Full Bladder Always Required For Adjuvant Radiation?

Husband is scheduled for adjuvant radiation therapy which will begin July 1. He had his CT simulation/scan yesterday and was not given any instructions for coming to the treatments with a full bladder or empty rectum. I contacted the radiology department (Moffitt Cancer Center, Tampa) and was told that this was not necessary. He did have gold fiducial markers put in place in the prostate bed and got all his tattoos for alignment. Has anyone else experienced this? From what I was reading, it seemed like the standard prep for radiation treatment post-prostatectomy. I contacted the radiation departments at MD Anderson, Johns Hopkins and Sand Lake Cancer and they said "the majority" of their patients are required to have full bladders but that some situations may not need it.

I asked very specifically about what to do to prep for SRT - and the radiation oncologist's mantra was "full bladder - empty rectum". He even stopped to asked me (almost in a bullying tone) DO YOU KNOW WHY WE WANT THAT?...

- and the key reason is to raise the bladder away from the prostate bed area - and not have anything in the rectum to push against the prostate bed area - to REDUCE THE RISK of damage to those areas by radiation and to help the technicians zap only what they want to zap - the cancer cells in the prostate bed.

-once a week they would take extra x-ray shots of me prostate bed to check that I was complying with their request.

-often the routine is drink two glasses of water an hour before treatment to have bladder full - that was too long of a wait for me and my incontinence.
-I was able to achieve a full bladder 10 minutes after drinking the water - and then run to the washroom after treatment to relieve myself ...

-I wish your husband all the best for his treatment - and he is very lucky to have such a caring caregiver in you - wishing you all the best too ( and make sure you give yourself some cancer-free days too !)

hugs,
Bronson

You need to ask YOUR Radiation Oncologist his thoughts on these issues in detail. If you feel his answers are not correct or satisfactory, find a different RO....I, like most of the guys here who have had R/T had it with a full bladder..

Also, you should be aware that big improvements have been made in the LINACS, the machines that produce and deliver the radiation in recent years..The treatment cost being the same, new machine or old, I would insist on modern equipment (less than 5 years old) being used...They can deliver a higher dose with less chance of damage to healthy tissue..Of course, facilities still using the older machines will vigorously deny that...

I will weigh in on this one. I feel its very important, so that no one ever ends up like I am, and having to live with an Urostomy/Stoma for the rest of my life, and still suffering from daily bladder spasms for life with no relief or remedy possible.

I had all 39 zap sessions with IMRT with a completely empty bladder. Because I had so many stricture problems post surgery, and since radiation is known to cause swelling at the bladder neck, the RO decided that I should have a Suprapubic catheter inserted for the duration of the radiation, and perhaps a month after it ended, in the event of swelling.

So I had the catheter surgically inserted per the RO. That was 15k operation itself.

Everyone that was having SRT or RT at the radiation center had to have a full bladder each and every zap session. It was their standard protocol. No exceptions. If you couldn't hold it, or if you wet your pants, off the table you went, and you had to re-drink enough water (typically 16-20 oz).

Prior to my radiation getting started, I asked the RO what she was going to do about it with me, since I had the catheter in place. Her famous words, "Don't worry about it, I got that covered". I asked what do you mean you got it covered, she said, "Don't worry."

I should have worried more. Because of having the catheter, my bladder was always empty. By the 4th of 39 treatments, I began to feel a deep burning pain in the region of my bladder. I reported it to the RO, she laughed it off, told me it was my imagination. With each passing treatment, the burning become worse, and lasted longer, sometimes for hours after each treatment.

Long story short, once the radiation ended, I had to stay on that catheter for 51 weeks. I was never able to urinate naturally without extreme pain, or most often, not at all. That radiation fried my bladder and bladder neck beyond repair, despite having 3 more stricture operations post SRT. I had no choice but to have major surgery with the ileal conduit surgery, producing the Urostomy/stoma.

How could it have been prevented, even with a catheter in place? So easy. They could have clamped off the exit tube of the catheter, and have me drink water. Or, they could have syringed in sterile water via the irrigation port on the catheter. I could have had a full bladder each and every zap session, if the RO hadn't been so careless and reckless.

And once I reported burning, why didn't she stop the treatments to investigate?

Despite the debate, the standard of care by the vast majority of radiation centers is to have a full or nearly full bladder. Period.

Even if you are told it doesn't matter, I wouldn't believe it for a second. I would drink the water whether they said you needed it or not.

I don't want you or anyone else to suffer the damages and pain I still feel nearly 5 years later from this botched radiation job. I trusted my doctor, and she failed me miserably.

Yes, I tried a malpractice case against her, but here in SC, the malpractice laws only protect the guilty, not the patient, so after working with 3-4 law firms, plus representing my self at the end, I got nothing, zip.

Yet I live with this disfigurement on my body, and without my device/appliance, I would be 100% incontinent for life. I live with the severe chronic pain and fatigue every day of my life, and there is no medical hope of improvement.

If the doctor insists you don't need a full bladder, make him put it in writing as a guarantee, be interesting to see if a doctor would sign it.

David

I am now 13 sessions into a 33 session course of SRT. I had a planning scan, and the instruction is that I must have my bladder in as close to the condition of the scan as possible. That is within 85% and 105% of the volume. This is checked every time I get on the table by doing a scan immediately prior to the treatment, the scanner being part of the whole gubbins that revolve around me,

The issue is that if the bladder is too full, bits of me are outside of the treatment area. If I am too empty, the bladder and specifically the bladder neck get too much heat and will end up irreparably damaged.

The bowel is empty - the idea here is to keep the bowel out of the treatment area. Again this is something that is checked daily. Even gas is a problem, the operators noticed I had gas on the first couple of treatments, and suggested start taking charcoal tablets, and have given me permission to fart in the treatment room (an invitation that I have not yet taken up - I do try and retain some dignity).

Please question your team very closely - very important that you understand why they are giving you advice that seem contrary to the rest of the world. More important in my opinion that you do this thing right, rather than quickly.

For what it's worth, I had SRT and I always had a full bladder, sometimes to the point that I had a hard time holding it. Again, FWIW, my SRT worked and I've had zero side effects.

I was given specific instructions by my rad onc - empty my bladder, then immediately drink (1) 8-ounce glass of water 45 minutes before my treatment each day.

This seems to be different from what many have reported here - so I asked my oncologist about it. He said that the important thing is repeatibility - that the same conditions occur when the initial imaging was made, and that the same conditions exist for each treatment. No need for a full bladder.

I suggest you follow the instructions of your specific doctor and let him follow the protocol that he has developed.

Jeff