Tall Allen said...
Balladeer- 6 months of HT may be in part due to your having a large prostate that has to be shrunk before the seeds are put in? That doesn't have to be done if he were doing HDR-BT rather than seeds. If you chose EBRT only, you should have at least 18 months of HT starting 2 months before EBRT. Expected urinary side effects are lower with EBRT-only, but so is the expected oncological benefit.
TA - Yes, my RO indicated that my prostate volume (50cc) was near the upper edge of qualifying for LDR-BBT, and that (as you've suggested here), the combined casodex, then lupron treatments should effectively shrink it to a point that would be fully acceptable (maybe 40cc or less?).
However, just to be clear, he indicated that his own internal (institutional) data for such high-risk patients choosing the triple-play (BBT+IMRT+ADT), supported no more than a "total" ADT period of 180-days. That's 1-month of casodex, followed by 2-months of lupron, followed by LDR-BBT at 3-months, followed by IMRT at months 4-5, with continued lupron for only 30-days post-IMRT = 180-days total. He stated that this decision was based upon a 15-year history with 3,000+ patients, and that the data was currently under peer-review for publication in the near future.
That said, it remains unclear to me at this point, why the LDR-BBT phase of the treatment is scheduled to occur 'before' IMRT, rather than 'after' it, and, since I am not a low- or intermediate-risk patient, it also remains unclear to me why the 'LDR' (rather than HDR) approach is being proposed in my case. I hope to get answers to those two questions soon, but the RO is out-of-state and not readily accessible.
Thanks again for your clarification.
Age at Dx: 65 (now 66)
Diagnosis (1/2018): High-Risk PCa
PSA (4/2017): 15
DRE (3x): Nothing found
Biopsy (1/2018): 6/12 cores '+' (5-65%)
GS-9 (Initial): 4+5=9, GS-8 (2nd Opinion): 4+4=8
PSA (3/2018) post-biopsy: 43
CT, Bone & PET Scans: No mets
3T-MRI: 1" dia. nodule right base (no lymph, but r-seminal vesicle involvement)
PSA (6/12/18): 69
ADT/HT: Casodex (6/13/18)
PSA (6/24/18): 34
Post Edited (Balladeer) : 7/14/2018 11:54:13 AM (GMT-6)