Gleason 9 PSA 14 Advice

vendetta said:

Thank You

Thanks VGama for the information, I will pass all of this along to my father. He is quite worried about the side effects that you mentioned but will endure them he said to fight PCa. We were not told of anemia being a possible side effect, what do "most" people do to combat this? Supplementation? Diet?

We were not given specifics regarding the Gys, but Dr. Spratt did mention that it is a higher dose than conventional, and therefore can be completed in half the time as conventional. I can ask about the Gys at our next consult/prep meeting. I do not know if the lymph nodes will be included, I will inquire about that as well.

I am also going to inquire about SpaceOAR hydrogel to see if they think it would be appropriate for my father's treatment plan. I do know that UofM is one of the clinics that offer this pre-treatment to minimize rectal side effects.

I will say that UofM Rogel Cancer Center has been a breath of fresh air. They seem to be very transparent, love questions, have empathy, and come across as extremely knowledgeable. If anyone in this forum is considering them, I would say at least to give them a shot for a second opinion as my father did.

I will do anything for my parents, they raised and tolerated me and made sure I could survive in this world. It is the least I could do for them. These past several weeks have really made me think about life and what I have accomplished. If I had to do it all over again, I would be an anti-cancer researcher. I'm too old for that now, but meeting these all-star doctors that are my age (I'm in my mid 40s) or about  5-10 years younger make me really proud of them.

Thanks again to you and everyone here for this wonderful source of information.

V,

Like Vasco, I would say that your father's plan is very, very good.  You obviously chose a winner in Rogel CC.

From the description of the IMRT you provide, they are using the SMART radiation delivery protocol on him (simultaneous modulated accelerated RT).  This allows higher dosing from a fractionated RT machine; it is sort of a half-way system, between conventional fractionated RT and SBRT -- usually dubbed Cyberknife or Varian True Beam by the manufacturers.  But SBRT (Cyberknife) is not ordinarily employed into a field of unknown parameters, although I have read that this is being researched.

Radiation dose, in Gray (Gr) from SMART is usually between 70-76 Gr.  The doctor can tell you exactly. Mainstream IMRT is usually 76 Gr, or close to it.  Mainstream IMRT is usually delivered over around 40 weekdays, with weekends and major holidays off, whereas SBRT can be done in as little as a week. So, you see how SMART in-effect 'splits the difference' in average delivery time.

There is ANOTHER acronym for IMRT SMART, which is syncronized moving aperture RT, which basically sounds like an early term for IGRT, but I am not certain.  Modern RT is routinely gated for breathing and even bowel gasses today.  Advances in RT delivery are improving at a rapid pace.

Anemia in cancers is usually caused by problems in the bone marrow, which I learned during lymphoma, but there are several types of anemia.  It is usually managable via infusion iron IV or other drugs.  They will monitor him closely for anemia and liver enzyme swings.   Liver results can swing wildly during almost all forms of cancer treatment, especially chemo.  Doctors know to watch this, but usually they are willing to let values drift very high to allow strong drug effectiveness agains the cancer.  During chemo my AST AGT levels went to 2.5 times normal, but the doctors said to ignore it, and that they would drift back down later, and they were correct. 

Vasco is an absolute wizard at hormonal therapy, which I know nothing regarding.  Several other guys are very knowledgable in it as well.  The doctors are juggling numerous balls in your father's case, which is why their yachts are large enough for private helicopters, I suppose,

max

vendetta said:

Thanks Again

Excellent info, Max, thank you. Does this mean they will be checking his blood during RT? Is that done weekly? Daily? I assume we don't need to ask for this, that it should just be done?

V,

I know that when on chemo, CBC and metabolic profile is drawn a few days before each infusion, to determnine if the patient is capable of getting the next infusion. In most chemos, a cycle requires an infusion between (on average) once every ten days to once every three weeks.  I am unsure of the protocol for radiation, but I would guess that he will have blood draws at least weekly, since he will be going five times a week.   Very likely, his blood draws will happen automatically, since the oncologists must excersie due caution for side effects or toxicity.  Almost all oncologists are also Board Certified internal medicine doctors.  But I would ask the doctors directly anyway.

max

Yes, I agree with Eric suggestion. Your dad should check bone health because of the effects of the hormonal treatment that he may follow during 24 months. Many of us PCa patients have osteopenia/osteoporosis without knowing, and DEXA scans are never requested by doctors unless one suddenly breaks a bone for no reason.
Aged people in particular are subjective to bone loss. Oncologists typically add to the ADT protocol bisphosphanates like Fosamax or Prolia when the patient shows advanced case of osteoporosis.

Regarding the anemia issue, for the moment you can look into diets that may help preventing a future occurrence. Surely some diets may have preferences than others in those getting radiotherapy. The colon lining is going to be affected leading to moments of diarrhea. You may get ideas on diets from his doctor. He may have to substitute his glass of beer by a glass of water.

Best,

VG