Witch Doctor 3Dcrt Vs. Imrt?

Witch Doctor:

 My Status:  PSA: 6.0; Gleason: 7 (4X3); Stage: T3A; Biopsy: 8 out of  9 cores positive.

My Selected Treatment: 6 months of Adjuvant Hormone Blockade (daily Casodex and monthy Lupron); 2 months into the AHB I will start 20 treatments of Proton Beam Therapy at Loma Linda targeting the prostate and immediate area followed by 25 treatments of 3DCRT targeting the wider pelvic area.  Total: 81 grys.

Questions:  1.  I know IMRT is a more advanced type of RT, but, in general, what is the difference between the two; and, 2. which would be better to use for the second half of my therapy, i.e. the wider pelvic area?

Thank you for devoting your time and knowledge to this forum.

Oceanman

You should get IMRT to the the pelvic area as well.  IMRT is "more conformal" 3D therapy.  It can be done in the pelvis though it is more work for the Rad Onc.

Interesting they are doing the proton therapy as an upfront boost, currently there is no evidence that is any better than standard therapy.

Giving you six months of ADT is also unusual since you have a high grade tumor and ADT may not affect a certain segment of hormone refractory cells.  If they are doing it to "shrink" the prostate so they can treat less, that is not really proven either and can result in actually missing the tumor.

Getting better dosimetry is desireable up to a point.  If you contrict the dose too much you actually miss the cancer.  No matter how good the technology , you still need a margin of some sort to cover subclinical disease.  It is like a surgeon getting a positive margin if he /she does not remove adequate tissue.  It is good to remove less tissue etc. but only up to a certain ill defined point.