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Should Zapping The Entire Prostate Replace Updated Imaging?
The last imaging scans I had were back in September 2025. Based on them, 8 grays of radiation per session for 5 weeks in a row were scheduled. Also, it was explained that the 1 square centimeter tumor on the imaging was to be targeted using SBRT and that despite trying to pinpoint the tumor, healthy prostate cells would also get hit collaterally.
Then in the month of January (2026), a new oncologist shows up and becomes the one to prepare me for the treatment. Just to confirm, I ask her about how the SBRT will work. She Then Proceeds To Tell Me Something Entirely Different!--something to the effect of: "We are treating the Entire Prostate," she explains. "The updated imaging you're requesting is not a major factor in your case because even if the tumor has shrunken substantially (from ADT), there are Microscopic Cells that don't show up on imaging that need to be targeted, otherwise they could grow rapidly, causing the tumor to return."
As she explained this, I thought, "Changing from targeting the tumor with 8 grays to targeting the entire gland with 8 grays--that's a lot to swallow!"
The burning question about this situation I have is this: If of several million prostate gland cells (according to AI), in my case, a few thousand are malignant, Would It Be Worth Sacrificing The Several Million With 8 Grays Of Radiation To Destroy A Few Thousand?
Further, does my situation appear to be one where, instead of using updated imaging to know exactly what's to be targeted, a "whole gland treatment" is being employed to "target everything?"
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You don’t tell us a lot about your case. What you described may or may not be a great decision.
What was your Gleason score? If 8 or higher More extensive treatment is frequently needed.
Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.
The biopsy only biopsies 1% of your prostate. In many cases, the cancer is found in different places after a prostatectomy, and it can be found to be quite aggressive in a lot of cases.
If you feel that the cancer is only in part of your prostate, you could get focal therapy something like HIFU, cryotherapy, Tulsa-PRO. Those techniques will only target the areas of your prostate that show they have cancer.
They may be a good solution for you, but it depends on whether things mentioned above were found.
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3 ReactionsI think even your original RO would admit that the plan was always to radiate the entire prostate. The targeting he mentioned was just to give some extra radiation to the visible tumor. A lot of prostate cancer is invisible to our best imaging systems. As such, the safe approach is to radiate the entire prostate so that all visible and invisible cancer cells are killed. Of course, healthy prostate cells will be exposed to radiation in this process but it is at a level that they can tolerate. See my bio for more info.
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3 ReactionsYou indicated that you had “… 8 grays of radiation per session for 5 weeks in a row were scheduled.” Was that just 1 session per week for 5 weeks?)
It’s not collateral (accidental) damage. Even with SBRT, for primary treatment the expectation is to hit the entire prostate with radiation. However, the expectation is to not hit any nearby healthy organs or tissues or beyond the prostate (i.e., minimal entry-dose, scatter, or exit-dose).
The new oncologist (“she”) informed you correctly.
(However, these days they can do what’s called the FLAME protocol, where they can boost the radiation to the prostate where it’s needed most, and less radiation where it might not be needed as much.)
Regarding your “burning question” —> With radiation, yes, the DNA in healthy prostate cells get damaged just as does the DNA in cancerous prostate cells. But healthy prostate cells have repair mechanisms that can repair the DNA damage (though not always). Cancerous prostate cancer cells usually can’t repair the DNA damage and therefore can no longer multiply so, they die. (ADT weakens them even more, and ARPI even more.) What’s left is a “healthy” prostate, 35% smaller than it was, but (over time) without any remaining cancerous prostate cells that survived the radiation.
The only time they would use narrowly targeted radiation is with salvage radiation treatments or if there were a few metastasized lesions that needed treatment.
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5 Reactionsthanks4sharing, the 8 grays are the total radiation exposure. They will be distributed unevenly. The dosimetrist will use your latest scans to determine the areas to be treated with the highest dose. ADT can destroy cancer cells. Those areas where the tumor has receded, and now contain microscopic cells will receive less of the total 8 GY dose dose.
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1 ReactionYour question has always intrigued me as it applies to the prostate. Forum members have described what is done during SBRT and in short, the tumor is zapped with the highest dose, and marginal areas, being at the periphery, receive a lesser dose.
But what has always remained troubling to me is this: we know that ionizing radiation can cause cancer by scrambling DNA; and yes, it can kill it too…so why can’t those ‘healthy’ prostate cells everyone talks about ‘recovering’ - also become malignant after radiation therapy due to their DNA perhaps NOT repairing itself properly and not recovering?
It seems to me that you would want the entire gland treated and eradicated one way or the other; of course always protecting surrounding tissue and organs.
Phil
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