HD Brachy + EBRT + ADT Anyone with experience to share?

Given that surgery really isn't a good option in your case, there are multiple RT choices still available.  I would not think Brachy would be ideal as it sounds like the cancer is not contained in the prostate is what brachy is most effective at killing.  Cyberknife can radiate around the prostate with precision and real-time imaging during the procedure whereas conventional radiation just hits an entire area which can result in more side effects, especially over time.

Unfortunately, the docs doing conventional radiation, Brachy-therapy and the cyberknife docs don't really play together much so you would have to investigate with different docs most likely.  At least that was my experience.  I had Cyberknife done in April at 53 but only 2 cores and 3+3, 3+4 so much less progression of the disease at time of treatment.

Good Luck with your treatments whichever path you choose.

desperate for hope said:

cyberknife for high risk?

According to information from the company, Cyberknife is not suitable for high risk PCa. http://www.cyberknife.com/uploadedFiles/CyberKnife_Treatments/Prostate/FINAL_CyberKnife _Information_Guide_Prostate_Treatment.pdf

I'm curious-- why do you think surgery isn't a good option? We've been told that there are no studies that compare RP+Adt+RT with HDBrachy+EBRT+ADT. We are still trying to figure it out. Both treatments have been offered. 

My husband is having a cystoscopy to see if the cancer is near the bladder neck. The ultrasound looks suspicious. The Rad Onc said that if it is, surgery is the better option because she couldn't radiate so near to the bladder. 

Thank you for your good wishes!

 

Thanks for article.  I would say that as a stand-alone treatment for advanced PCA that Cyberknife isn't a good option but it is an option in combination with additional treatments which in our case will always likely involve multiple treatments reginmins.  Hormone therapy (ADT) is certainly one of them.  My doctor wanted to use ADT on me but I declined as in my case, the "increase" in projected cure was around 1% so I didn't believe that the additional side effects that I would have to battle were worth another one percent when I was already in the 93-94 percentile. 

I presumed that the side effects and potential complications with surgery when other treatments are known to be required starts to minimize the upside of removing the prostate tho remove the cancer.  That is generally the largest upside with surgery.  If contained within prostate, you have removed the cancer when you remove the prostate.  In this instance, it didn't sound like that was the case. 

That was why I indicated surgery didn't seem like a great option.  I am not a doctor (nor do I play one on TV ) so my comment was just based on the information I had see thus far.   I would think brachy would have same issues as other options in terms of needing additional treatments.  Sorry if I addded confusion.

desperate for hope said:

Cyberknife nearby

Thanks Old Salt. 

I searched and was surprised to find that cyberknife is available at a different hospital but as I wrote above, it doesn't seem to be suitable for high risk, according to the company's specs. 

 

SBRT/CyberKnife may not be suitable as a MONOTHERAPY for high-risk patients, but I suggested that it could be part of a 'triple-play" plan of attack:

SBRT + IMRT + ADT.

But if your radiation oncologist advises that surgery would be preferably because of possible bladder neck toxicity from the radiation, I would follow her advice. We are just bystanders without full knowledge of your husband's situation and without a medical education.

PS: My situation (also high-risk) was close to that of your husband (Gleason = 9 etc) and my (academic, with many publications) radiation oncologist recommended SBRT + IMRT + ADT. But I was 73, which by itself precluded surgery. So, in that context, my status was different from that of your husband.

To answer your question- YES- there have been several studies which compare outcomes of men that have been through the treatments you identified. Two publication websites are journals which publish current data and have been adjudicated for accuracy. 1- The ASTRO journal (American Society of Radiation Oncologists) has published several comprehensive reviews which made significant advancement in treatment recommendations back in June of 2016.  2. Journal of Prostate Cancer Research Foundation, and 3- The National Comprehensive Cancer Network which publishes an easy to use table of suggested therapies, based on results of various tests. An updated NCCN guideline will be published in January of 2017.

My husband ( age 62)  had aggressive PCa,  8 of the 12 cores showed Gleason 8 or 9. He had a 3 pronged therapy. He was in excellent health, muscular and eats a healthy diet. His PCa was confined to the prostate. ADT for 6 months was used to remove testosterone- NO side effects. Next, at 5 months from start of ADT, he had 6 weeks of daily EBRT. 3 months after EBRT he had brachytherapy. Its been 4 years and he is fine, test results are great. Please note, however, that NEW studies show that when PCa is found later in life, 10 year survival is common, even if NOTHING is done. Your radiologist should have all of these studies at his fingertips and should share with you the treatment options based on your husband's test results.  Most alarmists and surgeons instantly promote surgery. This is a false premise that when the prostate is removed all of the cancer goes away.  If you would like the URL's to any of these 2015, 2016 studies, id be happy to send them. Best of luck to your husband.