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Completed SBRT Simulation Planning (CT and MRI)

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Prostate Cancer
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Posted 4/7/2018 3:57 PM (GMT 0)
I completed my CT Simulation planning yesterday at UNC-CH. Here is an update for those interested in SBRT.

Catheter was more difficult than expected, but not as tough as a biopsy. The hardest part was waiting about 1.5 hours between the CT and the MRI. They filled me up with saline, and clamped off the catheter. It stayed this way throughout the CT, and until my MRI was completed. I watched the Masters on my smartphone between sessions to help forget about the discomfort. They used the 3T MRI. Apparently leaving the catheter in during the MRI meant that I did not have to have any contrast injected.

I had an early dinner in Carrboro and headed home. I was stuck in traffic for 3 hours, but did not have to stop for a a bathroom break. Had 2 beers with friends at a local pub and felt fine.

Cyberknife treatment will begin on 4/23/18 and last for either 4 or 5 days. The length of time will be decided after they review the CT and MRI. Dosage will be either 36.25 grays or 38 grays. I was a little surprised to hear that 4 days was an option. At this point I am scheduled for 4 days, and they will add another day if needed after the planning.

RO did prescribe flomax and asked me to begin taking that now. I may wait until about a week before. Is that a bad idea?
Posted 4/7/2018 4:13 PM (GMT 0)
I may be getting forgetful, but I don't remember getting a catheter for the SBRT prelims. My RO also recommended something similar to Flomax. I think it's a good idea, because maintaining adequate urinary flow is important.
Posted 4/7/2018 4:24 PM (GMT 0)
I also agree that the catheter for the CT was the most difficult part of the preparation. My RO started me on Flowmax right after the CT simulation so about a two weeks before the start of treatment. Don't know if its really kicked in yet. I congratulate you on your urinary control, I would have had to pee four times before I got to the pub!
Posted 4/7/2018 10:02 PM (GMT 0)
I didn't have a catheter, and my CT and MRI were together. I was in and out in under an hour.

Some do it in 4 treatments at 38 Gy, which delivers a very high biologically effective dose (BED). Its BED is a third higher than the 36.25 Gy in 5 treatments. The 4-day plans usually use a technique called "heterogenous planning," where there are intentionally some hotter and some cooler areas. It more closely simulates HDR brachytherapy, where there are hotter areas along the catheters and cooler areas between them. That's why sighting the urethra with a catheter is very important - they have to devise a plan where hot spots avoid the urethra, otherwise it could be damaged. I think it's prudent to do it with 4 every other day treatments rather than 4 days in a row to allow for more healthy tissue recovery in between treatments.

I think it's a good idea to start flomax, ED meds, and NSAIDs (Aleve, Motrin) before the first treatment. And of course, vigorous exercise is important.
Posted 4/8/2018 2:23 AM (GMT 0)
Thanks everyone!

I will start the flomax about a week before the treatment begins and plan some extra exercise.
Posted 4/8/2018 6:09 PM (GMT 0)
3 Putt. Treated at Cleveland Clinic last June and I agree the saline and catheter to better define the uniary tract were not comfortable. CCF also uses an endorectal balloon for both the simulation and each of the five treatments. The balloon appears to both stabilize the prostate and thin the rectal wall and they claim to have fewer GI side effects when using it. Although I had no GI side effects (not even a wet fart) I did experience some mild burning on urination following the third treatment. The burning lasted for only about a week or ten days in total. Only 'mild' and I never did take the Flowmax since it was so mild. When I consider the side effects and issues associated with other treatments....this was a piece of cake. I was able to maintain a very active exercise program including cycling during and following treatment. I believe remaining active helps. I did feel a need to urinate even when I knew my bladder was empty whey cycling. My guess is that either irritation or swelling from the treatments was pushing up against my bladder. I keep looking for negatives but there hard to come by. Sex is still great (without meds) for my wife and I and she says she can't notice any difference except for the smaller 'wet spot'. Post PSA's following treatment continuing to drop. Best of luck to you on the journey.
Posted 4/9/2018 2:20 PM (GMT 0)
I think we're seeing that even among the SBRT practitioners, there is still a variety of protocols in use, both in prep and in treatment.

In my prep, the most uncomfortable part was the placement of the fiducials. I could not have an MRI (my pacemaker is not MRI compliant) but did have CT's - both with and without contrast. The catheter was uncomfortable, but after all the surgical procedures I've had, not a big issue. I did ask the tech if he had that darn catheter calibrated in feet, and he said "Heck no! Yards!"

My CyberKnife treatment was 36.25 Gy in 5 fractions, on a Wednesday, Friday, Saturday, Monday, Wednesday, IIRC, as we needed to complete it before the Thanksgiving holiday that year.
Posted 4/9/2018 7:26 PM (GMT 0)
I had a catheter for the simulation. No recommendation to start flowmax early ( but wish I had ).
5 treatments total of 36.25 GY. The 5 treatments were monday thru friday.

So it seems there are differences between RO's.

Only issue I had was the catheter being a bit painful when inserted.
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