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Thread: Please Help Me Understand_ADT, HDR & EBRT

  1. #11
    Quote Originally Posted by OldTiredSailor View Post
    Here is a link to a video of an interview with a Johns Hopkins PCa researcher (Kenneth Pienta). Dr. Pienta explains in some detail the mechanism, timing, and statistics of PCa spreading to other parts of the body.

    https://www.urotoday.com/video-lectu...-21-27-26.html

    My understanding is that radiation therapy cannot kill those distant dormant cells. But, hormone and chemotherapy do have a chance of killing off the single cells that are lurking about to potentially come to life and multiply in the distant future.
    Quote Originally Posted by DjinTonic View Post
    Correct, radiation requires a direct hit in the right (total) amount. A distant met, whether in a lymph node or soft or hard tissue, may or may not be treatable with RT depending on it's location.
    OTS (and Djin) thanks for the most fascinating video. The principles here could likely apply to any solid tumor malignancy. I remember seeing another video a couple years ago wherein a young researcher had identified a possible means, via protein or enzyme, cancer cells could 'signal' other cancer cells that the primary tumor is getting crowded and as the older cells don't die (via apoptosis) tells the rapidly growing new cells to leave home and look for someplace else to live.

    Regarding the roles surgery, RT and ADT in advanced PCa, my own case could have been a lot simpler, but it was not. At the time I knew very little, but I did know that it had already been nearly four years since the cancer had been first detected. Primary radiation seemed too much like shooting in the dark. And as it turned out, the scans and biopsy had been wrong.

    Though there was no "master plan" that early on, what evolved (as plans often do) is first to eliminate the motherlode, the primary food supply or source of testosterone. Initiated ADT when practical to starve any circulating cells, and RT to zap any that had managed to remain in the original homeland, the prostate bed.

    But then the coup de grāce, extending HT an additional six months, after my RO had informed me that the radiation would continue to kill cancer cells for another 8-9 months after the end of treatment... so the HT would work alongside the residual radiation. Of course, I wasn't expecting it to take another year or more for testosterone production to resume.... assuming that at some point, it actually will.

    Hopefully any circulating cancer cells will find nothing but a barren wasteland.
    Late 2012: PSA 4, age 62 all DRE's 'normal'
    Early 2014: PSA 9.5, TRUS biopsy (false) negative
    2015: PSA's 12 & 20, LOTS of Cipro ... Mar'16: PSA 25, changed Urologist
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2ea 15-40-100% G8(4+4)
    Aug'16: DVRP,
    "broad cut" 11 LN-,-SM, 53g 25% involved, multifocal EPE, PNI, B/L SVI, pT3b

    Jan'17:
    began Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Jan'18-July 2019: PSA's <0.008, T~12
    Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis
    "Everyone you meet is fighting a battle you cannot see"

    Mrs: Dec 2016: Dx stage 4 NHL/DLBCL,
    Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+6X IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog

  2. #12
    Hi Sw! Not sure if you sought answers to suggested questions for your MDs listed in your recent (5/17) post:

    I would ask the MD Team the following questions:

    - Why does my PSA appear to be rising rapidly?

    - Are there other non-PCa issues that are contributing to the rise?

    - Does G6 PCa normally cause a dramatic rise in PCa?

    - If my PCa is truly 100% G6 only, why is Eligard needed?

    - How should I decide between Radical Prostatectomy vs Radiation?


    You should inquire if you are a candidate for one of the new generation PET/CT Scans such as Axumin or Gallium-68. Since you are at Emory, the principle investigator for the Axumin Trial is Ashesh Jani, MD in the Dept of Uro Radiology/Oncology.

    Has surgery been ruled in or ruled out as a good treatment option with curative potential? If you elect surgery, will Eligard or some form of hormone therapy be required? For the majority of us, RP was straightforward and recovery time was fairly quick. Dr Sanda at Emory is a highly experienced RP surgeon and an academic thought-leader in Urology.

    You have a unique set of circumstances that add a few more variables to arriving at the "perfect" treatment decision for you.

    How soon did your MD advise to start treatment?

    Good luck making your decision. Once made, simply move forward and don't look back!

    MF
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  3. #13
    Senior User Sw1218's Avatar
    Join Date
    Jul 2015
    Posts
    186
    Quote Originally Posted by Michael F View Post
    Hi Sw! Not sure if you sought answers to suggested questions for your MDs listed in your recent (5/17) post:

    I would ask the MD Team the following questions: etc...
    yes. i saw this post and i plan to see my MO this wednesday and ask him these questions at this time. but may i ask you how would i find out if my PCa is truly 100% G6?

    Quote Originally Posted by Michael F View Post
    Has surgery been ruled in or ruled out as a good treatment option with curative potential?
    surgery was ruled in as a good option, but i'm not sure how well, my disability would handle the recovery period, plus the SE's.

