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wanting guidance on ADT/RT

hi all.
my father 69 diagnosed with gleason 9 psa 20.operated but margin is positive and extraprostatic extension on histo report.
now doc wants both EBRT and ADT to be given.
Please opine and guide us.

Re: wanting guidance on ADT/RT

I'm slightly surprised that surgery was undertaken. A Gleason 9 tumour (such as I had - read my rather long story on this site) will require EBRT and ADT. The objective will be to control, not cure the disease. Seven and a half years post diagnosis, I'm still hale and hearty and a couple of years older than your father and hope to last many more years. Do make sure that you have the advice of a good oncologist - much more useful than a surgeon.

Best wishes - OC in England

Re: wanting guidance on ADT/RT

Have you consulted a radiation oncologist? If not, I advise you to do so. It doesn't sound to me like this surgeon knows much about radiation. (Few do.) As of 2009 (the last time I researched this) EBRT would have been appropriate in this situation.

I am a physician survivor diagnosed with a Gleason 9 in 2009. At that time I did a great deal of library research on treating G 9s. My findings then on this subject may still be valid; my findings on primary treatment with radiation still are. But I didn't investigate radiation following failed surgery nearly nearly as deeply as some some other subjects, and I would advise a current opinion on this. It is certainly possible that a better method than simple EBRT has been found. If not, ADT prior to and throughout radiation makes the cancer more susceptible to radiation than without.

I strongly advise you to consult a rad onc at a university hospital. Some other centers can provide equally good information and care, but how is a layman to know which ones? I think it is close to impossible. Thus my recommendation for a university; there you can be sure that the docs know their stuff; if there is good center more convenient to you, they should know about it and be able to direct you.

Brooke Jennings, MD

Re: wanting guidance on ADT/RT

Have you consulted a radiation oncologist? If not, I advise you to do so. It doesn't sound to me like this surgeon knows much about radiation. (Few do.) As of 2009 (the last time I researched this) EBRT would have been appropriate in this situation.

I am a physician survivor diagnosed with a Gleason 9 in 2009. At that time I did a great deal of library research on treating G 9s. My findings then on this subject may still be valid; my findings on primary treatment with radiation still are. But I didn't investigate radiation following failed surgery as deeply as some some other subjects, and I would advise a current opinion on this. It is certainly possible that a better method than simple EBRT has been found. If not, ADT prior to and throughout radiation makes the cancer more susceptible to radiation than without. Given the spread, it might be advisable to continue ADT after that.

I strongly advise you to consult a rad onc at a university hospital. Some other centers can provide equally good information and care, but how is a layman to know which ones? I think it is close to impossible. Thus my recommendation for a university; there you can be sure that the docs know their stuff; if there is good center more convenient to you, they should know about it and be able to direct you.

Brooke Jennings, MD

Re: wanting guidance on ADT/RT

Hi,

I agree with others who have mentioned consulting a good medical oncologist. Based on your ID, if I am not mistaken, I might be able to recommend a few if your are from or around Mumbai.

I am in a similar situation you are in and our urologist, while he mentioned RP in passing, is much more inclined towards neo-adjuvant ADT + IMRT.

In your case, you must assume the condition's systemic and ADT must be administered irrespective of other modes of treatment.

AllTime from India

Re: wanting guidance on ADT/RT

Six months to two years of ADT and 66 Greys of radiation over 33 days seems to be the standard salvage treatment in North America. You don't need a very precise radiation treatment because only the general area where the prostate was, is getting radiated and they don't have a precise location to aim for. It is what I had five years ago at a large prostate cancer center and so far so good.

Re: wanting guidance on ADT/RT

Frank,

Isn't 66 Gy considered less than optimal these days? Most literature now recommends >70 Gy and preferably >75Gy with IMRT / IGRT.

I may be wrong here so would like to hear some more opinions considering that I may undergo RT in about 2 months.

AllTime

Re: wanting guidance on ADT/RT

66 grey for palliation. 70 to 74 grey for curative intent.
best wishes
john

Re: wanting guidance on ADT/RT

John,
I think you meant salvage not palliative. Salvage is done with curative intent too, after a prostatectomy, but is not the primary treatment. They use a little less for salvage because they only need to kill a few remaining cancer cells and not "cook" the whole prostate.

Re: wanting guidance on ADT/RT

Agree Frank, will have to lift my game.
best wishes
john

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