Anyone with pacemaker + IMRT?

Greetings. I'm the wife/cheerleader for my high Gleason 9, low PSA (3.32) 70-year old guy. I cover the boards; he prints out reams of research and reads them to guide his treatment. So I hope it's okay to post here as a wife even though I don't have a prostate.

My signature below sums up most of the facts regarding the disgnosis and treatments so far. The 400-character limitation didn't allow me to say that we got second opinions at Dana Farber, Sloan Kettering, and Tufts (where a medical oncologist Paul Mathew, MD has done research on men who present symptomatically rather than with PSA, i.e. have low PSAs but wind up with high Gleason scores. I hope to start a thread on that subject if we ever stop going to doctors! I'm aware that Lupron Jim and Shaba Doug fall into that small group. Go LJ and SD! Talk to you soon.)

Second opinions pretty much confirmed what my husband's original urologist recommended due to his age and having a pacemaker--neoadjuvant hormone treatment for at least 2 years, plus 9 weeks of radiation. The Tufts oncologist said my husband at a "high quality" response to the neoadjuvant hormones in that the urinary symptoms went away; the prostate had shrunk a lot; it was fairly smooth; and PSA was .01 about three months after starting the hormone treatment. This scenario is often not the case with high Gleason, low PSA patients. He thought the radiation plan was the way to go.

So the 9-week IMRT is scheduled to start next week. Our local radiation oncologist will work with my husband's cardiologist to discuss pacemaker issues. Turns out that in one study my husband found, about 25% of pacemaker patients getting IMRT for cancer had some problems with the radiation interfering with the pacemaker:
https://www.astro.org/News-and-Media/News-Releases/2011/Radiation-for-prostate-cancer-may-interfere-with-cardiac-devices.aspx

Has anyone on these boards with a pacemaker received IMRT? If so, would you share your experience and discuss how your radiation oncologist dealt with this? Thanks.

Thanks so much for your helpful information about your pacemaker acquaintance, Tall Allen. It certainly is limiting that people with pacemakers can't have MRIs and have to work around it.

We are just starting to learn through our own research about this triple-modality treatment--Lupron, radiation, brachy, but nobody has suggested it yet. We've been in a chaotic overload of opinions. The Dana Farber oncologist had said she didn't rule out surgery. So that meant seeing a surgeon, which we did at Sloan-Kettering since our local urologist had trained there and highly recommended someone at MSK. The surgeon would've done it--no surprise sinceMSK is super aggressive--but my husband and I felt the surgeon didn't state this with confidence. Then our Tufts appointment with the high Gleason, low PSA oncologist was postponed three times due to the horrendous weather in Boston. (We live way across MA.)

As everyone on these boards knows, just getting apointments and the materials together is a big undertaking that sucked up a worrisome amount of time. (My husband would've been finished the original planned radiation by now if the surgical option hadn't been thrown out.) Now he's under the care of a Mass General team, with which our local hospital is affiliated and where the radiation will be done. We met with them this week in Boston.

All these months later, the most current recommendation is the Lupron + IMRT, which the local urologist had suggested months ago! However, we've filed away the brachy info to take up once the IMRT is completed. My husband just "wants" to get started on the radiation since the research shows that advanced cancer men do well with the neoadjuvant/radiation combo. (He'd rather take a cross-country trip on his motorcycle.) I really appreciate your mentioning the brachy option and will look into that further.

BTW, aren't you a high Gleason, low PSA fella? That's yet another club nobody wants to be in. I'll try to post some helpful links on that soon. Thank you so much for your comment.

Hi, Allen.

Thanks for the important clarification about the tri-modal treatment of neoadjuvant hormones, radiation, and brachytherapy. Obviously what I thought was completely wrong--it's not possible to do the brachy as an "add-on." I'll share your information with my husband, though I'm fairly certain he's going to start the IMRT next week. (He'd already called off that plan in January two days before he was supposed to get the tracking seeds to explore the surgery option which two centers thought was possible.)

It's frustrating and wearying to figure out the best path--surgery/no surgery, radiation with/without hormone therapy and many more variations judging from these boards. Someone said each man's prostate cancer is a Rubik's Cube. That is certainly true. Onward!

With gratitude.

Hi Spouse21,

I have an implanted cardiac defibrillator (ICD) which is essentially the same as a pacemaker, and had 37 doses of EBRT.

It does complicate the treatment, but not in a major way. Prior to each treatment, I was wired up to an ECG machine so that I could be monitored during the treatment, and a strong magnet was taped over the ICD. The purpose of the magnet was to temporarily deactivate the ICD so that it could not fire prematurely if the radiation affected it in any way. Not sure if that would be relevant for a pacemaker, would depend on it's specific setup.

At the completion of each treatment, a cardiac technician visited me in the oncology area of the hospital and checked all the ICD settings to ensure nothing had been affected.

This procedure wasn't onerous but did significantly add to the time I was at the hospital for treatment. Most guys were in and out within 15 minutes, but I was rarely out within 30 to 45 minutes depending on how long it took for a technician from cardiology to come and check me post treatment.

Now as it happened, I did have a serious complication, which I am told is extremely rare, but was very serious.

After about 15 treatments, and absolutely no impact on the ICD, the cadiology technician decided to only do the post treatment check after every 3rd treatment, and you guessed it, there was a problem.

I exercise regularly and was in the habit of walking up a pretty steep hill at a pretty quick pace. My heart rate usually gets up to about 160 or 170bpm. The ICD is set to detect tachycardia and because of my exercise regime, was set to not activate until my heart rate got up to 220, something I could not achieve by exercise.

On the 2nd day after a missed check, I was on my way up the hill, when BANG!! The ICD discharged giving me an 800 volt shock. It did that 4 times over a period of about a minute - in fact until my heart had dropped it's rate to below 140 bpm - the factory default setting for the ICD. As you can imagine this was extremely unpleasant and very concerning. Luckily I wasn't far from home and was able to get there and hence to the hospital for a checkup. Upon investigation it seems that the radiation the day before had caused the ICD to reset to factory settings.

This has been the subject of great consternation amongst the radiologist, cardiologists and ICD manufacturer. Treatment protocols have already been changed and I am told a paper is being prepared for publication.

I don't mean this to scare you from treatment and a simple pacemaker would not be impacted in such a dramatic fashion, but it would be important to ensure it remains fully functional after each treatment.

Good luck,

Chas