My SRT thread

Since I got so much out of others' threads on the subject, I decided to start my own. I get my first of 40 treatments tomorrow, plan is 72 Grays total. I have very high confidence in my rad oncologist, and have heard only good things about him. Have had the gold seeds and prep CT/MRI, etc. of course, and now am ready for the blasts.

Probably unique relative to those that have posted here for my case is that I have ulcerative colitis, presently pretty much in remission. If there is a litmus test for whether modern IGRT will flair up lower GI issues, I should be it. On the urinary front, I am in pretty good shape, I call it 100% continent although every few days or so I lose a drop or two if I don't pay attention. I'll be happy with that if it stays the same after all is done and said.

Another issue with me is that since about the time of dx, I have had low testosterone - without supplementation, it runs between 130-190 typically. This has resulted for me in low energy, and some amount of tendency toward depression that I deal with so far pretty successfully. I am concerned about the additional fatigue that the radiation may bring on (although it should be less than what those with adjuvant HT have to deal with). On the positive side, I have read some research that indicates that T levels below 300 during SRT are beneficial to a favorable treatment outcome.

Just got back from a family visit vacation. Found out from my dad that it was believed by the medical experts at the time that my grandfather died of prostate cancer, not with it, as I had previously understood. My mother has recently been treated for breast cancer, so there are a couple of relevant genetic factors there.

One thing that seems different that I have been instructed regarding prep for the treatments is this: rather than coming in for the treatment with a full bladder ready to burst, they want me to void 30 minutes before, and then drink 8 oz of water - no more, no less. This is supposed to address problems with patients not being able to hold the full bladder long enough. All of the imaging so far has been with this same prep requirement. Seems like an improvement to me - I hope that more clinics pick up on this for the sake of other patients.

I don't plan to post daily or anything like that, but will try to update when things are changing, or when I have thoughts that might benefit others planning to (or hoping not to) go through this in the future.
Cheers, Jeff

Jeff,

Good luck. I did 72 gys over 39 treatments, so pretty similar. If you dont want to post daily, some guys do a weekly update to keep us up to snuff on your progress. I hope you do well with it ,and with few side effects

Jeff, Good luck with your IMRT. As far as the bladdder goes, I voided prior to leaving the office and drank a 17 ml bottle of water during the 20 minute drive to the hospital. Only felt like I would burst on one occasion and the techs never complained about the amount of fluid in the bladder. Urgency to pee becomes a real problem as well as the fatigue. But, I guess it affects everybody differently. Squid.

Thanks for the encouragement, guys
Treatment 1 done, 2.5% complete.
Don, I plan to stay with normal activities until I can't. I walk my large shepherd each evening - he gets desperate for some activity by the time I get off work, and nobody else in the family feels the need to accommodate him. I also have a smaller terrier, but he just gets a very short walk so he feels special as well. I just completed fixing up my front yard, accomplishing my goal to get it finished before treatments started. I plan to still putter in the yard over the course of this, but it is in a low-maintenance state at this point.

I had planned to schedule treatments earlier in the day, but based on inputs I got from several of you that have been through this, I changed my mind and went for 3:30. That way, traffic is not yet too bad either to work or home, and if I start needing to take part of the day off, I can go straight home. I ended up getting that time for every day except for the first and one other, so they were very accommodating.
Jeff

Just got my August PSA test back, it rose to 0.41. It is making the choice for SRT look like the right one. This puts my doubling time at right about 6 months. Thanks to the several of you that told me not to wait, I really didn't want it to go much higher than this before starting treatment.

I'm curious, to those out there that have asked their docs - does the PSA bounce occur for SRT without a prostate like it does for those that do radiation for their first treatment? In other words, if I monitor my PSA monthly like I have been doing, throughout the treatments, can I expect them to be reliable?

5% done, no problems except for traffic. I might ask if there are any openings earlier in the day in future weeks.
Jeff

Finished with week one, 1/8 of the way through... not much to report so far. Stomach cramps and gas last night, but I'm blaming it on the Chinese food that gave my wife the same trouble one day earlier. So far, the only "symptom" I'd say I have is that I am peeing just a little more often, and no longer sleeping all the way through the night without getting up to pee. So far so good. My main complaint is the traffic, and I am switching to midday appointments to address that.
I'm hoping I'm still complaining most about the traffic in a few weeks!
Jeff

I went through 33 sessions through to 21 January 2010 and fatigue was a definite issue...I would sleep all afternoon after a morning session. Urgency in urination became a real problem after 50% treatment...used to drive with an empty coke bottle on my knee.

