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What to ask the radiation oncologist about prostate cancer?

Posted by surftohealth88 @surftohealth88, 2 days ago

Tomorrow we have zoom call with radiation oncologist that was recommended to us by prostate surgeon. Our meeting with surgeon was somewhat confusing since we did not expect to be told that my husband's case is not "urgent" and that we should talk to radiologist and as well to a doctor that does focal treatments. We were convinced that RP was the best approach, as we still think that RP is a way to go with cruciform and IDC but since we were told that we should have consultations with radiology, we agreed. I can say with whole honesty that we were like two deer caught in headlight after we were told that there is no rush, and we both failed to react with NEW questions and stared at "old ones" on our paper in confusion. So, in preparation for tomorrow's appointment I am asking for help with possible questions - any suggestion and advise is welcome. Thanks so much in advance < 3

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surftohealth88 | @surftohealth88 | 19 hours ago

Just a short report about consultations since I am sure there would be perhaps similar patients in the future and might need some prospective and help in making decisions.

Meeting went great ! I was impressed with not only doctor's expertise but also with his honesty and genuine care. Radiologist took time ahead of the meeting to study our particular case and made detailed plan and program for treatment with 3 possible protocols using different radiation techniques. Since my husband has cribriform and IDC the most aggressive approach was deemed as one that would give the best results (radiation + ADT + one maxi brachi hit in the single spot with IDC using probes). The aggressive features of IDC and cribriform require aggressive approach. BUT - there is only one approach that is even more "aggressive" toward IDC and that is RP.

I can not express my gratitude to this doctor who put my husband's interest ahead of everything else and who spent 40 minutes presenting ALL of the options in every possible detail just to basically at the end give us a "wink" to go with our plan to have RP.

We are lucky that my husband is in good age group and healthy enough to have RP but I would also like to say that if you can not have RP or do not want to have it, there are many radiation options for you with possibly good results also. In case you have IDC and cribriform , RP would however give you the best chance of getting rid of the cancer.

Nobody can predict the future, of course, and results are also dependent on doctor's expertise. If you decide to have RP find the best robotic surgeon you can find, possibly in center of excellence or the one who did thousands of prostatectomies.

We are now doubly reassured that our plan and our gut instincts were correct and now we can concentrate on surgery preparations, PT for pelvic floor, etc.

Thanks everybody for all of your help and advice : ))).
Bill, you are as always source of wast knowledge and ALWAYS there to help everybody and/or offer the shoulder - may the universe return that to you in multiples < 3

Wishing you all wonderful and relaxing weekend and upcoming Mother's Day ! : )))

REPLY
2 replies
heavyphil | @heavyphil | 9 hours ago
In reply to @surftohealth88 "Just a short report about consultations since I am sure there would be perhaps similar patients..." + (show)
@surftohealth88

Just a short report about consultations since I am sure there would be perhaps similar patients in the future and might need some prospective and help in making decisions.

Meeting went great ! I was impressed with not only doctor's expertise but also with his honesty and genuine care. Radiologist took time ahead of the meeting to study our particular case and made detailed plan and program for treatment with 3 possible protocols using different radiation techniques. Since my husband has cribriform and IDC the most aggressive approach was deemed as one that would give the best results (radiation + ADT + one maxi brachi hit in the single spot with IDC using probes). The aggressive features of IDC and cribriform require aggressive approach. BUT - there is only one approach that is even more "aggressive" toward IDC and that is RP.

I can not express my gratitude to this doctor who put my husband's interest ahead of everything else and who spent 40 minutes presenting ALL of the options in every possible detail just to basically at the end give us a "wink" to go with our plan to have RP.

We are lucky that my husband is in good age group and healthy enough to have RP but I would also like to say that if you can not have RP or do not want to have it, there are many radiation options for you with possibly good results also. In case you have IDC and cribriform , RP would however give you the best chance of getting rid of the cancer.

Nobody can predict the future, of course, and results are also dependent on doctor's expertise. If you decide to have RP find the best robotic surgeon you can find, possibly in center of excellence or the one who did thousands of prostatectomies.

We are now doubly reassured that our plan and our gut instincts were correct and now we can concentrate on surgery preparations, PT for pelvic floor, etc.

Thanks everybody for all of your help and advice : ))).
Bill, you are as always source of wast knowledge and ALWAYS there to help everybody and/or offer the shoulder - may the universe return that to you in multiples < 3

Wishing you all wonderful and relaxing weekend and upcoming Mother's Day ! : )))

Jump to this post

Excellent consult. I was going to mention the High Dose Brachy to the aggressive area and then either SBRT/IMRT, but your RO beat me to it!😁
A lot to consider but one thing I would ask is this: If you decide on the aformentioned radiation protocol, which type of radiation would be better if you ever DID have to consider salvage surgery? SBRT or IMRT? They do the same thing but one is very focused, and the other not so much. Couldn’t hurt to ask. Best,
Phil

REPLY
proftom2 | @proftom2 | 8 hours ago

Such an excellent question. I am 5 years in on this aPC journey. I view Radiation Oncologist as leading edge. Two Years Ago I added annual educational consultations with my radiation oncologist. I have two. One at my local hospital cancer center, the other is a large teaching/research cancer research hospital NCI (National Caner Institute).

