ADT (HR 1.83, CI 1.2 – 2.7). Overall rates of bone metastases were 2.6% at 5 years and 4% at 10 years.
Overall prostate cancer specific mortality was 3% at 5 years and 7% at 10 years. Conclusions: In this
analysis, rates of BCR were fairly high and consistent with published RTOG studies, but rates of salvage
treatment were relatively low in comparison, indicating that not all patients who recur need, are offered
or want treatment. The limitations of this analysis include incomplete information on radiation dose and
field size. The strengths of this analysis include the size of the cohort and the length of follow-up.
Furthermore, as this cohort largely represents treatment in community settings, the results may be
broadly applicable. Research Sponsor: None
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3 Reactions@jc76 Tks!
It turns out that it costs $39/year for monthly issues.
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1 ReactionI would say be careful with what you read and future tripping with it. I am a believer of living in today. Not saying it is easy. We can get hung up in what we read and then suffer from anxiety and paralyzing fear from it and miss the gifts of today. Doc gave me 70-30 chance of never having to revisit this again. Is he right? I don't know and can't hang my hat on it. Finished Orgovyx/rad treatment 2 months ago and my PSA is undetectable with my T at almost normal. Will it hold? I don't know. Next test is in 15 weeks so I can start stressing in 13 lol. Live for today and hope for tomorrow.
-
Like -
Helpful -
Hug
2 Reactions@rotate
I sent you a private message
Just completed SBRT yesterday for Gleason 9, Grade 4 localized disease. I was told 12-18 mos ADT at initial RO consultation. Recent data (within the last 5 years) endorses disease free survival and mortality equivalent whether RT or RARP are the approach. I am counting on that!
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Helpful -
Hug
4 ReactionsYou can find studies, some showing >90% disease control with SBRT. It's been well studied. I wonder what made this “abstract” superior?
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1 Reaction@rbtsch1951 As you can see in the attached NCCN guidelines, your treatment regimen falls within the RT + 12-36 month guidelines for a Grade Group 4 (high risk).
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Hug
2 Reactions@kenk1962 My treatment was similar but I got 40 Gy. My testosterone hasn't recovered much a year after stopping Orgovyx (220 vs. ~550 pre-treatment) so next month I have a meeting with my oncologist. I'm starting to develop metabolic syndrome from low T (osteoporosis, high cholesterol, pre-diabetes) plus all the negative mental stuff from while I was on ADT is returning.
Oncologist, sexual health doctor and endocrinologist are recommending raising my T to 400-450 to help me feel better, get cholesterol under control, etc. My GP and urologist are dead set against this saying it's unproven whether this is safe.
I have a month to decide. I'm leaning towards doing this because my PSA is low enough that I have some wiggle room so that if it starts to rise I can stop, but I have mixed feelings. It would be GREAT to finally start to feel normal again but I also don't want to cause the cancer to start growing again. I know what you mean about needing T to work--I had to quit my job as a data analyst and can barely concentrate on anything anymore, though going on meds has helped.
-
Like -
Helpful -
Hug
3 Reactions