The concept of radiation is fairly simple: The higher the dose and the more accurrately it is delivered will result in greater effectiveness and less side affects. The issue is how to deliver the dose. It doesn't matter if it's proton, photon, fractionated, seeds or X ray, the output energy is the same, measured in greys. More greys mean more killing power, but also more side affects to adjcent organs.
The older ERBT was about
61 gy and resulted in a lot of reoccurrances. It was found that at least 81gy needed to be given. Cyberknife, HDR Brachy, IGRT are all different ways of delivering the energy dose. Any improvements in accurracy of getting the dose to go exactly where it is intended is always better.
The reason that Brachy/IMRT combination is used is that a dose of up to 150gy can be safely given. An IMRT or Proton dose that high would fry all the surrounding area.
It's all about
acccurracy and energy dose, the more accurrate, the higher the dose that can be safely given, and the higher the dose the better killing power.
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.