PACE NODES trial

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Hello everyone Wave

My husband was diagnosed with locally advanced prostate cancer Gleason 8 on 20th December. I've put all his stats on my profile (with his permission).

He will be starting radiotherapy in 3 months . He has been offered the chance to go onto the PACE NODES trial which is 5 x stereotactic radiotherapy sessions on prostate /OR prostate and nodes.

We've read all the information but have concerns that as his cancer is high risk is this trial suitable for him as it has previously been trialled on low and intermediate risk Pc?

We are having a phone call about this tomorrow. Our heads are spinning with whether he opts for the tried and tested conventional radiotherapy versus the trial.

  • Thank you Sun with face

Sun with face

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  • Good morning  . From my reading the PACE-C initial results for high risk patients are not due until 2027/8 so the only initial results published are on bladder and bowel toxicity which are showing similar results to the PACE-B trial.

    From my understanding the PACE-NODES trial is randomised to be with or without lymph node treatment so there is a 50% chance that the nodes would not be treated with SBRT so that would be my first question. Another question is what are the effects of SBRT on the bladder neck compared to conventional radiotherapy particularly in terms of long term genitourinary outcomes. 

    From a lay persons point of view you are being asked to choose between having the lymph nodes treated or not with a protocol which might have GU consequences.

    I hope this helps.

  • Thanks v much for your response .We really needed the clarity you've brought. 

    I never thought of asking about the impact of SBRT on the bladder!

    From what I've read, the conventional radiotherapy treatment doesn't treat the lymph nodes either so  one question is:

    Q Is there evidence of cancer spreading to nodes after conventional treatment. 

    The more I've read the information about the trial the more I feel that the big question for my husband is 

    Q Is there a risk in opting for this trial regardless of the possible nodes treatment as there's little information on efficacy of 5 SBRT sessions on high risk Pc , whereas the 20 conventional sessions are proven to be effective.

    I feel it's such a big decision that could have big consequences.

    Sun with face

  • Hi  , it is a dilemma.  The advantage with SABR appears to be that collateral damage is reduced.  PCa is slow growing so if you accept the trial with only the prostate being hit, if it works, you are in a better position.  Obviously if it doesn’t work, I presume you can then have a second blast of RT (I am not medically trained so that to me would be a major factor).  Good luck, David

  • The main question seems to be what are they intending to irradiate with the 20 session protocol. The higher the risk group the more aggressive the treatment usually is in order to minimise the risk of future progression or recurrence. You need an honest conversation with the oncologist about whether it would be of benefit to zap the lymph nodes now or leave it for the future. As SBRT uses a lower total Gy dose it does leave open the option of further radiotherapy in the future. Many men have whole pelvic radiotherapy with few if any long term side effects, my husband included. The fact that they are evaluating high risk patients with and without lymph node treatment in the PACE NODES trial indicates they must think there could be a benefit in treating the whole pelvic area. 

  • Thanks David

    We're just emailing the oncologist with questions now. 

    Selecting the right treatment without a  medical background is difficult but the long term impact is so important.

    Sun with face

  • I've just spoken to the radiotherapy nurse who is passing on our questions to the oncologist. 

    I've asked that as the cancer has spread to neck of bladder how is it best treated and what are the likely side effects 

    I've also asked how common is it for cancer to spread to nodes in high risk Pc. 

    The trial makes sense but in the long term is it effective for high risk prostate cancer.

    Sun with face

    Sun with face

  •   I think you have done the right thing asking the questions.  I do take  question as very valid ‘what are they intending to irradiate with the 20 sessions’. Armed with those answers, the choice is yours!  David

  • Hello,

    Have you decided on the trial, did you get answers to your questions, would you be willing to share.

    Thanks,

    Jane

  • Hi Jane

    Sorry for the delay in replying -we are on holiday in Australia  and New Zealand. My husband doesn't start radiotherapy until April so we took the opportunity to have a big holiday. 

    My husband decided not to go on the PACE NODES trial. His oncologist answered all our many questions really well. 

    In the end my husband decided to stick with the standard 20 sessions as he felt that the effectiveness of 5 radiotherapy sessions (PACE C Trial) on high risk cancer isn't yet proven and won't be published until 2028.

    If you have any questions that we have had answers to please let me know and I'll send the info to you. 

    Cathy x

  • Hi Cathy,

    Thanks for the reply, I'm so glad to hear you are away travelling before your husbands treatment starts.

    My partner has decided to see if he's suitable for the trial, he likes the idea of shorter sessions and the trial team keeping an eye on him, he would like to be put in the nodes  group, but no control over that.

    Thanks for everyones help with getting us this far.

    Jane