Decision Process re: radiation Type

vjs

Having just received a diagnosis of prostate cancer, my urologist indicated that radiation is his recommended approach and I'm scheduled to meet with radiation oncologist shortly.

I'm stage 2, with evidence of Cribriform pattern 4 so active surveillance is not an option. Recognizing that everyone is different and individual in their treatment protocol, I'd like any feedback re: which radiation approaches have the least lifestyle side effects.

neilm

I am stage 2 without Cribriform on active surveillance. I have researched for the last year or so my thoughts are this

Seed implants ( highly experienced surgeon ) seem to have positive reviews

Cyberknife which can be done in as little as 5 sessions, I understand leaves odds of ED around 50% for a functional 70 year old man. My experience is that if you need to use Viagra or Cialis you are considered functional

Proton Therapy , not enough data but it appears to be as good as Cyberknife but some indicate lower side effects. If / When I need treatment I would prioritize Proton, Cyberknife, then seed implants.

I am not a physician so these are all a layman's thoughts. I would consider with your physician whether intraductal carcinoma was part of your diagnosis. Some commentary regarding IC on this link , one member in this group ( Steve1961) has very strong opinions and experience with Cribriform. Just some items for research, find your best treatment with the help of your physician, best of luck!

https://pubmed.ncbi.nlm.nih.gov/31059665/

vjs

Neilm

Thanks very much for your comments. I appreciate you taking the time to respond.

I do not have any intraductual cancer present.
It seems every type of radiation approach claims in its description to have the least impact on urinary, sexual, or bowel function.

Thanks for the article you sent me; I will read it as well.

I would be interested in Steve 61 views on Cribriform street 4 if I can reach out to him. I will try to do so.

Thanks again

neilm

Here are a couple of resources , PCRI has a ton of helpful you tubes on their channel , Prostate Forum has a great group of recently diagnosed people who meet online. I have found this group very helpful. It’s hard to get time with my urologist, this is a great place to talk it through http://prostateforum.org https://pcri.org/

Clevelandguy

Hi,

Sounds like radiation is a good treatment path as long as you don’t have Intraductual. Just make sure they use the gel between your Rectum and Prostate to absorb the radiation. Proton radiation has a fixed length beam and might not requre the gel. Your Urologist should know what to do.

Dave 3+4

Steve1961

I LEFT YOU A RESPONSE ON YOUR OTHER POST

Old Salt

Here is the conclusion from the paper cited earlier in this thread (thanks neilm):

Conclusions: Cribriform pattern with intraductal carcinoma was associated with adverse outcomes in men with Gleason 7 prostate cancer treated with external beam radiotherapy while cribriform pattern without intraductal carcinoma was not so associated. Future studies may benefit from dichotomizing these 2 histological entities.

Therefore, it's important to find out what kind of cribriform pattern has been identified in patient vjs.

swl1956

I'm wondering if Cribriform is also resistant to focal ablation methods such as HIFU, IRE, Cryo, FLA and the like? Can't seem to find any info regarding this.

There is no reference to intraductal carcinoma on either of my biopsies or the Prolaris test. How does one know if it's present?

Old Salt

https://csn.cancer.org/discussion/comment/1714451#Comment_1714451

Ask your urologist. I am not sure whether the pathologist would have noted, but you can always send your biopsy samples to Johns Hopkins prostate pathology for a second opinion.

https://pathology.jhu.edu/patient-care/second-opinions

neilm

I agree with Old Salt, second opinion is important, especially if you’re not at a center of excellence. It seems to me focal therapies would destroy all living tissue contacted. My question would be could you effectively target the treatment. My impression of focal therapy is that it effectively destroys tissue but precision targeting is an issue and recurrence is high. Tulsa pro with live targeting might be the best of the bunch. Not a doctor here but I think focal married to Cyberknife precision controls someday could be a game changer I don’t think we are there yet.

swl1956

https://csn.cancer.org/discussion/comment/1714455#Comment_1714455

I'm now dealing with a "center of excellence" Fox Chase Cancer Center. This is the second biopsy at two different institutions I've had. A sample was sent out for a Prolaris test on the first one. Nothing indicated about intraductal carcinoma. Fox Chase offers HIFU and Cryotherapy. Both of which are FDA approved and likely covered by insurance. I also really liked the IRE procedure that they had done a study on, but it's not covered by insurance. I too believe Focal treatments will become a game changer especially with better targeting. It's clearly not applicable to all patients, but for those that qualify it seems to drastically lower the side effects risks. I'm close to taking a risk to try Cryo. My Oncologist says I am a good candidate. Even though these focal treatments are not typically recommended as first course of treatment. Many of the Major cancer centers do offer them. MSK, Johns Hopkins, Mayo Clinic, and many others. Obviously they have validity. Some now are using real time MRI imaging. Recurrence rates are higher than whole gland treatments, but you can retreat with focal and still have the options of RP and RT. Seems to me a risk worth taking? At least that what I'm thinking right this moment. I think the bigger risk, is how good are the individuals executing the procedures?

https://www.foxchase.org/clinical-care/conditions/prostate-cancer/treatment/surgery/focal-therapy

swl1956

Great Podcast from Cleveland Clinic

https://my.clevelandclinic.org/podcasts/cancer-advances/exploring-focal-therapies-for-prostate-cancer