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Salvage radiation

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Posted 5/20/2009 3:01 PM (GMT 0)
I have been looking into salvage radiation options, since my PSA is rising after the RRP last June. I am getting confused between IMRT and IGRT. What's better? Does it make a difference? Any help is highly appreciated.  
Posted 5/20/2009 3:34 PM (GMT 0)
I'm under the impression that IGRT, helps positioning in case of patient and/or organ movement, whereas IMRT shapes the radiation field to better reflect the contours of the targeted area.

There is also proton beam, which operates on a different basis then photon therapy. (I'm also under the impression that IMPT (image modulated proton therapy) is being researched.)
Posted 5/20/2009 5:42 PM (GMT 0)
Geebra,
IGRT is a more precise way if delivering IMRT photons. It is a good treatment for primary treatment of localized prostate cancer. Because of your situation, if it were me, I would elect to have standard IMRT. IMRT is precise enough to deliver dosage in the general prostate area. Most recurrent prostate cancer is so small that mapping treatment is difficult to apply and a best guess in many cases. IMRT will deliver well to the prostate bed and lymph nodes and will likely knock out that PSA climb...Also IMRT is regarded as quite safe and tolerable.

Tony
Posted 5/20/2009 6:00 PM (GMT 0)
Tony,

Isn't IMRT and IGRT sometimes offered from the same instrument together?
Posted 5/20/2009 6:37 PM (GMT 0)
The IGRT device is typically a CT Scan with the capability to deliver IMRT radiation. They physically look inside you and aim before each dose. The thought is that everything in the prostate area moves on a daily bases. Thus the mapping changes daily. IMRT 7 point devices don't have the capability of looking inside except via x-ray. But the point is that CT does not identify micro mets. Thus, IGRT is precise, but not as effective once the prostate is removed. Look at it like firing a bullet versus shot from a shotgun. Of course IMRT is more accurate than EBRT, it still will protect the bladder, rectum, and other organs sufficiently.

Tony
Posted 5/20/2009 8:14 PM (GMT 0)
Thanks. Squirm, I checked into Protons, but at least in Boston (the nearest center in Northeast I was able to find) they don't do salvage treatments. Tony, I was aslo under impression that IMRT is standart treatment for rising PSA after RRP, but I saw dsmc's post and signature about IGRT salvage option: https://www.healingwell.com/community/default.aspx?f=35&m=1475394&g=1476212#m1476212 , so, of course, I now have to know why one chooses IGRT vs. IMRT. dsmc, if you are out there, I'd appreciate your thoughts on the subject.  
Posted 5/20/2009 8:32 PM (GMT 0)
You certainly can choose to do IGRT. But know that thus far, I am side effect free from IMRT. And better yet I am also undetectable. But i am certain the IGRT can get you there as well.

Good Luck.

dsmc is my Facebook friend. If he doesn't check in soon enough I can tap his shoulder and let him know you are looking for him.

Tony
Posted 5/21/2009 12:15 AM (GMT 0)
Thanks, Tony.
Posted 5/21/2009 12:50 AM (GMT 0)
Any decision as it relates to cancer is difficult however I will have to go with Tony on this one. I to had IMRT and had some side effects during treatment but now 20 months later I have none and my PSA is also undetectable. Please know that I care and would love to hear what you do and how you progress. Whatever decision you make will be right.

peace and love
dale
Posted 5/21/2009 3:11 AM (GMT 0)
Hi Geebra, I think maybe it is the Docs specialty, if you will, and the equipment they have access to that lends to the decision. Tony is correct in that they do a cat scan daily to line up the treatments, after the scan they feed it into the computer and get the alignment for the RT. My treatments consisted of 50 zaps from 7 different points.On the lighter side I told my main girl that was doing my RT that I had had 1700 or so zaps and she cracked up and told me nobody had ever counted them before....lol. My Rad Doc showed me my plan after he had it worked up on a cat scan and it was very interesting in full color showing the planned attack.I believe either one would be fine. I had my first visit with my Uro/surgeon today since my RT and he was very pleased and said that he had a lot of guys with my results that never had any more problems over the last 15 or 20 years. I will not see him again until November for another PSA. Good luck to you and keep us posted.

David
Posted 5/21/2009 3:49 AM (GMT 0)
Thank you, guys. You are the best! I am still trying to get an appointment with the Radiation docs. One in Central NJ, where I live and one in NYC, where I work a couple days a week. While I am waiting I am trying to figure out the logistical issues: - Would I be able to continue to work? How long would it take evry day all in (getting there, waiting, the radiation, and back) - Is it worth some logistical inconvinience to do it at Sloan Kettering vs. local hospital with good reputation? - Once the treatment is decided, how long is the prep - plans, cast, etc? - The NYC doc says he does not see anyone without MRI. Did you have to do any other tests? What about MRI? Is it the type with endorectal coil? - If I do another blood test this Fri and have the reasults in a week, when do you think realistically the treatment would start? I know this is a lot of questions, but I am trying to get all ducks in the row now... Thanks a lot, Greg
Posted 5/21/2009 11:19 AM (GMT 0)
I worked every day except for a couple of weeks at Christmas. I was a little tired with the treatments and I am in construction.
I think I would opt for a local hospital just for logistics.
My prep was 3 weeks for the mapping. The cast, tattoos and cat scans were done in 1 day and the MRI another. I think it is probably a work load issue and would vary from clinic to clinic.
My doc said that the MRI was to be sure I did not have any other issues, cancers, etc going on.
I would think within a month, depending on their work load.
I hope this helps. This is just my experiences and there is lots of guys here.
Keep us updated and ask away.....

David
Posted 5/21/2009 3:54 PM (GMT 0)
In that case David, if I tap you on the shoulder, it will just be to say Hi.

Tony
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