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Difference between RT and ART?

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Posted 7/1/2015 1:51 PM (GMT 0)
What is the difference between adjuvant radiation therapy and radiation therapy (other than the obvious that ART is used in conjunction with another therapy?) Looks like I'll be starting ART in the next 6-8 weeks and I was wondering if there is any between the two like number of treatments, possible side effects, etc.
Posted 7/1/2015 2:27 PM (GMT 0)
Only in the details. IMRT, IGRT, RT, SRT, ART, SBRT are all ways of delivering radiation to the prostate.

RT if used with HT has more side effects than just radiation.

In general you can expect about the same side effects all us radiation folks get, bowel troubles, fatigue (for some), learning how much water to drink, etc...

If you're getting HT as well, then you'll have an additional constellation of SEs to enjoy.
Andrew
Posted 7/1/2015 7:13 PM (GMT 0)
In terms of side effects, aRT is the worst, sRT is a little better, and initial IMRT is the best. There is a compounding effect when radiation is given on top of tissues damaged by surgery, so recovery of ED and continence may be delayed or prevented (incontinence is very rare with initial IMRT). A daily ED med like Cialis, used from the start, may help prevent further damage to the neurovascular bundles, but I can't point to proof of that.

ART and sRT are typically completed in about 35 treatments with a total dose of about 70 Gy vs. 40-44 treatments with a total dose of about 80 Gy for IMRT

In your case, they will also treat the pelvic lymph nodes with a dose of about 50 Gy, and there is some potential for some bowel side effects from that.

I expect they will also give you at least short-term hormone therapy with it.

- Allen
Posted 7/1/2015 7:16 PM (GMT 0)
ART treatments are pretty much the same thing as IMRT -- similar dosages (maybe a bit less), similar side effects, similar number of sessions. I had 66.6 Gray over 37 sessions, timed to end six months after my surgery.
Posted 7/1/2015 7:22 PM (GMT 0)
I had thought about mentioning the continence problem that Tall talked about but since you didn't mention incontinence in your signature I figured, why spoil the surprise?

The received wisdom on radiation after surgery is that it tends to stop your urinary continence recovery wherever it is and maybe set it back a bit.
Posted 7/1/2015 9:42 PM (GMT 0)
Thanks y'all. Amazingly I was fully continent the moment the catheter came out and four months out we're still doing good in that department, just a little stress issue like most. Not so lucky with little willie, not sure if he will ever be up for the job without extraordinary intervention.

When I was talking options with the urologist/surgeon (Assistant Professor of Urology at UT School of Medicine if you're not following my other other thread) it sounded like an either/or situation: AS, -or- hormone, -or- radiation. Pick one. I said I didn't like the idea of AS or HT, so we settled on aRT. He's going to set me up with an RO at MD Anderson soon.

I was so looking forward to be into the getting blood drawn mode every x months but we're not done with my body getting assaulted.
Posted 7/1/2015 11:11 PM (GMT 0)
Hi John
Side effects ...depend on individual, some had went thru not a single issue. Others were not
Myself ...consider lucky...only the last couple of sessions got fatigue and need more rest.
All the best on which ever next treatment you are choosing.
Posted 7/2/2015 2:05 AM (GMT 0)
TA wrote a summary that hits the main points.

I did ART after surgery. I kept an almost daily log, linked in my sig (below).

I had colo-rectal surgery before the PCa adventure, so had a completely separate but equally exposed area of surgical scars to be damaged by the radiation, so my experience is somewhat uglier that the norm.
Posted 7/2/2015 1:22 PM (GMT 0)

142 said...
..I had colo-rectal surgery before the PCa adventure, so had a completely separate but equally exposed area of surgical scars to be damaged by the radiation, so my experience is somewhat uglier that the norm.


Interesting. I've had on and off issues with bleeding hemorrhoids and my local GI doc wants to apparently do a colonoscopy which might lead to something else, I see him next week and I'll find out for sure what his plans are. My urologist said it would be good to get this taken care of before aRT because bleeding would indicate possible side effects from radiation.

But it sounds like I would be introducing more problems if he does surgery and then I have scar tissue to be aggravated with radiation. Sigh.
Posted 7/2/2015 2:20 PM (GMT 0)
John

You are in some great hands at Anderson and no doubt getting some great advice there as well as here.
One question for you concerning bleeding hemorrhoids; have you heard of banding? I had it done at Vanderbilt in Nashville over 20 years ago and it worked great. There is minimal discomfort and you do not know when you pass the the dang things. (In 3 to 4 days) My wife drove me home, a two hour trip, right after the procedure. You can return to most daily activities the next day. Surgery on the other hand is painful and debilitating for several days.
Just trying to help a brother PC patient avoid some unnecessary pain and grief.

Woody
Posted 7/2/2015 2:53 PM (GMT 0)
Thanks Woody! I'm anxious to hear what the GI guy wants to do.
Posted 7/3/2015 6:39 AM (GMT 0)
John_TX,

Once you've got colo-rectal issues, I wouldn't know whether treated / untreated area is worse for RT, but I suspect untreated. Why? If you are treated, and everything heals up well, you radiate scar tissue. Ugly, but ...
RT on untreated but inflamed areas has the same potential issues as RT too soon after PCa surgery - that unhealed tissue may never heal again.

My colo-rectal guy saw me far too many times in the lead up to ART, as they were concerned that things were in as good a shape as possible before starting.
Posted 7/3/2015 1:15 PM (GMT 0)

142 said...
..If you are treated, and everything heals up well, you radiate scar tissue. Ugly, but ...
RT on untreated but inflamed areas has the same potential issues as RT too soon after PCa surgery - that unhealed tissue may never heal again...


Good point. My appointment is next week so I'll be able to intelligently discuss the scenario with him.
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