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Old 04-12-2012, 09:01 AM   #1
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external beam radiation

Does anyone know if there is one type of this treatment that gives better results. My doctors tell me this is all they recomend for me because of age and having had a reem job on my prostate. Like somone said they all claim to be the best? I live in the Atlanta area and am not shure what is offered here. I am only a Gleason 3/3 with 2 of 12 positive cores at 5%avg. in only one lobe P S A was 3.8. does Anyone have any ideas on this topic.

 
Old 04-12-2012, 12:34 PM   #2
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Re: external beam radiation

You seem to be an ideal candidate for Active Surveillance. In fact, given your biopsy results, you could be the poster child for Active Surveillance Active Surveillance involves getting your PSA checked four times a year and getting an annual biopsy. If the cancer starts growing you will have plenty of time to get treatment then. Unlike many other cancers, some forms of prostate cancer are indolent and never grow much. Many more men die with prostate cancer than die from it. It is vastly overtreated and all treatments entail some side effects. Why undergo any of the side effects of treatment if your cancer is not growing?
  • Of the radiation treatments, CyberKnife entails the least amount of bother (only 4 or 5 short treatments plus 1 visit to install the fiducials and get an MRI/CT scan), and is among the most effective and has a very low incidence of side effects. The five year results are great.
  • HDR Brachytherapy (temporary implants) and LDR Brachytherapy (seeds) are also very good as practiced at the best centers, but they entail local anaesthesia and a hospital stay.
  • IGRT/IMRT involves 40 or more treatments, which can be fatiguing.
  • IMPRT (pencil beam proton) also involves 40+ treatments, is very new and much less toxic than the old proton therapies as practiced at Loma Linda or Mass General. I think the closest pencil beam proton facilities to you are at UF Jacksonville or MD Anderson in Houston.

Side effects of all types of radiation will involve some acute (in the first month) urinary issues (frequency, and burning, especially with seeds) and possibly some bowel issues (frequency, fullness) that will go away. These side effects may also crop up a year or two later, but typically resolve on their own. Sexual side effects vary with the type of treatment and may not show up for a year or two. Side effects are usually worse the older you are and if you already had those symptoms before the start of therapy. I don't know how your TURP might effect whether you can have some of these treatments.

All of these will do an equally good job of getting rid of the cancer permanently. It's just a matter of the side effects you are willing to put up with and the bother you are willing to go through.

- Allen

 
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Old 04-12-2012, 12:47 PM   #3
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Re: external beam radiation

I should have mentioned that you may be a candidate for focal therapy -- treating only the part of the prostate that is known to have cancer in it. They can do this with cryotherapy, HIFU, laser, RF ablation or photodynamic therapy. The difficulty is in knowing that the cancer really is only in one lobe of the prostate. This occurs in only about 20% of cases. Most of the time there are tiny amounts of cancer in the other lobe too that can't be picked up in an ordinary biopsy. There are some specialized imaging techniques, like Color Doppler Ultrasound or elastography, that may help visualize it better but they are not as good as we would like them to be. Focal therapy can be used to extend the time on Active Surveillance, perhaps permanently.

- Allen

 
Old 04-12-2012, 01:19 PM   #4
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Re: external beam radiation

As Allan said AS is a viable option. You mentioned age as an issue and AS is highly recommended for older patients with stats higher than yours. Brachytherapy would not be recommended as you have had a TURP. The Radiology Centers of Georgia (RCOG) and the Dattoli Cancer center in Sarasota are two facilities that have a long history with radiation for prostate cancer.

 
Old 04-12-2012, 02:14 PM   #5
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Re: external beam radiation

My understanding was that LDR brachy following TURP is contraindicated unless there was an adequate amount of tissue left following TURP, and they avoid close placement to the urethra, and stranded seeds would be an absolute necessity. Of course, there are other considerations as well, like size of the prostate, but that may be changing. I haven't heard if HDR is possible following TURP but would imagine it too would have to be assessed on a case-by-case basis. But all this is very tricky stuff. Thinking about it, I can't say I'd be thrilled about any treatment following TURP -- damage to whatever is left of the urethra is risky. I'd want a radiation oncologist with a lot of experience in this kind of thing -- another reason to stick with active surveillance as long as you can.

