Do you dose escalate a patient with high risk prostate cancer who refuses ADT due to potential side effects?

Topics: Radiation Oncology • Genitourinary Cancers

If an otherwise healthy male patient in his 70s has Gleason 4+4 disease in 7/12 cores and left sided internal iliac nodes, but refuses any form of endocrine therapy or ADT due to potential side effects, how would you choose to treat the patient? Would you dose-escalate with RT, and if so, what volumes would you take to what dose?

Answer from: Radiation Oncologist at Academic Institution

I would treat the elective pelvis to around 50 Gy with a simultaneous boost to the LN to as high as tolerable based on proximity to the bowel. The prostate should be taken to normal dose-escalated levels depending on your fractionation, and you can add a microboost to a DIL. I generally do not add a...

Comments

Radiation Oncologist at Kansas City VA Medical Center
Agree.

Answer from: Radiation Oncologist at Academic Institution

I would treat with standard options of definitive EBRT to prostate and gross node, as feasible based on location and OAR tolerance, along with elective dosing to pelvic nodal basins up to likely the aortic bifurcation. I would not escalate further than normal EBRT doses. Consideration could b...

Answer from: Radiation Oncologist at Community Practice

First, I'd get a PSMA PET scan to check for bony mets, and assuming it was negative, would try again to convince the patient to take at least a short course of androgen ablation. Assuming he continued to refuse androgen ablation, I'd take the prostate and involved nodes to 70 @ 2.5/d, with the clin...

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Radiation Oncologist at Northeast Georgia Medical Center
Brachytherapy boost to prostate and proximal semin...

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