Post consult, pre SRT questions

Guys, two quick questions. First, at my SRT consult last week, the RO mentioned Calypso, where trackers are placed inside me for real time RT machine adjustments. I would need to have a procedure to place these markers in me. He presented this as an option, but kind of worded it that it is the best way to go. Is it? I thought this was more an acceptable practice with RT as a primary treatment. Second, his use of HT is Lupron (I asked about Firmegon??). But I see some guys out here on HW getting Lupron and Casodex. What is Casodex used for? Would I need that, too? Thanks. J

Good answer from Italatin8. The flare up concern is only when you are expected to have mets as I understand it. In my case it (Casodex) was positioned as just the standard of care to complement Lupron to ensure efficacy of testosteron reduction by attacking from two different angles. I am aware of the "implanted markers" approach you note but was not presented that option...I also thought it was reserved more for primary treatment but I don't know all of its applications.

JayMot - I finished ART in mid-June with a Varian Trilogy IGRT/IMRT machine which does a CT scan every day. This is when they tell you your bladder is not full enough or your bowel has gas or stool in it and to remedy the problem. I think the Varian TrueBeam can do the Calypso treatments (SBRT). However, I am not sure what they would mark with no prostate as Pratoman noted.

The advantage of SBRT machines is typically higher dosage in less sessions for primary treatment due to better accuracy and tracking in real time. I asked my RO if I could get SBRT for my adjuvant treatments and be done in a week and he said no, wrong tool for ART/SRT and they had the TrueBeam machine in the next room so no reason to not recommend it if appropriate.

My understanding (don't trust me) is they want to mop up a large volume around the prostate's former position and apply some radiation to the bladder and rectum areas (so many mm of depth) but not necessarily the full dose. So you go in for the 36-40 treatments of low dose radiation and get really tired of the daily regiment.

I would double check with your RO about the plan. It could be a new technique for ART/SRT so you would want to understand that if the question is being asked about markers.

JNF - I took your suggestion to search further on markers and ART/SRT and just got more confused. There is a lot of discussion but was unable to determine what the current state of practice might be. When you get into the weeds of the discussions, there are limitations to tracking movement with markers that may not make it helpful for some treatments. Seems the full bladder and empty rectum/colon is as important as anything.

I don’t see my RO until Sept so cannot ask for a while but it was never mentioned for my ART with a Varian IGRT/IMRT process and they had all the equipment available to do any type of treatment scheme. Maybe it is the same reason he said that 37 treatments are required for ART, nothing shorter.