Putting Off Treatment Part II

The cells...they come...they go...the dude abides(my new mantra)...wee beasties...they da best...much more interesting...life...shucks...life takes care of it self...death and ones tempting of it...now that takes work in a poetic kind of slam bam...well jam...beware the sweet...its sticky as the fly's eyes...umm...there are ducks and there are swans...go figger

Well, Glen, if they are planning 4 to 6 treatments, it would definitely be SBRT. If it is 10 or more treatments, it is probably some variation of IMRT or IGRT. I think the difference between IMRT and IGRT is that IMRT is Intensity Modulated Radiation Therapy -- without the image guidance, and IGRT is the same sort of radiation as IMRT, but with the added benefit of a real-time image guidance system. Not sure about those, though.

For my SBRT (5 treatments, about 45-60 minutes each) I had a planning CT scan, no MRI (my pacemaker is not MRI compliant). They implanted four tiny gold markers, called fiducials, into my prostate a week or 10 days before my first treatment. The machine used these four markers to ensure that it delivered the radiation where the planning algorithms dictated it should go.

In some cases, the same machine can be used for more than one type of radiation treatment, depending upon how it is set and how long the treatments are. I was told that the AccuRay machine used for my SBRT treatments could also deliver standard IMRT therapy. Where my SBRT treatments were almost an hour each, the individual treatments of a 40-fraction IMRT regimen would only be about 10 minutes each.

I've been putting off treatment since May 2017 when I had a local New Hampshire hospital biopsy (Transrectal method) showing only 1 core with less than 5% (Gleason score of 3+3). As of last July 1, 2020 when I had a biopsy at Mass General Hospital (Perineal Method), I now have 1 core of 0.5mm (5% Gleason of 3+3) and another core of 1mm (8% Gleason 3+3). So my cancer has doubled in 3 years. Dr. McGovern at MGH advises me to continue with watching and waiting. I'm wondering if this is still the correct path for me? I'm 69 years old and the cancer is just going to increase from here as far I can see. But, Dr. says I may never need treatment so why run the risk of possible side effects. What are others doing with my type of diagnosis?

Dave V.

On cellphone so cannot write much

Had first treatment yesterday. I'll have second today. I Was not claustrophobic as the machine rotates around you. I don't even mind that balloon that goes in the rectum.
The issue is that the position is really painful. I Have a very bad back and hips. Lying on my back is extremely difficult. I had extra pain all day because of it. I will ask if maybe we can find a way to place a large pillow or the like under my back.

I Will complete the treatment but am worried about this level of pain albeit it only 10 minutes of pain. I Was almost screaming it hurts so badly.

I Will write more tomorrow at my PC

Glen

Thanks mattam

Yes I am sure. I think we will figure out something to ease the angle I'm in.

Glen

Yes thanks Mumbo, Well they did put a wedge like pillow that helped. They however kept changing my leg position and toward the last 5 minutes, I had some pretty severe sciatic pain down from my hip socket to behind the knee but I held out. The rectum balloon is no fun but not really a bother.

Maybe someone can answer this one because I was going to ask but forgot. This was my second treatment. The paper with the dates and times said "Test then treatment" I was afraid it would be a CT scan like before however, I really did not need the two valium I took because the treatment machine took a CT scan but revolved around me which was a piece of cake as far as claustrophobia. My second treatment done today had the same thing happen and the reason I know is, the machine revolved for some 7 minutes then just stopped. there was silence and finally after about 4 minutes they said, "now the treatment starts" So I'm confused and as I said forgot to ask (I had to pee so badly) Will the machine take a CT scan before each treatment?
Not too big a deal but the less time spent on the table the better.
They also put some "stickers" on my body but I never actually saw them nor did I look for them. They said not to worry if they come off in the shower. Just wondering what that could have been? I'm already tattoo'd

Oh one more thing, I took the train to my upstate place and had to use the restroom twice in an hour and half train ride. I went shopping then came home and thank goodness they have a restroom on the first floor for us residents because I almost did not make it. It may be from the radiation or the 3 quarts of water and coffee I've been drinking today but am not sure. I suppose urinary frequency can occur but so soon? it's only the second dose.

All in all, I'll get past it. 2 down and 43 to go.....