    Quote Originally Posted by Michael F View Post
    If you elect surgery, will Eligard or some form of hormone therapy be required?
    i'm not exactly sure. but i doubt if i elect surgery, if i'm not required to.

    Quote Originally Posted by Michael F View Post
    How soon did your MD advise to start treatment?
    well, my uro advised surgery within a week of seeing him [march 13th]. my RO advised treatment before the end of the summer.
    D.O.B. 1973
    07/14 PSA 5.5
    08/14 Prostatitis & BPH
    07/15 PSA 5.9
    01/16 PSA 7.6
    03/16 PSA 6.2
    07/16 PSA 6.9
    10/16 PSA 6.9
    03/17 PSA 7.2
    05/17 3T MRI Good
    11/17 PSA 7.7
    11/18 PSA 10.8 Cipro for 2 wks
    07/18 PSA 11.9
    08/18 3T MRI: 3 lesions. No extra PCa disease, pelvic LAD, or pelvic lesions
    02/19 MRI Fusion Biopsy
    05/19 PSA 18.67
    05/19 PSA 14.81
    Bx Findings
    A. PROSTATE, LESION 1, LEFT APEX, 3D MRI FUSION BIOPSIES: * BENIGN
    B. LESION 2, RIGHT MID GLAND *PCa, GS 4+3=7 (GRADE GRP 3) 3 OF 3 CORES
    (95% DISCONTINUOUS, <5%, <5%) * GS GRADE 4 60% OF THE TUMOR
    0 PERINEURAL INVASION IS PRESENT
    INFLAMMATION.
    C. LESION 3, DIFFUSE LEFT MID GLAND, 3D MRI FUSION NEEDLE CORE BX's
    PCa, GS 3+4=7 (GRADE GRP. 2) LESS THAN 5% OF THE FRAGMENTED CORES
    GS GRADE 4 INVOLVES 5% OF THE TUMOR
    2nd Bx OPINION
    A. Benign
    B. PCa, GS 3+3=6 (Grade Grp. 1) 80% of 1 core
    C. PCa, GS 3+3=6 (Grade Grp. 1) 20% of 1 core

  4. #14
    Hi Sw! Thank you for your answers! Based on congenital factors, you will face more challenges than others BUT you will get through this!!!

    Quote Originally Posted by Sw1218 View Post
    ....

    How soon did your MD advise to start treatment?

    well, my uro advised surgery within a week of seeing him [march 13th]. my RO advised treatment before the end of the summer.
    When does your RO want you to start Eligard? I suspect fairly soon. A 6 month course should have a tolerable and manageable impact. Ask your RO to consult with an orthopedic endocrinologist to confirm if you can expect to tolerate this HT well.


    Quote Originally Posted by Sw1218 View Post
    this stuff is scary. i HONESTLY don't know what to do.
    Making the Best and most correct decisions can be very difficult. If your MDs feel that your rising PSA is due to PCa, then required treatment is on the near horizon. If this is the case, then you know exactly what NOT to do. Do NOT wait too long to start treatment! This means that your treatment decision should be made fairly soon.

    Don't be afraid to move forward. You will be heading to your goal of CURE!

    Stay Strong! Be decisive! Act now and get this behind you!

    MF
    Last edited by Michael F; 05-22-2019 at 02:13 AM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  5. #15
    Senior User
    Join Date
    Nov 2018
    Posts
    242
    Is EBRT and IMRT the same thing or are they different. Is one better than the other. Is it older or newer Equipment?

  6. #16
    My understanding is that IMRT and IGRT are both forms of EBRT... EBRT means "external beam", which is pretty much any x-ray based RT (i.e., not implanted or "brachy"). IMRT is a newer form where the external beam is "intensity modulated" (IMRT) via computer control. Additional, many IMRT machines are also "image guided" or IGRT, where the machine first does a CT scan to determine where everything is located on that day (it does change) before starting the EBRT.

    Sounds complicated, but it's actually simple when you know the terminology.
    Late 2012: PSA 4, age 62 all DRE's 'normal'
    Early 2014: PSA 9.5, TRUS biopsy (false) negative
    2015: PSA's 12 & 20, LOTS of Cipro ... Mar'16: PSA 25, changed Urologist
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2ea 15-40-100% G8(4+4)
    Aug'16: DVRP,
    "broad cut" 11 LN-,-SM, 53g 25% involved, multifocal EPE, PNI, B/L SVI, pT3b

    Jan'17:
    began Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Jan'18-July 2019: PSA's <0.008, T~12
    Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis
    "Everyone you meet is fighting a battle you cannot see"

    Mrs: Dec 2016: Dx stage 4 NHL/DLBCL,
    Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+6X IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog

 

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