Both are excellent. Why two? Simple, Radiation Oncology technology advancements and innovations are changing prose cancer treatment for the good and will be for a long time. My rule of thumb is NCI cancer research treatment hospital have access to leading edge knowledge and radiation devices.

Self-education is a vital part of cancer survivorship.

REPLY
kenk1962 | @kenk1962 | 5 hours ago
In reply to @surftohealth88 "We have app. in 2 hours, I will let you know if anything interesting transpires regarding..." + (show)
@surftohealth88

We have app. in 2 hours, I will let you know if anything interesting transpires regarding future treatment .

JC - there was only one core of 14 with finding of 4+3 (gleason 7), and two with 3+3 . All of the rest was clear. BUT, that 4+3 contains cribriform and IDC formations. My husband is 69 and very fit and healthy.

First pathology stated IDC, and second opinion stated "possible IDC", both agreed about cribriform. Nevertheless, that one core puts my husband in "intermediate high risk" group.

PSMA showed cancer being contained in the gland and in that one single spot in prostate.

One lymph node was inconclusive but the scan was examined again by extremely experienced radiologist who told us that it is actually negative, and it was also confirmed by surgeon. So, hopefully it is negative.

All in all, unusual case with having one single core with such aggressive features :(. If it was 4+3 without cribriform and IDC decision would be more straightforward and easier. Cribriform cells tend to escape and metastasize and IDC sometimes make micro environment which almost protects cancerous cells inside those ducts. Nobody proved it yet but some studies show that most relapses after initial radiation actually happen to patients with those features and in this paper that was posted by Dailyeffort it looks like some patients that were without IDC and Cribriform before RT end up having them after failed RT. In another study IDC patients had better success with RP than RT for metastases free survival.

All in all, IMHO RP would give the best chance for elimination of aggressive features that are present at this time. What future holds only heavens know ...

Jump to this post

I am a 63 year old, 8.1 PSA, Gleason 4+3 "unfavorable intermediate risk" patient. Only one biopsy core positive had Gleason 4+3, but I also had eight other positive cores with Gleason 3+4. No IDC or Cribriform which I acknowledge are more problematic, but my Gleason 4+3 core did touch the outer perimeter of my prostate.

I chose SBRT radiation for my treatment primarily because the 4+3 core was in contact with the outer perimeter. This concerned me because it seemed reasonably likely my 4+3 core could have some microscopic escape from the prostate into the surrounding tissues. If so, then I believe the SBRT radiation will take care of this while radiating the entire prostate.

However...if my cancer did not contact the outer perimeter of my prostate, then I probably would have selected RP surgery instead of radiation.

I'm cheering for you. Best wishes.

REPLY
kenk1962 | @kenk1962 | 5 hours ago
In reply to @surftohealth88 "Just a short report about consultations since I am sure there would be perhaps similar patients..." + (show)
@surftohealth88

Just a short report about consultations since I am sure there would be perhaps similar patients in the future and might need some prospective and help in making decisions.

Meeting went great ! I was impressed with not only doctor's expertise but also with his honesty and genuine care. Radiologist took time ahead of the meeting to study our particular case and made detailed plan and program for treatment with 3 possible protocols using different radiation techniques. Since my husband has cribriform and IDC the most aggressive approach was deemed as one that would give the best results (radiation + ADT + one maxi brachi hit in the single spot with IDC using probes). The aggressive features of IDC and cribriform require aggressive approach. BUT - there is only one approach that is even more "aggressive" toward IDC and that is RP.

I can not express my gratitude to this doctor who put my husband's interest ahead of everything else and who spent 40 minutes presenting ALL of the options in every possible detail just to basically at the end give us a "wink" to go with our plan to have RP.

We are lucky that my husband is in good age group and healthy enough to have RP but I would also like to say that if you can not have RP or do not want to have it, there are many radiation options for you with possibly good results also. In case you have IDC and cribriform , RP would however give you the best chance of getting rid of the cancer.

Nobody can predict the future, of course, and results are also dependent on doctor's expertise. If you decide to have RP find the best robotic surgeon you can find, possibly in center of excellence or the one who did thousands of prostatectomies.

We are now doubly reassured that our plan and our gut instincts were correct and now we can concentrate on surgery preparations, PT for pelvic floor, etc.

Thanks everybody for all of your help and advice : ))).
Bill, you are as always source of wast knowledge and ALWAYS there to help everybody and/or offer the shoulder - may the universe return that to you in multiples < 3

Wishing you all wonderful and relaxing weekend and upcoming Mother's Day ! : )))

Jump to this post

So glad to hear your radiation oncologist consultation went so well.

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