Received G9 Biopsy

Hi JC,

You may be interested in this recent ASCO abstract:

Long-term treatment outcomes from the International Multi-Institutional Stereotactic Body Radiation Therapy for High-Risk Localized Carcinoma of the Prostate (SHARP) Consortium. (2024)

"Abstract

Background: Stereotactic body radiation therapy (SBRT) leverages advanced image-guided radiotherapy techniques to deliver high doses of radiation over the course of 5 or fewer treatments. High-risk localized prostate cancer has been historically treated with more protracted conventional radiotherapeutic techniques, though use of SBRT is now supported in this setting by subgroup analyses of randomized trials as well as medium-term prospective data from phase II trials. However, most patients with high-risk prostate cancer continue to receive extended treatment courses in part due to trepidation surrounding the long-term outcomes of SBRT in high-risk disease. We sought to report long-term efficacy and toxicity outcomes from the SHARP consortium for men with high-risk prostate cancer treated with SBRT.

Methods: Individual patient data from men prospectively treated on five clinical trials evaluating SBRT for high-risk prostate cancer across five institutions were pooled. Analysis was limited to patients with more than 24 months of follow-up. Adjusted 5-year overall survival (OS) was calculated for the entire cohort of high-risk patients. Kaplan-Meier analyses estimated 5-year biochemical recurrence-free survival (BCRFS) and 5-year distant metastasis-free survival (DMFS) stratified by receipt of androgen deprivation therapy (ADT). Multivariate analysis quantified the benefit of adding ADT to SBRT, adjusting for patient age, iPSA, Gleason Score, T category, ADT use, and nodal radiation. Crude rates of CTCAE grade 3 or greater GI or GU toxicity were calculated.

Results: Data from 373 prospectively treated patients were pooled for analysis. Median follow-up time was 60.2 months. 282 (75.6%) patients received ADT for a median duration of 9 months. Adjusted 5-year overall survival was 87.9% (95% CI 84.2%-91.6%). Estimated 5-year BCRFS for men who received ADT was 81.4% (95% CI 76.2% - 86.5%) compared to 77.2% (95% CI 66.9% -87.6%) for men who did not (logrank p=0.04). Estimated 5-year DMFS was 92.4% (95% CI 89.1%-95.8%) for men who received ADT versus 93.6% (95% CI 87.5%-99.8%) for men who did not (logrank p=0.62). On MVA, adjusted HR for BCRFS with use of ADT compared to no ADT was 0.7 (p=0.017). Crude incidence rate of late grade 3 or greater genitourinary or gastrointestinal toxicity was 4.1%.

Conclusions: The safety and efficacy profile of SBRT for high-risk prostate cancer remains favorable at long-term follow-up. ADT of medium duration improves BCRFS in men with high-risk prostate cancer but did not reduce the incidence of metastatic failure at a median of 60 months. SBRT and ADT should be routinely integrated into shared decision-making for men with high-risk prostate cancer pursuing definitive radiotherapeutic treatment."

Djin

Thanks Mumbai,
That is easier to understand. I gather the previous post was mostly encouraging. I wasn’t sure about the following excerpt.

“but did not reduce the incidence of metastatic failure at a median of 60 months”

JC9Sav said...
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.

You are well underway.

With hormones You will feel like taking a nap despite a good nights sleep and not doing things that would normally make you tired.

Now, get into a good exercise routine to combat the side effects of the hormones,

Keep moving.

Park further away when you go shopping.

In the back of your mind remember its just for 24 months. Wait….you already have 2 months down. 22 months!!

Finally: Did they mention Calcium/Vitamin D supplements? Citrical. Helps keep your bones strong during hormone therapy.

The sluggishness will get worse with time.

Just keep moving. If you feel tired and haven’t done anything to deserve feeling tired, its time to move. Its that simple.

For me personally a good brisk walk in the morning right away helps…..alot. Everyone is different.

I also would recommend an activity tracker. Not something as expensive as an Apple Watch but something like a Fitbit Charge. Way cheaper, does not need to be charged everyday (mine needs a weekly charge) and gives you a sense of activity each day by tracking steps, heart rate, and how well you sleep

If you do start walking more dont skimp on sneakers. I find that alot of the aches and pains disappear when i get into a new pair of sneakers (knees/hips/ankles). I go through a pair of sneakers monthly if I am getting 10000 steps a day. (Fyi Just living life you get 2000-3000 steps per day.) The sneakers just lose their cushion. I buy ~$50 sneakers, but catch sales sometimes where they are $35 and I buy an entire years worth.

