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No sig diff in rad toxicities/full or empty bladder?

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Posted 8/15/2018 5:53 PM (GMT 0)
I'm on day 12 of 15 IMRT/IGRT. Of course, everyday I've been worrying about the full bladder issue. So I finally searched for studies on the matter; and lo and behold there are multiple findings that it doesn't really matter much. Gotta run for #12. Cheers

https://www.tipsro.science/article/S2405-6324(17)30019-7/fulltext

https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1120/jacmp.v8i1.2286

Post Edited (Steve Smith) : 8/15/2018 1:46:42 PM (GMT-6)

Posted 8/15/2018 8:00 PM (GMT 0)
Is that a hypofractionation protocol? Primary or salvage? 15 fractions is unusual for either.

Your google obviously came up with different citations than my google. Please cite the studies you are referring to.

I came up with this:"The bladder volume variations may cause dose changes proportionately. Monitoring the bladder’s volume before fractional treatment delivery will be crucial for accurate dose delivery."
/www.ncbi.nlm.nih.gov/pmc/articles/PMC4969718/

It didn't matter as much with older radiation techniques because the dose to organs at risk and toxicity were so high no matter what. But IGRT/IMRT has sub-millimeter planning accuracy and much smaller margins. It is especially important with moderate or extreme hypofractionation.
Posted 8/15/2018 9:26 PM (GMT 0)
I have read so much on the subject, I start ebrt in two weeks, no way I'm chancing it. I'll chug the heck out of water if it helps any. I do always, probably drink 20 glasses a day as it is.
Posted 8/15/2018 9:54 PM (GMT 0)

Tall Allen said...
Is that a hypofractionation protocol? Primary or salvage? 15 fractions is unusual for either.

Your google obviously came up with different citations than my google. Please cite the studies you are referring to.

I came up with this:"The bladder volume variations may cause dose changes proportionately. Monitoring the bladder’s volume before fractional treatment delivery will be crucial for accurate dose delivery."
/www.ncbi.nlm.nih.gov/pmc/articles/PMC4969718/

It didn't matter as much with older radiation techniques because the dose to organs at risk and toxicity were so high no matter what. But IGRT/IMRT has sub-millimeter planning accuracy and much smaller margins. It is especially important with moderate or extreme hypofractionation.

Mine is 15 fraction total 37.5 and one hdr brachy at 15. This regimen is becoming very common. I'm unfavorable intermediate.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200189/

and from 2017 study conclusion for "The impact of bladder preparation protocols on post treatment toxicity in radiotherapy for localised prostate cancer patients",
"The empty bladder preparation approach has non-inferior acute and intermediate post RT GI and GU toxicities in patients treated for localised prostate cancer with advanced radiotherapy techniques compared to the full bladder preparation."

I've been full, regardless. But it may turn out that there has been unnecessary concern about this issue.

Post Edited (Steve Smith) : 8/15/2018 4:04:05 PM (GMT-6)

Posted 8/15/2018 9:59 PM (GMT 0)
when I did IMRT, my RO wasn't too concerned about how full my bladder was. He wanted some in there, but wanted a consistent amount everyday. I only drank one 16 oz bottle about an hour before treatment.

Andrew
Posted 8/15/2018 10:01 PM (GMT 0)
You didn’t mention the brachytherapy boost. Very bad idea to not have a full bladder during the IMRT part.
It has to be full enough to lift the bladder off the prostate.
Posted 8/15/2018 10:07 PM (GMT 0)

Tall Allen said...
You didn’t mention the brachytherapy boost. Very bad idea to not have a full bladder during the IMRT part.
It has to be full enough to lift the bladder off the prostate.

read the study

https://www.tipsro.science/article/S2405-6324(17)30019-7/fulltext

Post Edited (Steve Smith) : 8/15/2018 4:11:16 PM (GMT-6)

Posted 8/15/2018 10:16 PM (GMT 0)
I have not conducted a literature review, but based on these findings, I suspect similar findings have been reported in other studies.

InTheShop, yes it seems consistency is just, or more, important than fullness.
Posted 8/15/2018 10:19 PM (GMT 0)
I recently posted about the radiation damage to my bladder from RT. When my URO told me about the red areas he saw inside my bladder, I asked him if having an empty bladder vs full mattered at the time of RT as the RT folks had me empty every time before treatment.

URO said that some RO want the bladder empty, as water/urine can cause the beam to bounce/deflect?? really did not understand the URO's answer but was wondering if somehow the RO screwed up in telling me to empty my bladder before RT, after reading on this site, how many guys were told to have a full bladder at time of RT vs empty.

I go back for tissue samples early next week to determine if the bladder red spots are cancer from the radiation

History from URO
59 y.o. male w/ high risk prostate cancer, He had a radical prostatectomy in 2015. He had Gleason 9 disease with seminal vesicle involvement. There is a focally positive margin. pT3bN0MxR1, Gleason 4+5 s/p RRP + BPLND (10/13/2015) and adjuvant radiation therapy.
Posted 8/15/2018 10:24 PM (GMT 0)

ntzguy said...
I recently posted about the radiation damage to my bladder from RT. When my URO told me about the red areas he saw inside my bladder, I asked him if having an empty bladder vs full mattered at the time of RT as the RT folks had me empty every time before treatment.

