Recent discussion with a colleague about "escalating local therapy and de-escalating systemic therapy when aiming for cure of a localised cancer (vice versa for metastatic ones)" motivated by your writings. Thank you Dr Storey.
My husband was treated last Fall with 28 proton radiation treatments of the prostate only at Mayo (Phoenix), is on Orgovyx for at least two years and Abiraterone/Prednisone for two years. Cancer localized per MRI and PSMA/PET scan
Gleason 9, 8 out 20 cores had cancer, PSA 46.6. I believe the Stampede trial was the inspiration for the current treatment plan.
It was not recommended to have radiation of the nodes/pelvis.
Is another look at treatment plan warranted?
He will be 74 in a few months...quality of life is a concern ...he has coronary artery disease, chronic fatigue syndrome....previous history of bladder cancer (2020)
Thanks for reading. Stay the course. Don't look back - overall plan is great. PSA is quite high with Gleason 9. This is more for earlier "high risk" disease. Even though I wrote this (and practice like this), I would treat your husband with at least 18-24 months of ADT - likely strongly rec 2 yrs. Not medical advise - my email is on this site - as a friend, I'm happy to discuss - just reach out with contact info. If you wanted something more formal - I'm easy to find I think in OKC. Take care.
It's hard not to look back, for instance should he have had whole pelvic radiation, Brachytherapy boost etc.
It is deeply reassuring to receive your feedback regarding length of time for ADT. His quality of life is poor currently, but we are hoping that his treatment will be curative and he will have many years left.
Thanks for talking about what I, as an over-researched, under(never !) treated Gleason 4+5 ( < 10% one core of 14 fusion biopsy) have wondered. A whole story of why I now question the whole concept of health "care"...... a long story, and I may well die an earlier than necessary death because of it. But on topic, any comments about this study?
When I look at it, my thoughts are......why not 10-12 months ADT.....is the marginal "curative" benefit in going from 10-12 months to 18, 24, etc worth the additional duration of ADT life quality deterioration?
I think my urologist and RO are good people, and perhaps very competent in their technical skills...but they perhaps are just victims of assembly line "care" and all those times pressures......."care" seems to have been minimized....... "care" takes time they don't have/aren't allowed?
PSA now 12....8 ,30 months ago...PSMA PET in 3 days has me terrified of fatal news of course!!! IF somehow luck out and still qualify for prostate RT or WPRT, how do I find an RT who will take an hour to SERIOUSLY consider my concerns and thought process about this dire predicament...fear of PCa death with no treatment vs fear of some possible horrible SEs with SOC RT......with BPH, urinary and bowel issues entering treatment?????
Interesting paper. Thanks for sharing it. 12 months ADT is near the flat part of the curve...no need to go longer than that. I was hoping to see support for 6 months, as Dr. Storey suggests.
Thanks for reading - that is basically a "formal" look of the data I covered above in a narrative - same issues - same problem - old techniques are going to over estimate benefit. You should be able to get someone to treat for 6-12 months with radiotherapy - point them to this article. Many just worry about legal issues in US market I think. Hopefully your scan is clear - odds are it will be - PSA doubling time well >30 months. I'm in OKC - happy to help find you someone in your area regionally.
Thanks Dr. Mark !! You seem to be a remarkable and unusual person in your field...Few Docs would ever respond to such an unsolicited patient communication. Right now my coverage is Kaiser, and you know how that works I'm sure..... I'd need to sign up for Medicare B and supplement to have coverage for other Docs. Alost impossible to find someone who would treat me the way I would want to treat patients...... had I unimaginably become a Doc! I would never dream of asking you to spend valuable time helping me locate the right RO for me...... if you already have an idea of such a Doc, of course that would be great! I suppose I could just fork over $500(enuf?) to schedule a visit with him/her. Oh yes, I'm in Portland OR.....met with Kaiser RO Dr. Nautiyal 2 1/2 years ago, and a PSMA PET 2 years ago......I had to ask for it?????? For all I know, Dr. Nautiyal is the most proficient RO here....difficult to explain my mixed feelings?? He was not willing to discuss brachy boost for a Gleason 9 patient? Sorry......I go on.......blah blah blah!!
Thanks again Dr. Storey.....those are some lucky patients in OKC.........and happy about the new version of the Thunder!!!
Dale
P.S. Point to your article, the one I linked....or both?? I would just expect prostate ROs had read the Consortium study????
I don't know anyone up in Portland (looked yesterday around a bit) - I'd encourage you to go back to Dr. Nautiyal and ask about getting started with radiotherapy and ADT and wanting to stop the ADT early if 1) you don't tolerate them (some men do fine with them) and 2) your PSA gets really low in the 6-12 months following treatment. I'd guess, within that framework, most MDs will work with you. Best of luck.
