Hi, Julie. If you're considering radiation there is a twist on the suggestions you have been given so far that you may wish to check out on your own. In June I received stereotactic body radiation (SBRT) via the CyberKnife system to treat my 3+3=6, T1c, 1 of 12 cores positive with 15% involvement PCa. SBRT is similar to IMRT and different at the same time. SBRT delivers a hypofractionated dose to the prostate that achieves a biological equivelent dosage of about
95 Gy. I received five fractions (five sessions) of treatment each about
45 minutes in length. The SBRT delivery systems use hundreds of shaped radiation beams to deliver an extremely accurate dosage to the prostate while minimizing radiation to surrounding organs and tissue. A big advantage of CK is that it has the ability to track prostate movement in real time and make adjustments to dosage. Two of the most popular delivery systems for SBRT are CyberKnife and Varian. IMRT typically adjusts for prostate position once a session. Three months out from treatment I have had zero side effects and my PSA has dropped to 1.35. A variation on SBRT which might be appropriate for a Gleason 7 is a combination of IMRT with a SBRT boost which is designed to replace the dosage you would receive from seeds. My radiologist indicated to me that they do this quite frequently with excellent resuls. Yet another procedure you may wish to consider is HDR (high dose rate) brachy with MRT. With HDR they insert radioactive wires into the prostate for pre-determined periods of time to deliver high dosage internally to the prostate. I don't know if the size of your husband's prostate would be an issue there or not but HDR with IMRT has an excellent success rate with relatively low incidence of side effects.
A couple of papers you might wish to look at:
This is the latest paper on what CyberKnife SBRT does: http://www.tcrt.org///mc_images/category/4309/04-katz_tcrt_9_5.pdf
This is a study out of Georgetown where they are using a CK boost with IMRT:
Monday, 27 September 2010
Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.
Clinical data suggest that large radiation fractions are biologically superior to smaller fraction sizes in prostate cancer radiotherapy. The CyberKnife is an appealing delivery system for hypofractionated radiosurgery due to its ability to deliver highly conformal radiation and to track and adjust for prostate motion in real-time. We report our early experience using the CyberKnife to deliver a hypofractionated stereotactic body radiation therapy (SBRT) boost to patients with intermediate- to high-risk prostate cancer. Twenty-four patients were treated with hypofractionated SBRT and supplemental external radiation therapy plus or minus androgen deprivation therapy (ADT). Patients were treated with SBRT to a dose of 19.5 Gy in 3 fractions followed by intensity modulated radiation therapy (IMRT) to a dose of 50.4 Gy in 28 fractions. Quality of life data were collected with American Urological Association (AUA) symptom score and Expanded Prostate Cancer Index Composite (EPIC) questionnaires before and after treatment. PSA responses were monitored; acute urinary and rectal toxicities were assessed using Common Toxicity Criteria (CTC) v3. All 24 patients completed the planned treatment with an average follow-up of 9.3 months. For patients who did not receive ADT, the median pre-treatment PSA was 10.6 ng/ml and decreased in all patients to a median of 1.5 ng/ml by 6 months post-treatment. Acute effects associated with treatment included Grade 2 urinary and gastrointestinal toxicity but no patient experienced acute Grade 3 or greater toxicity. AUA and EPIC scores returned to baseline by six months post-treatment. Hypofractionated SBRT combined with IMRT offers radiobiological benefits of a large fraction boost for dose escalation and is a well tolerated treatment option for men with intermediate- to high-risk prostate cancer. Early results are encouraging with biochemical response and acceptable toxicity. These data provide a basis for the design of a phase II clinical trial.
Oermann EK, Slack RS, Hanscom HN, Lei S, Suy S, Park HU, Kim JS, Sherer BA, Collins BT, Satinsky AN, Harter KW, Batipps GP, Constantinople NL, Dejter SW, Maxted WC, Regan JB, Pahira JJ, McGeagh KG, Jha RC, Dawson NA, Dritschilo A, Lynch JH, Collins SP.
Reference: Technol Cancer Res Treat. 2010 Oct;9(5):453-62.
Good luck to you as you sort out your many options.
Dx: March 2010
PSA @ Dx: 4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason: 3+3=6 (confirmed by second pathologist)
Biopsy: 1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
Bone scan and chest x-rays: Negative
Prostate Volume: 47 cc
PSA Velocity: 0.19 ng/ml/yr
PSA Density: 0.092 ng/ml/ccm
PSA Doubling Time: > 10 Years
Treatment Decision: CyberKnife radiation treatment in June 2010. Side effects: None