Glen

I only know what happened to me. My techs did a quick CT every day to check bladder, bowel, and body positioning. They then wait for RO’s on duty to review and ok the actual treatment. Not sure who determines the small adjustments made where the table clicks a couple times but suspect the RO directs that. Some days the process is really fast, other times they are waiting on RO before pushing the treatment button.

Another rare item that can happen is the machine can have a QA fault that stops the machine and they reset and it picks up where it left off. The machine can also breakdown on your treatment (not in the mechanical sense) and the techs have trouble starting or completing the session. Happened to me once in the morning and It was down for a few hours and I came back at 7:00pm for my treatment. Probably will not happen but don’t flip out if something unexplainable happens one day.

There is a lot of safety built into the machine’s computers so if anything does not check out, it will stop rather than burn a toe off. TMI I suppose...

Quick question-My testosterone doctor is going to test my blood January 4th (If I can make it to Staten Island after radiation) I wonder if my PSA will be affected by the radiation and will it rise or fall? The reason is if it gets too high he may stop the testosterone until he gets a report from my urologist which I do not want.
As some may know, I am not being upfront with the testosterone clinic about the Pca. Yes my radiologist oncologist knows I am on TRT but not the doctor who prescribes the testosterone (I know that most doctors would stop prescribing and that is a shame but reality-partly for good clinical reasons and partly for CYA)

So PSA up or down or no effect just yet? (it will be 11 days of treatment by then)

Glen

Thanks Cyclone!
The PSA is part of the TRT protocol. They take blood every 4 or 5 months to measure how the testosterone level is doing. They also check other hormones and red blood and iron counts along with PSA
I just did not want to show a big rise in PSA the last measure was 5.1 about two months ago but I do not share my bloodwork as that one was my RO's test before treatment began.

Yes I'm taking it one day at a time. The staff are all very nice and understanding. I do apologize to them about being a difficult patient with the pain problem.They help me get up and down which is not always the case with some tech's

Merry Christmas, happy holidays and New Year

Glen

theswan said...
I looked up why PSA remains after removal of the prostate and it has to do with prostate cells that have escaped the surgery.

Glen

A small psa reading that persists following surgery can be due to:
1. prostate tissue left behind as you say, but also ...
2. extra prostatic sources (other areas of the body can produce small amounts of psa)
3. cancerous cells outside the prostate that may or may not be a worry (so slow growing not to be a threat).

It's why they keep testing for a while if you record an initial small psa reading. They want to see if you fall into one of the better cases above, where nothing needs to be done.

Bad day after 4th treatment. On the subway I had to urinate but could not.
I eneded up at the ER and had a catheter put in. I Was in a lot of pain
I see the RO tomorrow and have no idea what awaits me.
I was afaird of this. Not sure if treatment will continue or get postponed. The quick infection test did not show infection. I hope it's not the radiation

I'm pretty scared

Glen

Ok I read your your last post three time...do you know for sure what caused the need for a catheter...I understand the pain...but was the pain resolved by the trip to the ER...is your pain level generally the same as it was prior to The trip to the ER...physical...not mental...a fine line twixt...is your mind and all the vibrations of such the main source of discomfort or is it the resolved stricture...I am assuming it is resolved as you said "I Was in a lot of pain...not I am in a lot of pain...if you just still your mind...where are you...your last sentence and the lack of "this too will pass" is telling...be patient on your inner strength...it will not tarry...if you pray...pray for that strength to endure your anxieties...feign from making deals with yourself...its the "devils" game...help us...to help US and by doing so...help you...Im thinking hard on on ya swan...real hard ...again try(which is to do) be where in truth you really are...neither behind or ahead...the past and the future is always with you...use that truth but you be the one that dallies in it for yourself...never give or even lease it to any one or anything else...Hey we all know you have the imagination...the poetry of creation...live there...be there...you have always been doing that...don't stop now...its working...with little regard for fear...being afraid is one thing...I become afraid daily...but one thing I am not...by the grace afforded me...afraid of...is fear....

Swan t would be highly unlikely i think, for this new issue to be caused by the radiation after only 4 treatments. But i guess anything is possible. As logo said (i think) there is really no need to be scared. One way or another this will get resolved. Its a minor bump in the road of life. I know, easy for me to say, but try to relax, believe me, i know what fear of medical issues is like, it will pass.

I hope you get some reassurance from your RO today, keep us posted.