RCOG is known for promoting ProstRCision, which is their fancy name for seeds+IMRT. I could never understand why they did all that for low risk PC. The Moffitt Cancer Center in Tampa also has a good reputation.

- Allen

Last edited by Tall Allen; 04-12-2012 at 02:39 PM. Reason: added misgivings

 
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Old 04-13-2012, 10:39 AM   #6
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Re: external beam radiation

First off in reading your replies to others I came to the realization that you are not only a knowledgeable person but a caring person as well. Frankly I was very much hoping for your reply. I can see the wisdom in an AS program as you describe it. Although I am 72 I am very active and still walk 24 miles a week and weight lift and other activities. Because of this and otherwise good health my doctor believes I should be treated as a younger man and fight it. He wanted me to do both the seeds and beam that Radiology Centers of Georgia prescribe. However in my interview with them they shot that down because of the TURP, only recommending ex beam. Like you I was thinking ProstRCision was an overkill at the expense of compounding negative symptoms. AI sounds good but leaves me with two problems. My grown kids don’t like the idea at all, they read too much about cure rates for this and that. The other thing would me getting used to thinking about something growing inside me guess I ‘m chicken. Again think you for your kind and considered reply. I do realize that compared to most people you help I got it made but even for me it’s scary stuff. I pray for us all!!

 
Old 04-13-2012, 10:40 AM   #7
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Re: external beam radiation

Thank you Johnt 1 I am most grateful for your well considered reply. I am indeed 72 but my doctor believes I should be treated as a younger man because I am very active and still walk 24 miles a week and weight lift and other activities. AS was the first thing I ask him about he said lets fight it your still a young man physically. I did consult with Radiology Centers of Georgia where they told me that I only qualified for the beam treatment. I may have to re evaluate the AI in view of your and Allan’s comments. I will say that it sure feels good hearing opinions that are not trying to sell me their treatment. Thanks again for the help.

 
Old 04-13-2012, 01:36 PM   #8
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Re: external beam radiation

AS isn't just for old folks anymore. The new NCCN guidelines (NCCN is an organization of most of the top cancer treatment centers in the US) as well as the protocols of every major center of excellence in the US and Canada would offer you AS just based on your pathology report and PSA, which would probably place you in the "very low risk" category, irrespective of your age. If your life expectancy were less than 20 years, AS is the only option they would recommend, but even with greater than 20 year life expectancy, it is still one of the recommended options.

I think that with your previous TURP, any kind of treatment may give you trouble. It is impossible to irradiate the prostate without causing at least some irritation to the urethra, whatever you have left of it. The beams have to go through there. The only therapy that might be able to avoid it is pencil beam proton (available at UF Jacksonville and SD Anderson).

Tell your kids to read updated cure rates that are published in peer-reviewed journals. It used to be the case that radiation had far worse cure rates than surgery. They found that by increasing the dose and using better machines and techniques for delivering it, they could get the same or better cure rates without the side effects of surgery. Those, and possibly other even better options, will be available to you the longer you wait to be treated. I have an 85 year old friend who was just treated with CyberKnife. Maybe in 10 years there will be a pill you can take that targets and kills cancer cells only (they're working on it). Also, tell them that Active Surveillance is active. You will be monitoring your cancer continually and will be prepared to act if it progresses. With any luck, it will never progress.

- Allen

 
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Old 04-16-2012, 03:01 PM   #9
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Re: external beam radiation

From what you post in your question, have you considered "active surveillance" - your biopsy diagnosis sounds familiar to mine and at this point I'm choosing AS.

 
Old 05-10-2012, 05:15 PM   #10
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Re: external beam radiation

rushemose,
Research all the treatments suggested by Tall Allen. I had Protons at Loma Linda and I am very satisfied with the results. Basically no side effects other than those resulting from a failed RP in Canada. As for focal therapy as a patient I wouldn't go for it. I don't like the bit at a time approach and would rather have the finality of a cure such as offered by Protons without side effects which may result from piecemeal treatments. That's just how I feel.
Bob

 
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