Received G9 Biopsy

JC - Many RO’s seem to be using hypofractionated treatment (roughly twice the dose, half the treatments) so the duration is 20 - 30 sessions which is still a long time but weeks shorter. Your Uro is not the person to pay attention to about modern radiation but good to hear that it is not being ignored.

As halbert mentioned, SBRT is intense dosage for just a few sessions but there is a reluctance to use on high risk patients so your treatment scheme will take some time. I would definitely see the IU Simon RO, Cleveland Clinic has expertise in SBRT as I recall. You may be able to have an intense treatment at one location followed by general radiation closer to home, lots of possibilities.

A RO supervises the beam radiation treatment which is somewhat standardized at the major cancer places (same equipment, protocols,etc). The technicians handle all the actual treatment work since nothing touches you (similar to an Xray or CT, only the Star Trek version with cool modern equipment.) In my case, an RO signed off on each treatment after the preliminary daily scan and the radiation field was set (your organs are not in the same place or condition every day). It was not my RO all the time as they mix appointments with treatments and my RO could be out of office that day but one of the RO's looks after each daily treatment.

On the other hand, physical insertions such as low dose and high dose brachytherapy usually involves the RO and possibly other doctors.

If you were to just get standard beam treatment, there may be a cancer clinic or hospital closer to home that would have the appropriate equipment and personal (RO's, techs) to do what the Simon RO would recommend. However, things like surgery, brachytherapy, proton beam, etc would be done at their main facility. Many times, the high risk diagnosis with other factors suggest the "triple play" treatment of hormone therapy, concentrated radiation to prostate, and standard radiation to the local area for best results. You want one doctor to lead the team that you trust.

I recommend to a friend to also go to Mayo and they provided the same recommendations as the RO he saw in the Twin Cities so he chose to travel 5-10 minutes vs. 1.5 hrs each way. My wife did the same thing with BCa recurrence. However, we have good local medical facilities here with the University of MN and Mayo nearby. Small town America does not have these benefits very often.

The above two posts are spot on and closely relate to my own (Gleason 9) experience (see my medical summary). As I recall, the rad oncologist stopped by one time to ask how I was doing. He also told me that I would get tired after a certain number of sessions. That was about ten years ago. Nowadays, I see him once a year.

Nice, a plan is coming together.

There are two types of brachytherapy, 1) low dose (LDR) which are many small permanent seeds that are implanted and left in place and 2) high dose (HDR) which is a high dose temporary radioactive source that is placed in a few areas and removed after a short period.

https://radonc.ucsf.edu/conditions-treatments/types-of-treatment/brachytherapy-hdr-ldr/

You should try to understand exactly what the full scope of treatment is. Gold markers can be used with different radiation schemes and allows the prostate to be better defined. Did they mention following up with general radiation or just the hormone drug and brachytherapy?

It is great that they started you on bicalutamide.

You are now being treated.

Your cancer cells are becoming weaker by the minute!!

Had my virtual appointment this morning with an oncologist at Simon. I will be taking bicalutamide until I receive my Lupron injection which will be in a week or so and at that point I will stop taking the bicalutamide and remain on Lupron injections for about two years - once every three months. After about two and a half to three months of being on hormone therapy I will receive HDR brachytherapy followed by some external radiation treatments.

It's a little scary knowing that I can't have the surgery once I start radiation but hopefully there will be no need for surgery.

I did feel good after talking to the RO yesterday. But this morning, the urologist staff called to schedule an appointment to start the surgery consultation. I told her not to bother that I’m going to do radiation. She said you can’t have surgery once you do radiation. So then I started wondering if I made the correct decision. So time went on this morning, and I was waiting for my virtual appointment which was over an hour late, so I finally called. There was confusion over whether it was virtual or in person, but it’s clearly in my portal that it was virtual, so they apologize for the mistake. So I had that extra time to wonder about surgery and radiation some more. I still believe that radiation is the route I need to go, considering I’m high risk, and I show EPE. But the elation I felt after talking to the RO yesterday got knocked down a peg because of the non surgery option. Then I got a little more down when I started thinking about side effects, although I’ve read all of them they just haven’t quite hit home yet. But thanks To this site and all the comments I receive it really does help. Thank you all so much.
I will keep checking for more comments as they are very helpful. I don’t know that I will have any updates for a week or so, so thanks in advance for any additional comments.

You can check my signature for the other way to do things. I was a G7(4+3) going into surgery, came out with a G7(4+3+5 tertiary) and received a G9(4+5) from expert second opinion on pathology. While my PSA was undetectable at 3 mos, I decided to go ahead with adjuvant radiation given the high risk nature of the final situation. So what started with surgery in Nov, ended with RT done in June for my treatment duration.

You have a solid G9(4+5) going in with probable EPE and high PSA. That is not the best situation to be timid about treatment. Hitting it hard is the best strategy and your oncologist(s) seem to agree. The hormone therapy will quickly stop the cancer from growing and lower your PSA thus they give it some time to do its job then start zapping the prostate area hard and go for the win.

Your decision is good and it is time to enjoy the freedom of being off the fence and getting after the rogue cancer cells. Look forward and don’t look back, time to be positive and look forward to getting done.

Thank you, you guys are the greatest and know just what to say to ease my mind.

JC9Sav,

You have confirmed g9
You have an EPE
Your psa was pretty high

Radiation is the best (but not only) choice.

Radiation will treat the prostate and nearby areas.

Surgery only gets the prostate.

(Everyone wants your money)

Psma pet gave you the information you needed to make the best choice. 5 years ago psma pets were still in the process of getting approved. So your chances of success are already better than what most guys had just five years ago.

Listen, it stinks you have cancer. Everytime you get down, take a look at that bottle of pills they gave you and think to yourself “thousands more pca cells are starving to death today…..”

Then walk around the block to clear your mind.

Such awesome and encouraging comments guys, thanks so much.

Something that gave me reassurance, that should now give you reassurance ...

There came a day when I realized I was pursuing a multi-layered treatment approach ... in my case, it was ADT injections, then chemotherapy, then ZYTIGA, and then radiation.

Two of those are ongoing ~~~ the ADT injections, and the ZYTIGA, which is a daily medication.

With the treatments you have described, you have a multi-layered & targeted plan that is already mapped out.

Here's to that!

Sending my encouragement ~
CYCLONE ~ # Iowa State University

Been a while but was waiting on hormone therapy to do it's thing and information that was new. Had appointments with my medical oncologist yesterday and RO today. Current Lab results show a PSA of 1.38. My PSA at the start of hormone therapy was 15.6. Big improvement. Will be receiving 5 treatments of SBRT over two weeks and continue ADT for 2 years. I guess I was wrong about HDR Brachytherapy. Urination flow has vastly improved.