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Jerome J. Spunberg, M.D.
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   Posted 11/16/2006 7:06 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Hormonal therapy up front would certainly be a reasonable option as it would at least delay matters for up to several years. There is nothing wrong with considering IMRT for 5 weeks and CK as a boost as an alternative to 8+ weeks of IMRT either. Tough call and an individual one.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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mauiman
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   Posted 11/17/2006 6:15 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Thank you so much for your response. The fact that you and other doctors do this as volunteers is a real testament to each of you. Are you suggesting radiation OR Hormones? or are you suggesting BOTH? Our doctor has suggested 6 months of hormones on top of the radiation? We are afraid that might be too much for him and are particularly concerned about the impact on the mind if we try hormones.

We live in Stamford, CT - do you know how I can find a CK facility in our area?
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mauiman
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   Posted 11/17/2006 6:20 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Thank you so much for volunteering and providing this response. This information is extremely helpful for me and my family.
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Jerome J. Spunberg, M.D.
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   Posted 11/17/2006 7:29 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
All the CK facilities are listed by state at www.accuray.com and you can pick up near you to evaluate his case. I think that either hormonal therapy or radiation therapy alone would be sufficient, and would probably not plan on doing both. The reason for considering hormonal therapy at all was the high Gleason's score.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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Donald B. Fuller, M.D.
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   Posted 11/17/2006 4:41 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Agree - Radiotherapy without hormonal therapy is very reasonable (high dose IMRT or combined forms such as CK + IMRT - as discussed by other MDs) -

High Gleason score in the absence of other risk factors is a questionable indication for hormonal therapy. Most of the literature indicating benefit of hormonal therapy added to radiotherapy has been derived from patients with advanced tumors, treated with various forms of antiquated, underpowered, radiotherapy (i.e. - "pre-IMRT"). If you restrict the literature analysis to contemporary "high powered" forms of radiotherapy, a beneficial effect of hormonal therapy is far more difficult to prove or even suggest.

If you are still contemplating CK monotherapy, you could have the pathology slides reviewed by an "expert" and see if they downgrade to a Gleason 7 or less, which might cause him to be eligible for some of the CK monotherapy protocols. There is some subjectivity to Gleason scoring.

Donald B. Fuller, MD
Radiation Oncologist
San Diego CyberKnife Center
5395 Ruffin Rd
Suite 103
San Diego, CA
92123
858-505-4100
www.sdcyberknife.com

Radiation Oncologist
Radiation Medical Group
2466 First Ave
San Diego, CA 92101
619-230-0400
www.rmgmed.com
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Jerome J. Spunberg, M.D.
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   Posted 11/17/2006 7:55 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
I like your last point about the path review.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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radsrus
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   Posted 11/18/2006 4:54 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
We are also not huge fans of hormonal therapy except in the setting of recurrent/metastatic disease. Patients really do not feel well on Lupron or Zoladex. The only reason I would use it is if he did not want definitive therapy and there was evidence of disease progression. I think there is reason to be very concerned about the Gleason score, and we would favor treatment, but I think that there might be times I would not treat after looking at his entire medical history and current status.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

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Jerome J. Spunberg, M.D.
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   Posted 11/18/2006 8:19 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
It depends upon his prognosis re: the other medical problems as to whether treatment would be beneficial.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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mauiman
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   Posted 11/19/2006 6:20 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Again - thanks so much to each of you. You really helped bring a lot of clarity to our issue. I am overwhelmed by your responsiveness.
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Jerome J. Spunberg, M.D.
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Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Feb 2006
Total Posts : 4214
 
   Posted 11/19/2006 9:44 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
I am interested to hear what you decide to do. Let us know.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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