Radiation questions

You sorta fit my situation as far as locale and services. Some things I asked the rad. onco I consulted were:

What criteria do you use to determine when to begin? Is it PSA results and if so, when is the kick off point? In my case, it was the second above .20 result, which is the 'national recommended standard"

What will be radiation dose and over how many sessions?

Will I need to drink water before hand and if so, how much and when?

What will be your radiation treatment pattern? Will you hit or avoid the rectal wall, the bladder and such. Show me a diagram of what you would radiate of my internals.

Will you radiate the remains of the seminal vessels structure? How about the lymph nodes? How many will you radiate.

What do we do if I start having pain for extreme discomfort during the sessions? (The reason for this one is Purgatory and a couple others experience with misalinged or reflected radiation causing damage and pain. You need to reach an understanding up front of how and when you will stop and figure what is happening. Don't count on them wanting to stop, unless you have discussed it before hand. This will show him you are a doctors nightmare- an informed patient.



I would think he may want to wait for 6 weeks or maybe 3 months, for healing to finish, along with allowing time for a better read on what your true psa is. 2 weeks is too early to test and know anything. I am sure there will be other suggestions. Good luck.

My biggest concern in your shoes would be incontinence - it is sometimes said that the level of incontinence you have at the start of SRT is what you will end up with permanently. That is the main reason to wait after surgery before starting. A conversation about this would be merited.

What SE does the doc expect you to experience? What will he do if you experience them?

I would strongly suggest you find IGRT if at all possible.

They take a Cat scan prior to every treatment. Then they adjust the treatment based on the positioning of your organs that day. Pretty neat stuff.

They will tell you if your bladder is full enough or if you need to evacuate your rectum.

I would discuss wide pelvic that also radiate the lymph nodes, depending on what your PSA does.

I made it for 3 years until I saw a definite pattern in my PSA to suggest a BCR.

Good luck. It really is no big deal except for blocking out 7 weeks of time to be at the radiation site.

Yes, a CT scan before each treatment---that is the essence of I *G* RT. The "guided" part. It's a minimal CT scan just to see where the organs are on the day of treatment. I was given three "dot" tatoos--one on the side of each hip, and one near the pubic bone. They line the machine up on these dots each time, assess the innards, then zap you.

I had a resurgent pc-related tumor surrounding and actually INVADING my bladder last Fall (they could see it when I was scoped!!). After 80 Grays of radiation, I had NO side-effects except extreme fatigue. I had full continence, no strictures or other complications, no diarrhea or bowel problems, etc.

I did the IGRT thing as a primary treatment and my RO said the radiation from the daily CT is little compared to the therapeutic dose. You could ask if they count CT radiation dose in the overall amount you'd receive.

The question I'd be asking is the skill and experience of the doctor and the technicians doing the treatments. There skill and knowledge is key to having a successful treatment.

Don't know if I missed this in the thread but I'd also make sure you've very clear on what will trigger the need to have the radiation (specific PSA, scan, etc).

There are a lot of tradeoffs in this PC treatment game. Yes, you are exposed to a few more particles of radiatio with the CT scans, but just consider the potential impact of having all of your treatments based on one scan.

Your organs do shift and move. One day they may adjust by 4 mm, the next day 6 mm. Much of the shift is due to the rectum, which is in essence the main part of the prostate bed. Without the IGRT, they might be nuking my rectum several mm deeper, which is not a good thing.

I am really impressed with the precision of the technology.

Goodlife

I only had a ct scan once when I got my tatoos and they checked out my insides. After that I got a simple xray to fine tune the machine after lining up on my tatoos.

The added radiation from lining things up was likely no more than 1/10 of a gray over the 30 treatments using the limited information I have right here. The treatments themselves totaled 68.5 grays.

I'm sort of reminded of the scene in "Butch Cassey and the Sundance Kid" where the posse is chasing them and Butch and Sundance are faced with jumping off a cliff into a river. Sundance is concerned that he can't swim until Butch points out the fall will likely kill him.