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Posted 6/18/2013 11:29 PM (GMT 0)
I'm 76 yr old, was diagnosed 4 yr ago. First bx was 3+3 in 2 cores only. PSA 4.5. Gleason 6. DRE questionable or negative.
For these four yr I did A.S.
PSA: went up from 5.8 to 8 on 12/12. Previous bx was inconclusive with atypia but no malignant cells.
Bx now shows "Gleason 3+3. tumor present in 1 of 2 cores,involving 5% of needle core tissue."
"Gleason 4+3, tumor present in 1 of 2 cores,involving 20% of needle core tissue"
Pelvic scan with double contrast 3 wks ago: negative, except for atherosclerotic changes, renal cysts which I've had before, etc. Nothing worth mentioning.
I'm about to start IMRT.
It looks that my prognosis for survival is good. What I'm worried about now is the side effects. Not so much the sexual area as much (I'm single, divorced and without female companionship). What worries me more is the side effects, especially urinary/rectal effects of radiation like burning, pain, possibility of ca of rectum, bladder, etc.
Could I hear the experience of some of you who have had already IMRT?
Thanx a lot!
Posted 6/18/2013 11:50 PM (GMT 0)
Hello .....

I believe where you are at right now, is where I was at in 2003/2004 - except, of course, that technology has most likely improved over the past 9+ years.

I am 70 years old, divorced and have not had a female companion for almost three years - so there is some commonality there too.

Prior to my Brachytherapy treatment (96-seeds) in 2004, I had what was then called External Radiation - radiation accurately shot to three different marked points in the pelvic area - and it was done daily or 5 times a week for 5-weeks - total of 25 treatments about two months before the Brachytherapy.

I was 61 at the time, and my side effects were not at all strong. My appetite was fine and there was no lingering pain at all. It did tire me out and the nausea was very minimal.

Now, at 70, my side effects have been greater ... but with different forms of treatments - so that's not a fair or accurate comparison. I would guess that your doctor gave you some sort of literature outlining the various types of side-effect "possible" - but it is just that - "possible" and nothing more.

Good luck on your upcoming treatments - wish I could have been a little more help!

Posted 6/19/2013 4:54 AM (GMT 0)
There is now a whole new generation of LINAC's (Linear Accelerators) the machines they use to deliver the radiation in use. A Varian RapidArc is one of them. These new machines can deliver a stronger dose to the target area quicker while avoiding healthy tissue much better than the older equipment. Rectal and bladder damage is no longer the problem it once was..I would find an R.O. who has access to one of these newer machines...Many R.O.'s today like to add a year or so of HT to act as a adjunct to the radiation. This seems to boost the effectiveness of the radiation by a considerable amount. But it also adds to the side-effect load...See how your R.O. feels about this..

Best of luck to you and welcome to the forum...
Posted 6/19/2013 7:57 AM (GMT 0)
You can now get the whole thing done in 5 treatments with fewer rectal and urinary side effects. It's called SBRT. I had it done with Novalis RapidArc, but it's usually done with CyberKnife. The important thing to reduce toxicity is to track the motion of the prostate both within and between treatments and delivers the radiation with sub-millimeter accuracy. (Most IGRT techniques only track between treatments).The total amount of radiation delivered is only half of what is needed with IMRT, yet it is equally curative. Unless you're one of the unlucky ones who are genetically predisposed to be super-sensitive to radiation, side effects are generally mild, irritative and very temporary.

The probability of a secondary cancer in the area is about 1% with IMRT according to one study-There are no long enough studies, but since the dose to organs at risk is less, I'd guess the secondary cancer rate is much less than that with SBRT.
Posted 6/20/2013 6:32 PM (GMT 0)
Tall Allen:
My understanding is that the amount of radiation at the end of the Rx is the same whether you get IMRT or SBRT.
Thus, your statement that one gets less radiation (half?) doesn't make sense to me. It should be the reverse. I'd like to hear your reply please.
One problem I have with SBRT is the lack of enough (if any) long term follow up, well controlled studies published regarding side effects.
I want to thank you all for your comments and insight.
As a newbie, it feels good to be welcomed by all of you.
Best to all!
Locolindo
Posted 6/20/2013 8:02 PM (GMT 0)

Locolindo said...
My understanding is that the amount of radiation at the end of the Rx is the same whether you get IMRT or SBRT. Thus, your statement that one gets less radiation (half?) doesn't make sense to me. It should be the reverse. I'd like to hear your reply please.

IMRT is usually 40 treatments of 2 Gy each = 80 Gy. SBRT is usually 5 treatments of 7-8 Gy each =35-40 Gy. However, the biologically equivalent dose of SBRT is actually higher for SBRT vs IMRT. This is because the low alpha-beta ratio (about 1.5) of prostate cancer has a multiplier effect on the cancer cell kill rate when the radiation is given in fewer more intense doses.

Locolindo said...
One problem I have with SBRT is the lack of enough (if any) long term follow up, well controlled studies published regarding side effects.

Six years is the longest I've seen for SBRT. Ten years is the longest I've seen for dose-escalated IMRT (from MSK).

I agree that it would be great to have randomized controlled studies for any treatment. To my knowledge, they do not exist for IMRT vs SBRT, IMRT vs RP, IMRT vs BT, IMRT vs PT, IMRT vs AS, or any pair of those five common alternatives for initial PC therapy.
Posted 6/20/2013 9:31 PM (GMT 0)
Thank you, Tall
Posted 6/20/2013 11:35 PM (GMT 0)
Locolindo,
Congratulation on making an excellent decision on your treatment. I had 79.2g's IMRT in 44 sessions; I'm satisfied with my decision since it was really my only logical choice--2 treatments didn't thrill me so I decided to do "it right the first time"..
Dink plenty of fluids to prevent "freezer burn"..I probably didn't and then had a colonscopy afterwards--a bad decision. Since I'm on lupron it's impossible for me to seperate the SE's..Your RO may recommend a short course of adt for 6-12 months to increase the radiation's effectiveness--maybe not with your low stats.

The treatments daily are a cake walk and shouldn't take more than 45 minutes of your time..Fatigue may be you biggest SE if you aren't on hormones..
All the best to you!
Bill eyes
Posted 6/21/2013 1:36 AM (GMT 0)
Loco,
The side effects of radiation differ per individual, but the normal expected SEs are:
ED- 35%
Urethritis- 2%
Proctitis- 2-4%
Secondary cancers are a non starter in your case at less than .5% in 20 years.
The real issue is Proctitis, which can make your life miserable if you are one of the unfortunate rare individuals that get it.
Your prognosis for survival is very good and at 76 the probability of dying from PC is very low even if you choose not to undergo treatment..
Good luck
JohnT
Posted 6/21/2013 2:12 AM (GMT 0)
John T: appreciate your post, thank you!
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