I've been through 6 rounds of chemo on have been on HT (Lupron) for 7 months and I'm about to finish up 25 EBRT treatments this Wed. My PSA for my 4+3 has hit a low of .40 and has risen over the last 3 tests to .82. I also have indraductal carcinoma of the prostate (IDC-P) which is very aggressive and classified as a gleason 4/5 disease which is undetectable with PSA tests (it's a watch and wait for mets to show up on scans). My Testosterone has been less than 30 for 8 months so it looks like it's castrate resistant already.

Heres my question...Should I even go through HDR Brachy boost after I finish up with EBRT this wednesday? If my "normal" pca isn't responding then why go through another invasive treatment if nothing else is working?


Thoughts? (My leaning is not to go through it)
Thanks
Todd

Hi Todd, a few thoughts...

In all probability your EBRT plan was designed with the idea that you'd do the brachy boost. Normally, there are more sessions planned (35?) so if you don't do the brachy boost then I think you really need to re-visit the EBRT.

Next, my understanding is that PSA during EBRT is very unreliable since it stirs up so much prostate activity. My MO even stopped testing my PSA during my EBRT. So I don't think you can say at this point that your radiation isn't working. For the same reason, I don't think you can say that your PCa is castrate resistant.

My recommendation would be to huddle with your RO and ask him how he expects your PSA to be reacting at this point and if he'd do the EBRT differently if you don't do the HDR brachy. I also think the biggest question is: is there a chance for a cure? If so, you want to throw everything at it.

Last note: I'm a Gleason 9 and I'm doing fine with EBRT/brachy boost after close to four years.