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IMRT - need to understand more

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Posted 9/18/2009 5:45 PM (GMT 0)
David, I think I may be head down the path for a suprapubic catheter, not real appealing after all my caths and cath time, but it would be worrying about this all the time. My only guess, is that the last corrective surgery did nothing for me, it was the painful dialation process, but now that's it been a month to the day, it's returning to its pre-dialation level. My new rad. oncologist thought the suprapubic method might be the best thing to get me through two months of radiation, and then go back to worrying about the bladder neck problem later.
She doesn't want me blocking up in the middle of RT, or needing to go to the ER to deal with it. We will see, real tired of the entire mess after 10 months.

Let you know how the VA thing goes.

David in SC
Posted 9/18/2009 8:15 PM (GMT 0)
David, that makes sense to me. I hope all goes well with the radiation treatments.
Posted 9/18/2009 8:53 PM (GMT 0)
Thank you squirm.
Posted 9/20/2009 12:22 AM (GMT 0)
Hi David,

Been out of touch for the last week and I see that you have many replies but I will add mine to the reading.



I think I understand that they can safely give you more gys with IMRT, but not sure. (This is the case when coupled to IGRT "Image Guided Radiation Therapy". The combined regimine allows for improved targeting of the prostate or bed if it has been removed so that the surrounding organs [bladder and rectum] recieve a lower dosage. I recieved 81 G as primary treatment. I believe the dose is lower with salvage.)

I think she said you don't have to feel your bladder up before treatments, does that make sense? (I was told to drink enough water to partly fill the bladder. I drank about a pint before each session)

What are typical gys given for radiation as a primary treatment vs. gys for a salvage job? (81 is fairly typical some less not too many are higher for primary. Don't know on the salvage)

I think in the last phone call, she was talking as much as 72, isn't that a lot for salvage only? (Do not know)

And as a reminder, she was dead set against including HT as part of this process. (I am halfway through the ADT part. My research and my doctors said results are superior with ADT. Of course in my case we were talking about radiation as primary vs. surgery.)

David, I have had no long term side effects from the radiation and only a short episode of urinary and bowel disfunction during the treatment. As Tony said earlier the hormone has been a bigger nuisance. I still have a year before I can try to take a break.

Best of luck to you.

Don
Posted 9/20/2009 3:07 AM (GMT 0)
Hello Don,

Thanks for writing. Your 81 gy does sound in the ball park for RT as a primary treatment. The 70-72 gy that my new doctor is suggesting is based in part on my pre- and post- surgery psa velocity. She feels its still local in the vincinity of the one postive margin I had. She changed to IMRT to help minimize some potential problem areas for me, especially the stricture/blockage problems I have experienced in the 10 months since my main surgery, despite two corrective surgeries. I certainly have a second list of questions for her when we meet again this Monday morning, to begin the setup and marking process for the treatments. I still don't want to do this, and not to be repetitive, but because of the severe RT problems and side effects I had 9 plus years ago for other cancers, and as I write, I am beginning the process of slowly blocking up again even though I had laser corrective surgery for the very same problem a month and a day ago, requiring another 38 days on a catheter. Just very tired of the entire ordeal. Honestly seems like its never going to end.


Glad you are holding your own too.

David in SC
Posted 9/20/2009 3:15 AM (GMT 0)
David-I have followed your story and can feel your frustration.  You deserve a break.

Just out of curiosity, will you get another PSA test before the radiation starts?  It would give you one additional piece of information as you embark upon the radiation..

Dave

Posted 9/20/2009 4:08 AM (GMT 0)

IMRT & IGRT are much better than the old Radiation, but if your concerned with precision look into Proton Beams. I understand that Loma Linda does some salvage radiation. Not sure what the requirements are, but worth asking.

David your scar tissue is re-forming, I'd guess, as it did for me. I'm just living with it.

Ken

Posted 9/20/2009 2:41 PM (GMT 0)
Dave, I don't think so, though personally, I think it would be a good idea and will ask the rad. onc. in the morning before the fun begins

Ken - proton beam not available in my area, limited health insurance doesn't want to pay for any out of area treatment. Sure it is scarring again, but its only been a month since they did the day surgery with the laser, one month. After the last corrective surgery there, I lasted almost 6 months. I need a better solution.

In general, despite my 0900 appointment in the morning, I still have more doubts, fears, and concerns about this step. I don't like feeling this way, part of me realizes its the only reasonable course of action, I am pretty convinced I have re-occourance. I don't like doing something this major feeling so negative about it. I was hoping I could reconcile my mental doubts with reality and come to terms. Not there yet, mabe I never will.

Unless my new doc takes full control and will factor in this blockage issue, I don't know what else to do. I am not in the denialist school at all, not anytime in my life with what I have faced, but there is a part of me that screams to put a brake on the whole PC thing, and just go on with my life and do nothing more, what will be will be. I hate the proverbial sword hanging over my head, which in my case started back in 2007 when my psa shot past the 4.0 limit. Since then its been one thing after the other. Just venting.

David in still a soggy SC, Go Patriots!
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