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Just when I thought all the necessary decisions had been made- this falls on me:
Oncologist started me on hormone therapy and sent me for IMRT of the whole pelvic area, while the radiologist wants to blast only the prostate alone.
Oncologist says: better survival rate
Radiologist says: faulty study, no statistical basis, but certain collateral damage and associated side effects
I don't have faith in either of them.
open to advice...
Background: 56 years old, diagnosed 12/07, PSA 23, gleason 4+5=9 in most of all 6 cores, first Zoladex implant 1 1/2 months ago.
I have done a great deal of reading on this issue.
Early studies showed "whole pelvic" radiation confered no significant benefit.
Therefore there are some doctors that do not subscribe to it.
However, those studies are now considered to be flawed.
There was a more recent study, I believe it was done by a Dr Roach et al.
RTOG 9413? maybe... can't remember.
The Roach study seems to be generally accepted by radiation oncologists as the basis for current treatment guidelines.
It had patients in four different groups to evaluate Prostate only vs Whole Pelvic and also neoadjuvant hormone therapy vs. adjuvant hormone therapy.
The group that did the best was the whole pelvic with HT prior to and concurrent with radiation.
I can't remember the end points, whether it was biological disease free survival or overall survival but the benefit was about 20%.
I just finished my course of IMRT treatments with 25 whole pelvic sessions and 20 prostate only for a total of 81Gy.
The side effects were quite tolerable and are fast clearing 2 weeks post-treatment.
Bear in mind that whole pelvic radiation is generally reserved for patients that are locally advanced and considered high risk. If there is any reason to believe that the cancer may have migrated to the lymph nodes, then whole pelvic is in order.
In my case, even though there was no concrete evidence, I had some slightly enlarged pelvic nodes and a very high PSA.
That was enough justification in the mind of my doctor.
As to the dose, in radiotherapy it is known that the higher the dose, the better the response.
81Gy may not be necessary in all cases but I had a high volume tumor.
My doctors shrank it with HT and blasted it.
I had a lot of trepidation about the "whole pelvic" and the high dosage because I thought it would make it harder to avoid collateral damage to the bowels and bladder. It seems my fears were unfounded as I had no real problems during the treatment. I am now 15 days post-treatment. Unless some toxicity shows up later, I would say that I tolerated it very well.
The radiation oncologist and his team did a fabulous job.