High-Risk Prostate Cancer: Prostate or Whole Pelvis radiation?
🧠The Cancer Gamble: Precision Strike or Carpet Bomb?
When you’re diagnosed with high-risk prostate cancer, it’s not just the disease you’re up against—it’s a mountain of decisions. Some come fast. Others hit you like a slow-moving truck. This was one of those moments.
A close friend of mine—a Ph.D. pathologist—gave me some early perspective:
“You need to understand your options. Even for high-risk prostate cancer, there are treatments beyond radiation that can work.”
I realized I didn’t need to rush a decision. My androgen deprivation therapy (ADT) was already working. Testosterone was dropping. PSA levels were falling. So, I started seeking more expert opinions.
đź©ş A Second (and Third) Opinion
I got referred to a highly respected medical oncologist. His recommendation?
“You need full pelvic radiation.”
That wasn’t what I was expecting. Then he referred me to a second radiation oncologist, who used a different kind of machine. Now I was more uneasy.
His rationale?
Treat the entire pelvic region, not just the prostate.
Why? Because it only takes one or two rogue cells to migrate through the lymphatic system or bloodstream and start multiplying elsewhere—most likely in the lymph nodes. That’s metastasis. And that’s a whole different battle.
Even though my PSMA PET scan came back negative, no scan is perfect. Micro-metastases can be missed. And when it comes to radiation—it’s a calculated gamble.
🏰 The Fort Analogy
Imagine your prostate is a fort.
- Drop a missile on the fort, and you destroy the enemy (the cancer inside).
- But what if some of the bandits (rogue cancer cells) are already out on patrol?
- If they’re not in the fort anymore, they’re setting up outposts elsewhere—that’s metastasis.
So, the question becomes:
Do you only hit the fort, hoping they’re all inside?
Or do you expand the target area and effectively carpet bomb the surroundings—just in case?
That’s how I started viewing External Beam Radiation Therapy (EBRT)—a bigger blast radius, more coverage. But the idea that one or two cells might have escaped? The odds were low, but that was gnawing at me.
🎯 Weighing Precision vs. Coverage
I reached back out to the CyberKnife facility. I had questions:
- How effective is this treatment for high-risk prostate cancer?
- Should we go beyond the prostate?
- What about side effects and recurrence risk?
They connected me with another radiation oncologist—someone with over 20 years of experience. He was under contract with the CyberKnife facility. His advice?
“Go broader. Full pelvic radiation.”
That stood out. In a healthcare system where medicine is also a business, that kind of honesty mattered.
⚙️ Technology: Does It Matter That Much?
CyberKnife can narrow its radiation beam down to the width of a pencil lead. That’s precise. But my tumor was about 1 cm in diameter, and you always target a margin beyond the tumor.
So how narrow did the beam really need to be?
The ERBT machine I was considering had a minimum beam of around 1 cm anyway—and that’s about the area they planned to hit.
I began to wonder: was there really a clinical advantage to CyberKnife in my case?
đź“Š Guidelines and Gut Checks
The new radiation oncologist I’d been referred to walked me through the treatment guidelines and recurrence risk. It was sobering—but this was my reality now. So what to do?
Neither approach was wrong. Both had merit. But it came down to:
How much of your body do you need to radiate to kill all the cancer?
đź’ˇ Other Opinions, Other Options
Meanwhile, my pathologist friend kept nudging me:
“Western medicine treats cancer very aggressively. The long-term side effects of radiation can seriously affect your quality of life.”
She urged me to explore focal therapies—less aggressive, more targeted treatments. I planned to speak with another top urologist to better understand if these were even viable options.
I knew this much:
I needed to be able to sleep at night knowing I had chosen a treatment I believed would kill every last cancer cell in my body.
⚖️ Final Thoughts: CyberKnife or Carpet Bomb?
By this point, I was leaning away from CyberKnife—and possibly even radiation altogether, especially if a focal treatment could work now and leave radiation as a fallback later.
So it came down to two key questions:
- Do I target just the prostate—or expand treatment to make sure I get any stray cancer cells?
- Do I want to risk side effects now—or save radiation for later if it comes back?
As far as radiation goes, the dilemma—simply put—is this:
🎯 Target a Smaller Area (CyberKnife)
✔️ Lower risk of side effects
❌ Greater risk of missing migrating cancer cells
đź’Ą Go Broader (EBRT)
✔️ Higher odds of eradicating all cancer
❌ Higher risk of long-term side effects
Except it’s not that simple. There’s no guarantee side effects will be better or worse with either treatment. All we have are models and percentages. It might happen to you… or it might not. It’s a gamble.
I’d talk to the new urologist, and then—hopefully—I’d be able to choose my path.
👉 To be continued…
