Abramowitz, Garyi, and Prato

Saw Dr. Abramowitz at Sylvester/UMiami this morning. Strongly recommends starting radiation therapy based on my rising PSA, G8, EPE and positive margin, including whole pelvic nodal RT. 68 Gy in 34 fractions. Says I'm a good candidate for hypofractionated radiation regimen trial, 25 fractions, is making inquiries. Because I want to minimize time away from home in Saipan, I'd be in favor of entering the trial, even knowing there's a heightened risk of SEs. Abramowitz wants to add ADT: Casodex + 6 months Lupron. TrueBeam, with CBCT for image guidance, based on statistically significant better long-term outcomes for G8s with ADT. Wants to do 3T MRI dce dwi and PET CT Axumin before starting therapy, but we're having trouble scheduling them before I leave Florida in 2 weeks. As others have noted, the doctor's scheduler is (almost) as important as the doctor. There's the scheduler who moves mountains to accommodate your needs and apologizes profusely when she's unable to do so; then there's the scheduler whose every look and intonation says, "What makes you think that you're somehow special?" Sylvester-Deerfield, today at least, was blessed with the latter.
Garyi met me at Sylvester as I was finishing up with Abramowitz at the reception desk. He started peppering Abramowitz with questions, which somehow ended up reminding Abramowitz of John Belushi in The Blue Brothers. I'm not sure whether he meant that to be a compliment.
BTW, though Abramowitz is a very congenial and witty fellow, he did give me Blank Face Doctor Look when I asked about cure rates. He put my chances of nonrecurrence after SRT at 50/50 purely by the science and 60/40 if he weights it based on his overall experience of patients with similar pathology to mine.
Went to lunch with Garyi and Ken Prato. A good time was had by all. Garyi recommends I have all my internal organs removed, soaked in pomegranate juice, and then reinstalled in my abdomen in a more aesthetically pleasing pattern. He offers to do this laparoscopically, so long as he doesn't run into too much scar tissue. Prato pretty much just stared at him in amazement while munching on parboiled broccoli. It was a quintessential South Florida experience.
On a very slightly more serious note, thank you Ken and Garyi for helping me get through the day.

I don't remeber what Gary ordered for main course, but your right about dessert! Pie and ice cream, I think. I had a couple of forkfulls, but Ken resisted successfully. For main course, I had the paella. Yum.

Even though I get heat from everyone for eating Broccoli 🙄, I truly enjoyed both lunches (the company, not the lunch, although lunch was good too). Having 2 mini-GFMPH's within a week should get us some kind of prize.

Just so you know, Amar Kishan and Chris King at UCLA have begun their clinical trial of SBRT for salvage. I'll probably blog about it tomorrow - it is not without issues. After several back-and-forth conversations with Dr Kishan, I am distinctly undecided. The issues raised by SBRT are different from those raised by conventional IMRT or even by moderately hypofractionated IMRT. I am unreservedly enthusiastic about your hypofractionated protocol - it sounds excellent in every way.

Wow guys sounds like you had a great day would have loved to been there to have listened to the conversation and the good food!!!

Larry

Allen, can you provide a link to the UWisc study? I looked on your PC blog, but I think all the hypofractionation trials I found were primary tx, intact prostate. Maybe I missed something.