An update for those who are interested:
Unless something changes my mind, I'll be starting a course of 39 fractions 1.8 Gy (70.2 Gy total) at UCSF in early January and I will not be combining it with ADT. The hope is that my PCa is still localized and radio-sensitive. I understand that my odds are not great and I will have to live with the fact that my slight recovery from nearly total ED may be over.
Despite my low PORTOS score, my radiation oncologist clarified in followup communications that he does, in fact, recommend SRT--something that wasn't completely clear in our face-to-face encounter. I sent my records to Johns Hopkins for a medical second opinion (MSO). Just unwrapped that today and found that it agrees with my RO's recommendation of SRT. The UCSF doc is not encouraging me to combine ADT with the SRT, because (as I think I explained earlier in this thread) he believes I am not likely to derive enough additional benefit from the concurrent ADT to outweigh the risk of the side effects. JH just says, given my overall excellent health and prostate pathology, they would recommend "consideration" of ADT during RT. I am inclined to trust my RO's advice on this although I confess that my fear of ADT plays a role.
For the science buffs, the PORTOS score is explained by Allen in depth but in (mostly?) lay terms here
. The PORTOS score is an exciting new development (although it brought unwelcome news in my case). However, because PORTOS is in the subject line and others may happen upon this thread as PORTOS scores become more widely reported, I will pass on a few caveats. The study published in Lancet Oncology regarding this genomic signature has some limitations. Among them, the researchers were unable to capture the time between prostatectomy and salvage radiation, PSA level when initiating SRT, PSA doubling time, post-surgery PSA nadir, and positive margin status (or Gleason grade at the margin). In addition, it has not been validated by other researchers yet. If I were to take it as a final word, I would not be doing SRT.
One thing that differed slightly in my RO's analysis and JH's is that JH identified my rapid PSA doubling time (about
3.5 months) as a factor weighing in favor of salvage treatment. My RO did not even think that a meaningful doubling time could be calculated when my PSA was still so low. However, my February to December PSA scores followed a very regular doubling pattern (linear on a logarithmic scale). No "bouncing around."
In another thread
, Tall Allen mentioned that Dr. King is already routinely delivering 72 Gy (not 70.2 Gy) and MSK may be doing so for SRT as indications are that dosage escalation may correlate with greater chance of cure. Can anyone confirm this about
MSK? I'm planning to forward Dr. King's study to my RO and would like to pass on accurate info about
other ROs who have expanded the envelope.
Dx 2/1/15 (age 65)
8/14 PSA 6.4; 2/15 PSA 5.45 (8% free); DRE+
Bx 1/26/15 8/12 cores; 3 cores G7 (3+4); 5 cores G6 (3+3)
RALP (UCSF) 4/8/15; nerves spared; sling made from vas
Pathology: G7 (3+4, tertiary 5); ECE-, SM-, LN-, SV-; PNI+
Decipher: 6.6% 5-yr metastasis; 6.3% 10-yr PCa mortality; PORTOS low
PSA 5/15, 8/15, 11/15: <0.015; 2/16 .031; 5/16 .053; 8/16 .107; 9/16 .129; 12/16 .199
10/16 Ga68-PSMA PET/MRI: clear