Gleason 4+5( 1 core of total 18 , < 10% in that one core), negative PSMA PET for nodes or distant metastases. Had EBRT 28 sessions with focal boost to PIRADS 5 area and WPRT, adjuvant ADT concurrently with EBRT, 18 mo. duration. PSA 3 months post RT was 0.02 in September. T VERY low. Experiencing mild ankle edema, bothersome sleeptime hot flashes, sudden daytime hot flashes , then chilly, hot again, etc. Lifetime chronic facial skin condition seems to have worsened....immune system? Very itchy hands and forearms....old age (76), ADT, or both?
I will conclude 12 mo of ADT by April-May......3 monthi injection coming up in mid January.
With above in mind, is there a definitve answer re the question of ADT duration for someone with my diagnostics? Current MO seems to believe anyone with any 5 should have the longer the better!! But, my PSA 0.02 just 3 months after completing RT seems reassuring that longer duration might not be needed?
Glad the PSA went very low very early - I personally believe that grants some extra flexibility. There is no "definitive" answer - ie, we have never tested 12 months vs. 18-24 months in good responders (very few MDs probably even aware of 6 month PSA kinetic data). Standard of care is 18-36 months. My personal opinion max would be 18 months. My guess is very little absolute difference in stopping them at 12 months vs. 18 months but that is opinion - risk / benefit discussion with your MD there - ADT can mess with a lot of stuff. Obviously on internet - opinion, not medical advice. A trial just started in India last yr looking at 1 yr vs. 2 yrs but it won't be complete until around 2030.
My husband was treated last Fall with 28 proton radiation treatments of the prostate only at Mayo (Phoenix), is on Orgovyx for at least two years and Abiraterone/Prednisone for two years. Cancer localized per MRI and PSMA/PET scan
Gleason 9, 8 out 20 cores had cancer, PSA 46.6. I believe the Stampede trial was the inspiration for the current treatment plan.
It was not recommended to have radiation of the nodes/pelvis.
Is another look at treatment plan warranted?
He will be 74 in a few months...quality of life is a concern ...he has coronary artery disease, chronic fatigue syndrome....previous history of bladder cancer (2020)
Recent discussion with a colleague about "escalating local therapy and de-escalating systemic therapy when aiming for cure of a localised cancer (vice versa for metastatic ones)" motivated by your writings. Thank you Dr Storey.
Interesting...I'll share with my husband.
My husband was treated last Fall with 28 proton radiation treatments of the prostate only at Mayo (Phoenix), is on Orgovyx for at least two years and Abiraterone/Prednisone for two years. Cancer localized per MRI and PSMA/PET scan
Gleason 9, 8 out 20 cores had cancer, PSA 46.6. I believe the Stampede trial was the inspiration for the current treatment plan.
It was not recommended to have radiation of the nodes/pelvis.
Is another look at treatment plan warranted?
He will be 74 in a few months...quality of life is a concern ...he has coronary artery disease, chronic fatigue syndrome....previous history of bladder cancer (2020)
Any feedback appreciated!
Thanks for reading. Stay the course. Don't look back - overall plan is great. PSA is quite high with Gleason 9. This is more for earlier "high risk" disease. Even though I wrote this (and practice like this), I would treat your husband with at least 18-24 months of ADT - likely strongly rec 2 yrs. Not medical advise - my email is on this site - as a friend, I'm happy to discuss - just reach out with contact info. If you wanted something more formal - I'm easy to find I think in OKC. Take care.
Thanks so much for responding!
It's hard not to look back, for instance should he have had whole pelvic radiation, Brachytherapy boost etc.
It is deeply reassuring to receive your feedback regarding length of time for ADT. His quality of life is poor currently, but we are hoping that his treatment will be curative and he will have many years left.
Best regards,
Telia
Thanks for talking about what I, as an over-researched, under(never !) treated Gleason 4+5 ( < 10% one core of 14 fusion biopsy) have wondered. A whole story of why I now question the whole concept of health "care"...... a long story, and I may well die an earlier than necessary death because of it. But on topic, any comments about this study?
https://www.urotoday.com/conference-highlights/astro-2022/140316-astro-2022-optimal-duration-of-androgen-deprivation-therapy-adt-with-definitive-radiotherapy-for-prostate-cancer-an-individual-patient-data-ipd-meta-analysis-from-the-international-marcap-consortium.html
When I look at it, my thoughts are......why not 10-12 months ADT.....is the marginal "curative" benefit in going from 10-12 months to 18, 24, etc worth the additional duration of ADT life quality deterioration?
I think my urologist and RO are good people, and perhaps very competent in their technical skills...but they perhaps are just victims of assembly line "care" and all those times pressures......."care" seems to have been minimized....... "care" takes time they don't have/aren't allowed?