Larry…My first two SBRT treatments were non events that had me questioning if they even had the ‘beam’ turned on. Following the third treatment I experienced burning when urinating and my wife (an RN) gave me an over the counter AZO Urinary Pain Relief Extra Strength. Although it turned my urine a strange kool-aid color it helped enough that I didn’t require anything stronger (a script for Flomax that I had from my RO was unfilled). The burning was also present during ejaculation. The burning slowly disappeared in about two weeks following treatment. My radiation team encouraged me to remain physically and sexually active prior to, during and following treatment. I told my wife she was part of my treatment and rehab. I stayed with my regular spinning (cycling) program at the YMCA as well. My RO suggested that an active life style would help and I believe it helped significantly.

SBRT hits the prostate and surrounding area very hard. A lot of radiation is crammed very precisely into a short period of time and your urethra passes in the middle of it all. SBRT was patterned after HD brachytherapy and it’s believed to be more effective than lower dose methods. Given the extent and aggressiveness of your particular diagnosis I would guess your Radiation team has an very aggressive treatment plan and the discomfort you’re feeling is normal. I would keep your team members informed of how your feeling and follow their recommendations. Best wishes and thanks for keeping us updated. We all benefit from one another’s experiences…Terry

Larry, I'll just mention something you probably already know: exercise has been proven to help many who are depressed.

Djin

JC, your lack of zest, as you describe it, is certainly understandable. When I was diagnosed, and for a while after treatment, I felt the same, I just didn't know which way was up. you've faced a life changing illness, and have been forced, maybe for the first time, to face your own mortality. Thats a challenge for anyone. Don't be too hard on yourself. Or your wife, she's probably conflicted and is trying to juggle 2 resonsibilities at the same time.

Djin and Stephens comments are excellent. I found exercise, as hard as it was to get started, to be an excellent practice, both for my physical AND my mental well being.
But also, at the time, a certain member here who is no longer on HW, introduced me to the idea of mindfulness meditation. It took me a long time to get it. And when I enrolled in the Ornish Heart Disease Reversal Program, stress management via meditiation was a key element, and thats when I finally got it. I find its a great way to manage stress, and keeps me on an even keel.

Hang in there, it gets better

JC, your ADT treatment is to knock your testosterone down to nothing. Testosterone has shown to fuel PC. Hair loss, shrinking testicles, mood changes, lack of libido and decreased energy are all side effects of ADT. Exercise, weight training and a good diet helps both your mood and physical wellbeing. Also, a new hobby to keep your mind busy works wonders. The good news is by dropping your testosterone to nothing you are keeping your PC in check and increasing your age longevity.
My best wishes,
Jack

JC9Sav said...
My urologist or maybe my medical oncologist mentioned that some men have to stay on ADT for life.

Yes some of us are, but you are currently in the "I am going for the cure" line. When you are done you will have to keep an eye on your psa on a regular basis, but with this treatment they really are going for the cure. You are taking a mighty swing at your cancer.

Every day that you feel tired, your prostate cancer cells feel....worse.

Thank you for the encouraging words. Right now battling high blood pressure due to hormone therapy. Doctors just doubled my lisinopril dose from 20 mg to 40 mg block.

Thanks for the great advice. I was guilty of searching the internet on longevity but have since stopped. Right now any advice on persistent headaches mostly in early morning when trying to sleep. I’m not one to get headaches so it concerns me.

Sometimes it’s the simplest of things that are overlooked. Drinking more water is all it took to relieve the headaches.

Hey there. I'm late to your post, as I don't frequent this site much anymore.

I'd like to offer some encouragement. I'm coming up on 12 years past a diagnosis rather similar to yours. The G9 5+4 online searches lead you down some dark paths, but really most of those are based on some quite old information. There are many men, probably most men, who do well today after primary treatments even with such high risk diagnoses.

You can see the history in my signature. It's very difficult, and there aren't many who truly understand what you're thinking, what you're experiencing, with that diagnosis. It seems like a different disease than the low risk variants. We're not so much worried about side effects as we are about absolute survival.

I'm hoping you continue to do well as time goes on. All the best!