It is essential to have a full bladder during the treatment otherwise you risk bladder and urethra problems...I had urethra scarring that only became acute 4 months after the end of treatment, but surgery in May cleared it up.

Good luck mate.

End of week 3 - nothing bad yet except for the fatigue - some days it's pretty significant. I have to have a sharp mind at work, and that goes away sometime in the afternoon now. It seems that the mental fatigue sets in before the physical. I am happy that the urinary and bowel symptoms have been extremely mild so far. I like the appointments at mid-day. This clinic has new patients at 2:00, and things get messed up afterward. Something to consider if you are looking at what time of day to schedule your treatments. I have been trying to walk the dog regardless of how I feel, and I think that is helping with the fatigue.

Aussie Bloke: we have rules about no cell phone usage here, but nothing about coke bottles. I suspect I might get pulled over if I started using one, though. We have a pretty good excuse, but I don't think I want to have to go there.

Jeff

End of week 4, 20 down and 20 to go! I'd say things are going very well. No significant side effects except for the fatigue, which is increasing. Before this week, the fatigue gradually set in starting about noon. Now, it starts in about mid-morning. I am mental toast by mid-afternoon, and I am doing my work a favor by leaving then. I am getting in about 7 hours a day right now. I have contingency to work only 6. Getting lots of rest, especially on the weekends. Still trying to get some exercise most every day.
If fatigue is all I have to deal with, I will be one happy camper.

I asked the doc about when to get a PSA test next, and he said at 3 months after the end of treatments, which means about Jan 1 for me. He said that the half-life of PSA is about 1 month. I asked about the duration of the cancer, how long it takes to die off. He said it can be between 6 and 18 months! He is only looking for the same or less PSA, not really 0 for quite awhile. It should not increase after treatments are over, that would indicate a failure. I see my uro surgeon next week to get her take on everything.

Cheers, Jeff

Jeff, glad to hear you are over the hump and the side effects aren't too bad. Same with me except my fatigue was heaviest at the end of the week. about your upcoming psa test at 5 weeks into SRT. I also had one at the start of week 6 and it had risen to .4 from .3 at the start. The radiation oncologist wasn't too concerned and said it wasn't unusual. As you can see from my signature, my psa has been dropping post SRT.

All the best,
Jake

End of week six. The fatigue this week wasn't as bad as last week for some reason. Got to do more exercise, mow the lawn, etc over the weekend. Haven't lost as many hours at work this week either. And this was before I got the PSA test results...
As of the end of week 5, test result was 0.17, down from 0.41. Not sure if radiation is supposed to work that fast, but I'll take it!

Just one additional symptom - dripping some blood during BM. I think that it was a hemorrhoid that got disturbed... I'm not ready to blame it on the radiation although it might have inflamed it a bit. A few questions for the rad oncologist next Monday.

Only two weeks to go - and dropping PSA! I still consider myself blessed.
Jeff

End of week seven. Still fatigued, but no worse than the fifth week. Have had problems with bleeding due to inflamed hemorrhoids all this past week. I am treating as I know how with hydrocortisone suppositories (as a colitis sufferer, I am prepared). They've improved, but then gotten worse again. I asked the doc about them, and he didn't think the radiation has anything to do with it, although he wouldn't rule it out. I am only up 2-3 times at night to pee.
I asked the doc a couple of questions:
- my PSA is down as of week 5 from 0.41 to 0.17. Is it too early for the radiation to have taken effect? His answer: what is different now from the last time I had it drawn? Since the only thing is the radiation, we'll take it as a sign that the radiation is working. (Of course, I didn't mention the thousands of prayers that have been made, but I'll leave that for a different conversation).
- he asked for my slides - did he have them re-assessed? He brought me into his office where he accessed the records - they were reanalyzed, with the exact same result as initially: 3+4, 10% carcinoma, negative margins. I asked, in light of the likelihood that the radiation is working, and that implying that the cancer is local, how does he explain the negative margin assessment? His answer - it just goes to show how limiting the dx technology is.

As I was counting down the treatments to the rad tech, she said, "you're one off. You only have 39 treatments scheduled." That was more good news to me! I have my last treatment next Tuesday!
All in all, so far, aside from the fatigue, side effects have been minimal. I still consider myself blessed, and many prayers have been answered so far. I have hope that I didn't have before the treatments began.
4 more treatments to go!

Jeff,
Good luck with your IGRT. Hopefully all goes well and the side effects will be minimal.