Should I do SRT only or SRT+ADT?

Positive margins, PT3A and a Gleason 8 with a rising PSA? I'm no doctor, but I think you'll need to throw the kitchen sink at this, which means HT and SRT. And I would start right away. Good luck to you.

That's a tough call. ADT is suppose to weaken the PC cells for the RT to zap them better, but then the ADT will mask the result of the RT until it's worked it way out of your system.

Not sure if there are any studies that confirm or deny this.

If the SRT fails, you'll be doing HT anyway.

I see no reason to not follow your RO's advice.
Andrew

So now what? Does he demand that his RO use ADT or he's fired? Say he read it on the 'net ?

I did ADT just one three month shot before SRT. That was when only a Canadian study supported but no one else. I begged my doctor for it and never looked back. It wasn't that bad. Plus you can always boost to women that you experienced hot flashes! They are sometimes quite impressed and sympathetic. Go for it.

I agree to do the ADT. If you don't feel comfortable with the initial advice of SRT only, then go seek additional opinions from other rad-oncs and med-oncs that treat a lot of high risk advanced stage prostate cancer. With the very high PSA and G8 I don't know why they didn't also use ADT initially. Those numbers do not indicate that surgery alone would suffice.

As far as telling the doctor "I saw it on the net"...just where do you think they get their information? They are just as dependent on the net as the rest of us. If we are reading and discussing the studies they should be reading and studying, what in the world is wrong with bringing it up? I do it all the time and my doctors appreciate it.

John_TX said...

JFL1957 said...
I believe the RO at MD Anderson recommends ADT with SRT if a PT3a or higher. At lease that's according to the posts by John_TX.

Correct - in fact the MD Anderson RO will NOT just do SRT. Their rigid protocol is ADT first and then a few months later (or after the prostate bed is healed from surgery) SRT. I don't have any idea if the protocol changes depending on the patient's risk factors.

I did not want ADT (actually I was expecting to be done after surgery) or radiation but here I am on Lupron and starting SRT in a couple of weeks. It's not fun being on Lupron but it's the very best way to keep the beast in the pen.

I guess I'll cross the bridge too. I've heard good things about MD Anderson. Octorobo had a good experience there and that's where I'll be heading when the time comes. Good luck John_TX and keep us posted. I'll be watching with interest.

JFL1957 said...
..I guess I'll cross the bridge too. I've heard good things about MD Anderson. Octorobo had a good experience there and that's where I'll be heading when the time comes. Good luck John_TX and keep us posted. I'll be watching with interest.

Thanks! MDA is a center of excellence so I think I'm in good hands for the future (have been so far.)

My post RALP report is similar to yours. I did Adj RT two months after RALP. ADT with RT after RALP is not universal. My RO and Uro both agreed that ADT was not an absolute requirement for my treatment. Studies may show improvement using ADT with RT following RALP, but how much improvement? My doctors' recommendations suited me just fine because I desperately want to avoid ADT. My treatments have been too recent for me to draw any conclusions from the success of my treatments.

Andyatli said...
In the GETUG-AFU 16 study, all patients' PSA were 0.2 or above. My PSA is in the close 0.1 range. Should I do both? Still not sure.

That's because they were going with the traditional definition of "biochemical recurrence." More recent analyses demonstrate that, especially for men with any adverse pathology (ECE or positive margins), a rising PSA of anything higher than 0.03 predicts that it will continue to rise to 0.2 with 98% certainty. If you were going to make an argument against adjuvant ADT, that would not be it.

The ability of ADT to radio-sensitize cancer is well established, and is not controversial. It shuts down the cell's ability to defend against the radiation assault by inhibiting the androgen receptor. Some had questioned whether it was still necessary with modern dose-escalated radiation, but a randomized trial last year, DART 01/05, put that question to bed.

There are nomograms you can play with to find probabilities that it is still curable - but remember, group statistics never predict for the individual case.

- Allen

I had SRT in 2010 after surgery in 2009. And I just had SRT, nothing else.

The crucial thing with my treatment was I beleive that there was a great deal of talking between my surgical team and the SRT team. Someone from the surgical team even sat in on the planning meeting when they worked out how to shape the beam to hit the target area.

At my last RT check-up they also said that the fact that the SRT got my PSA down to undetectable, and that it's been undetectable for five years since then, indicates to them that the only cancer cells left in my body after surgery were the ones in the area they targetted during the SRT. They said that had there been any other cancer cells somewhere else, then they would not have remained dormant this long and would have now been big enough to have started producing enough PSA for it to be detectable.

There was no hormone therapy to mask the effect of the SRT, thus the SRT acted as both the diagnositic tool and the solution at the same time.

Now. Nobody has told me this, so it's a calculated guess, but I can imagine that on looking at my pathology report the RT team would have thought, well if there was some PCa by the bladder neck and some in the seminal vesicles, then the area near there is where there might still be some cacner cells to be causing the post surgery recurrence, so that's the area we will target.

Thus:
I think the question you could ask the RT doctors is which area they want to target and what is their reasoning behind hitting that spot as opposed to any other.
They do not just target an area like a sphere near where the prostate was, but actually shape a beam to hit specific areas, as this photo from my blog about my SRT shows:
1.bp.blogspot.com/-P52m7_qWDr8/UFgoOgPZFOI/AAAAAAAAANs/eHAykihwuIY/s1600/SDC10429+-+kopie.jpg

The photo was taken in the RT control room while I was being blasted and if you look in the bottom right hand corner, then you will see a monitor screen with an irregular grey shape on it: that is the very irregular shaped target area.

And, if you're interested in the rest of my blog about having SRT then see:
englishalf.blogspot.nl/2012/09/aprilmayjune-2010-having-rt.html?view=magazine

Alf