PSA now 12....8 ,30 months ago...PSMA PET in 3 days has me terrified of fatal news of course!!! IF somehow luck out and still qualify for prostate RT or WPRT, how do I find an RT who will take an hour to SERIOUSLY consider my concerns and thought process about this dire predicament...fear of PCa death with no treatment vs fear of some possible horrible SEs with SOC RT......with BPH, urinary and bowel issues entering treatment?????
Interesting paper. Thanks for sharing it. 12 months ADT is near the flat part of the curve...no need to go longer than that. I was hoping to see support for 6 months, as Dr. Storey suggests.
Again though - old data is used. Newer - higher cure data will push this earlier and earlier.
Thanks for reading - that is basically a "formal" look of the data I covered above in a narrative - same issues - same problem - old techniques are going to over estimate benefit. You should be able to get someone to treat for 6-12 months with radiotherapy - point them to this article. Many just worry about legal issues in US market I think. Hopefully your scan is clear - odds are it will be - PSA doubling time well >30 months. I'm in OKC - happy to help find you someone in your area regionally.
Thanks Dr. Mark !! You seem to be a remarkable and unusual person in your field...Few Docs would ever respond to such an unsolicited patient communication. Right now my coverage is Kaiser, and you know how that works I'm sure..... I'd need to sign up for Medicare B and supplement to have coverage for other Docs. Alost impossible to find someone who would treat me the way I would want to treat patients...... had I unimaginably become a Doc! I would never dream of asking you to spend valuable time helping me locate the right RO for me...... if you already have an idea of such a Doc, of course that would be great! I suppose I could just fork over $500(enuf?) to schedule a visit with him/her. Oh yes, I'm in Portland OR.....met with Kaiser RO Dr. Nautiyal 2 1/2 years ago, and a PSMA PET 2 years ago......I had to ask for it?????? For all I know, Dr. Nautiyal is the most proficient RO here....difficult to explain my mixed feelings?? He was not willing to discuss brachy boost for a Gleason 9 patient? Sorry......I go on.......blah blah blah!!
Thanks again Dr. Storey.....those are some lucky patients in OKC.........and happy about the new version of the Thunder!!!
Dale
P.S. Point to your article, the one I linked....or both?? I would just expect prostate ROs had read the Consortium study????
I don't know anyone up in Portland (looked yesterday around a bit) - I'd encourage you to go back to Dr. Nautiyal and ask about getting started with radiotherapy and ADT and wanting to stop the ADT early if 1) you don't tolerate them (some men do fine with them) and 2) your PSA gets really low in the 6-12 months following treatment. I'd guess, within that framework, most MDs will work with you. Best of luck.
Hi -
Gleason 4+5( 1 core of total 18 , < 10% in that one core), negative PSMA PET for nodes or distant metastases. Had EBRT 28 sessions with focal boost to PIRADS 5 area and WPRT, adjuvant ADT concurrently with EBRT, 18 mo. duration. PSA 3 months post RT was 0.02 in September. T VERY low. Experiencing mild ankle edema, bothersome sleeptime hot flashes, sudden daytime hot flashes , then chilly, hot again, etc. Lifetime chronic facial skin condition seems to have worsened....immune system? Very itchy hands and forearms....old age (76), ADT, or both?
I will conclude 12 mo of ADT by April-May......3 monthi injection coming up in mid January.
With above in mind, is there a definitve answer re the question of ADT duration for someone with my diagnostics? Current MO seems to believe anyone with any 5 should have the longer the better!! But, my PSA 0.02 just 3 months after completing RT seems reassuring that longer duration might not be needed?
Glad the PSA went very low very early - I personally believe that grants some extra flexibility. There is no "definitive" answer - ie, we have never tested 12 months vs. 18-24 months in good responders (very few MDs probably even aware of 6 month PSA kinetic data). Standard of care is 18-36 months. My personal opinion max would be 18 months. My guess is very little absolute difference in stopping them at 12 months vs. 18 months but that is opinion - risk / benefit discussion with your MD there - ADT can mess with a lot of stuff. Obviously on internet - opinion, not medical advice. A trial just started in India last yr looking at 1 yr vs. 2 yrs but it won't be complete until around 2030.
Interesting...I'll share with my husband.
My husband was treated last Fall with 28 proton radiation treatments of the prostate only at Mayo (Phoenix), is on Orgovyx for at least two years and Abiraterone/Prednisone for two years. Cancer localized per MRI and PSMA/PET scan
Gleason 9, 8 out 20 cores had cancer, PSA 46.6. I believe the Stampede trial was the inspiration for the current treatment plan.
It was not recommended to have radiation of the nodes/pelvis.
Is another look at treatment plan warranted?
He will be 74 in a few months...quality of life is a concern ...he has coronary artery disease, chronic fatigue syndrome....previous history of bladder cancer (2020)
Any feedback appreciated!