Surgery vs Radiation

Vaid

My father is diagnosed with Prostate Cancer,psa 21, Gleason 3+4, all cores on right side positive, no positive cores on left side, extra prostatic extension found. No nodal involvement found in PSMA PET. He underwent a nephro-ureteroctomy surgery 2 years back for a tumour in ureter. Now diagnosed with prostate cancer . We are asked to decide between radiation and surgery for prostate. We consulted a radiation oncologist who suggested 25 sessions of regular image guided radiation for complete prostate plus pelvic lymph nodes .Although we are inclined to do radiation, I am worried about side effects of radiation since lymph nodes will also be treated and since he has a left hip metal prosthesis. Will it increase the side effects? In such cases is surgery a better choice than radiation? Would appreciate any comments on this. Thanks.

Vaid

Just to add, My father is 70 years of age. radiation oncologist recommendation was 25 sessions of regular(not proton) image guided radiation for prostate, seminal vesicles , pelvic lymph nodes and 18months of ADT. He has metallic left hip prosthesis. Will these increase his side effects drastically? Any similar experiences? Is surgery a better option in such cases? Proton therapy is super expensive(10 times) and doctor says it is not going to be of much help to him and won't be able to justify the costs. Thanks.

Vaid

Radiation oncologist also said no rectal spacers will be used since there is an extra prostatic extension. No rectal spacers, radiation for prostate, seminal vesicles, pelvic lymph node radiation and presence of hip prosthesis. Can all these increase his side effects drastically? We are really worried and wondering if surgery is a better option?

VascodaGama

Hi,

In your dad's case with the hip prosthesis, radiation treatment is possible but the radiotherapist must take into account for scatter and backscatter radiation when planing the rads isodose.

As you comment above, various fields of attack will be planed, each with different doses. The direction of the rays in each radiation session can also be done avoiding the metal hip.

I wonder the total grays Gy of the suggested 25 sessions. Typically IMRT delivers 1.8 to 2.0 Gy per session/day but it can be compensated for lower doses. However, the importance is the total dose administered.

In prostate cancer treatments in full IMRT protocols (gland plus lymph nodes) the typical dose is close to 70Gy. Other modalities apply higher doses per session (lesser number of sessions) for a total of 40Gy.

You need to get second opinions from radiotherapists.

Best wishes,

VGama