25 instead of 39 IMRT treatments study -U bet I'll tell my doc tomorrow

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 11/16/2009 3:24 PM (GMT -6)   
I just found a reference to a study that was presented to the American Society for Radiation Oncologists (ASTRO) on November 4, 2009. It was conducted at the University of Miami School of Medicine.

http://www.redorbit.com/news/health/1779898/shorter_radiation_course_as_effective_as_standard_therapy_for_prostate/index.html

http://prostatecancerinfolink.net/2009/11/05/short-course-radiation-therapy-for-localized-prostate-cancer-two-new-trial-results/

You can bet I will discuss this when I meet my new RO at MDA tomorrow. Sure would be nice to receive 25 treatments instead of 39, especially going into the holidays. The study indicates that there was no appreciable difference in cancer recurrence after 39 months of the study.

Yee Haa!!

We'll let you know how the conversation goes,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero

Post Edited (Sonny3) : 11/16/2009 1:51:04 PM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 11/16/2009 3:34 PM (GMT -6)   
Was the dose the same in both time periods? The total dose given is more important than the time period in which it is delivered.
I would be hesitant to take a lower dose even though it meant fewer treatments. If they give the same total dose in fewer treatment sessions it might be OK.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 11/16/2009 3:40 PM (GMT -6)   
No John, the total dose was actually higher. What the study seemed to indicate was that the higher dosage could be delivered in a shorter time frame with no appreciable increase in side effects and at no detriment to the long term outcomes.

Now I realize that this study was done on guys that still had prostates, but my questions will be why wouldn't it work for Adjuvant Therapy as well.

It will be an interesting conversation I am sure.

BTW, I added another link to a similar study with a little more detail.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 11/16/2009 3:50 PM (GMT -6)   
John, here is an interesting side note to SRT for me. I plugged in my numbers in the Sloan Nomograms calculator for SRT. Accurately described my situation and computed the doubling times using my two post surgery PSAs (in their calculator).

The only thing I changed was the Gy number for the treatment.

At 66Gy the Progression Free Probability at 6 years was 41%
At 70 Gy it dropped to 36%
And at 80Gy it dropped down to 21%

Now I know almost next to nothing about IMRT so far, but this just doesn't compute to me. Use more radiation and get less longevity. DUH!

What's your take on this one.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 11/16/2009 4:24 PM (GMT -6)   
Sonny, I did the same thing when we thought John was heading for SRT and found that the percentages of disease-free progression dropped at the higher doses. Will be interesting to see what others have to say. The rad onc we had met with as well as our uro/surgeon had indicated a treatment of approximately 6600 rads over 7 weeks but we never got to the point where the rad onc had formulated her precise treatment plan for John.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/16/2009 4:26 PM (GMT -6)   
Sonny, I know you and I have since disucssed this, but please post what you f ind out. I believe you in what it calculated to, but it definitely contradicts what my own doctors said when determining greys for my treatment, and treatments in general.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/16/2009 4:41 PM (GMT -6)   
P.S> There are some at my radiation clinic, that get zapped twice a day, once in the morning, once in the afternoon. It's bad enough going through this once a day, plus the logistics would be hard for a lot of people.

I agree with JohnT, you wouldn't want to short yourself on SRT now that its needed, the number zaps only matters in delivering the correct amount of greys needed to give you your best shot.

I still think 72g is a lot for salvage, but that is what my radiation oncl. calculated for my case.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


riverbend
Regular Member


Date Joined Mar 2009
Total Posts : 39
   Posted 11/16/2009 5:17 PM (GMT -6)   

I did this with Proton radiation at Loma Linda.  I was in a clinical study with 20 sessions instead of the standard 45.  Overall, I received less Gy (60 vs. 81) but I received a higher daily dose (3.0 Gy vs. 1.8).... This is called a hypofractionated dose.  There are studies that seem to indicate that Prostate cancer responds especially well to hypofractionated doses.  This is due to the low alpha-beta ratio of prostate cancer.  I do not claim to understand this, but my doctor at Loma Linda explained it to me in that fashion.  You can also Google "prostate cancer alpha-beta ratio" and find a bit more on the subject....but most of that is over my head.

I'm 4+ months out and my PSA has dropped from 3.0 to 1.0 and I have had no side effects at all.  Of course, the real test will come 5-10-15 years out after the survival data on these clinical trials is analyzed.

For me the hypofractionated trial saved me time away from home...it saved me money (1 month less of housing costs in Loma Linda)....in theory this should help make Proton radiation (and perhaps other radiation) more competitive from a cost standpoint.


Dx T1c in April, 2009 at 45 years old after recent PSA tests ranged from 2.93-3.25
2 of 14 cores positive at 5% and Gleason 3+3... 2 cores taken from a "protuberance" were "ASAP"
Proton radiation at LLMC May-June 2009


riverbend
Regular Member


Date Joined Mar 2009
Total Posts : 39
   Posted 11/16/2009 5:31 PM (GMT -6)   
Of course I quickly posted my reply before reading the links in the original post... Very exciting and promising.  I do however believe that you are incorrect in saying that you will receive more total Gy if you choose the treatment with fewer doses.  And I also think that the statement above that "it's the total amount of Gy that is the most important" is also incorrect.  I bet when you check with your doctor you will find that you would get a higher daily dose, but fewer Gy if you choose the option with fewer total treatments.  Again, as my doc at LLUMC explained it to me: For prostate cancer, 60Gy is EQUAVILENT to 81 Gy when given in hypofractionated doses.  You can imagine that I asked a LOT of questions before I settled on a treatment with a smaller overall dose of radiation.  All my questions were answered to my satisfaction and I am happy that I participated in the study.



Dx T1c in April, 2009 at 45 years old after recent PSA tests ranged from 2.93-3.25
2 of 14 cores positive at 5% and Gleason 3+3... 2 cores taken from a "protuberance" were "ASAP"
Proton radiation at LLMC May-June 2009


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 11/16/2009 5:31 PM (GMT -6)   
RB thanks for the insight. Been looking at stuff like this all day to prepare for my meeting with the RO tomorrow.

I keep seeing TV's Mr. Rogers in my head saying "Can you say hypofractionated". Cracks me up every time I think about it.

Sonny
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