URO said that some RO want the bladder empty, as water/urine can cause the beam to bounce/deflect?? really did not understand the URO's answer but was wondering if somehow the RO screwed up in telling me to empty my bladder before RT, after reading on this site, how many guys were told to have a full bladder at time of RT vs empty.

I go back for tissue samples early next week to determine if the bladder red spots are cancer from the radiation

History from URO
59 y.o. male w/ high risk prostate cancer, He had a radical prostatectomy in 2015. He had Gleason 9 disease with seminal vesicle involvement. There is a focally positive margin. pT3bN0MxR1, Gleason 4+5 s/p RRP + BPLND (10/13/2015) and adjuvant radiation therapy.

Good luck to you, ntzguy. Hopefully no more cancer!
Posted 8/15/2018 10:30 PM (GMT 0)

ldog said...
I have read so much on the subject, I start ebrt in two weeks, no way I'm chancing it. I'll chug the heck out of water if it helps any. I do always, probably drink 20 glasses a day as it is.

Good luck ldog! Yes I've gone in full. It's easy to do. Just empty then drink 20 ounces one hour before.
Posted 8/15/2018 11:07 PM (GMT 0)
Ask our forum member Purgatory about the damage an empty bladder can lead to. It convinced me not to try that.

For my IMRT, I embraced a consistently full bladder as my goal, both during the planning CT session and at each treatment. I found that I could quit drinking anything 2 hours before the session. Empty somewhere during that time. Then, about 40 minutes before the session time I'd drink about 14 ounces. I played with the timing and amount for a couple of weeks before the sessions began, to get the desired result.

My radiation techs checked for bladder condition during the x-ray positioning check. They sent one guy back to drink more water since we watched him empty just before they called him down. He rather sheepishly came back to the waiting area with a bottle of water in his hand!
Posted 8/15/2018 11:37 PM (GMT 0)
Thanks for the link.

n=20 (10 with full bladder, 10 with empty), which fully explains the lack of statistical significance. Also they lumped grade 2 toxicity in with Grade 1 (instead of lumping grades 0 and 1 together). I'm glad you're not hanging your hat on a single small retrospective study.
Posted 8/16/2018 12:07 AM (GMT 0)

Steve Smith said...

Tall Allen said...
Is that a hypofractionation protocol? Primary or salvage? 15 fractions is unusual for either.

Your google obviously came up with different citations than my google. Please cite the studies you are referring to.

I came up with this:"The bladder volume variations may cause dose changes proportionately. Monitoring the bladder’s volume before fractional treatment delivery will be crucial for accurate dose delivery."
/www.ncbi.nlm.nih.gov/pmc/articles/PMC4969718/

It didn't matter as much with older radiation techniques because the dose to organs at risk and toxicity were so high no matter what. But IGRT/IMRT has sub-millimeter planning accuracy and much smaller margins. It is especially important with moderate or extreme hypofractionation.

Mine is 15 fraction total 37.5 and one hdr brachy at 15. This regimen is becoming very common. I'm unfavorable intermediate.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200189/

and from 2017 study conclusion for "The impact of bladder preparation protocols on post treatment toxicity in radiotherapy for localised prostate cancer patients",
"The empty bladder preparation approach has non-inferior acute and intermediate post RT GI and GU toxicities in patients treated for localised prostate cancer with advanced radiotherapy techniques compared to the full bladder preparation."

I've been full, regardless. But it may turn out that there has been unnecessary concern about this issue.


I read that same study and a few others in regards to 15 treatments compared to 25 and how there really isn't any difference in SE's, etc... I'm guessing that some/most hospitals will stick with the 25 based on money being made.
Posted 8/16/2018 3:14 PM (GMT 0)
I mentioned to my RO at one of my weekly meetings that at times if I had to wait for treatment longer than say 45 minutes after last drink it would become very uncomfortable. He said you guys really are obsessed with this full bladder thing. I know we stressed it but it's not critical that it be absolutely full.
Posted 8/16/2018 4:31 PM (GMT 0)
It should be full enough to lift the bladder away from the prostate and anchor the prostate. The degree of filling has to be the same as it was during the planning study - the whole plan is based on the organs being in the exact same position they were in when they took the MRI/CT. Else why do IGRT at all? This is especially critical with hypofractionated radiation and SBRT, where near misses can be very toxic.
Posted 8/16/2018 5:07 PM (GMT 0)
What TA said. I get a scan every week, the techs and then the RO check it, and they’ve increased my water intake by two ounces twice. Tech explained that they look at an outline on their screen to see if my bladder is inside, on, or beyond the lines. The outline is based on simulation but drawn slightly larger to provide a margin of safety. On or outside the outline is what they want.
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