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Re: 3D-CRT

Does anyone know if the majority of people getting radiation treatment after surgery receive IMRT or 3D-CRT? Haven't read a lot about 3D-CRT anywhere so presume it's yesterdays solution? I might be wrong so would appreciate your thoughts on this.
Rene

Re: 3D-CRT

Rene,
After my surgery, back in 2007, when I got evaluated for radiation I asked the radiation oncologist about 3D-crt. I knew they did have the 3D-crt capable equipment. He said that it was not necessary, that the IMRT would do just as well in my situation. I do believe the charges are substantially higher for the 3D-crt, though we did not discuss that.

The bulk of my treatment was with 4 shooting positions for the beams. But for the last 7 treatments they made a change and I was getting 6 shooting positions as I recall. But no one advised me of any change to the IMRT nature of the treatment.

I believe that IMRT was used because there was no prostate remaining, and thus no precise location where cancer cells would be found. Rather they can just irradiate a volume within the pelvis where they are confident they will do no substantial harm. And where the cancer cells are most likely to be found.
And the IMRT is precise enough for that task. (This is just my personal view of things.)

Re: 3D-CRT

Rene,

It would be very difficult to answer your question:

Does anyone know if the majority of people getting radiation treatment after surgery receive IMRT or 3D-CRT?

Because that kind of data would be very diffcult to get hold of. At present there are many variations of techniques all designed to get a better aim and to reduce collateral damage. The reason for this, espcially as far as the prostate gland is concerned, is that there can be a fair bit of movement in the gland's precise location. Presumably, and I don't recall seeing anything on this subject, there is less concern about movement when the gland is no longer there, since it seems unlikely that there would be the same movement in the prostate bed.

I think the decision that are made might sometimes depend on the availability of the relevant equipment. But why don't you ask your radiologist to explain to you why they are suggesting this specific therapy and not any others?

All the best

Terry in Australia

Re: 3D-CRT

Terry. I can't get hold of him and I'm running out of time before my first tratment that's why I'm desperate for input from members on this site.
Rene

Re: 3D-CRT

Rene,
I am assuming that you have had your prostate out based on your later post.

I would first question whether you need radiation right away. What was your post surgery nadir(lowest) PSA? If your PSA in less than 0.02 then you might just want to wait and see if you get lucky and delay radiation treatment. If the nadir is more than .04 and/or is going up then get treatment before your PSA hits 0.2.

As far as the radiation machine; any old one will just about do ;-). Actually any beam shapping one will do since they don't precisely know where to radiate so it will be a box about 3 inches by 2 inches by 2 inches. No precision required. I went through this disccussion with my radiation oncologist too.

When you are on radiation you should also be getting hormone treatment and you might want to take a baby aspirin (a recent study claims it improves the chance of killing the cancer if you were high risk).

I am 2 weeks out of 5 through my radiation treatment and it has not caused any problems yet but I am told that it is the last week that is the toughest.

Re: 3D-CRT

Hi Frank
Gleason score 9, age 61, PSA before surgery 6.4 and 6 weeks after surgery 0.16 (that's the one that worries me!)
Thanks
Rene

Re: 3D-CRT

Rene,

I realise that oftentimes insurance calling the shots may guide final decisions, but surely you can delay the start of your treatment until you can satisfy yourself about the issues that are concerning you?

It is not as if you have evidence of the disease raging out of control - I would expect that the delay, if you do this, would only be a matter of weeks and that assuredly is unlikely to make any difference to the final outcome.

It is far more important, in my book, to be satisfied that what you are gong to to is BEST for YOU and not rush into something that you have doubts about.

Re: 3D-CRT

Rene,
Yes, go direct to radiation, hormone therapy and the aspirin. I would add pomegranate juice even though the results of a study on that are supposed to be released soon and haven't been.

You've got your prostate out which is good. You should live at least another 10 years and hopefully with another new treatment within those 10 years, a lot longer. That's what I am counting on.

Re: 3D-CRT

Rene,
Was your Gleason 5 & 4 or 4 & 5?

Re: 3D-CRT

4+5=9
Rene

Re: 3D-CRT

Rene,
The Sloan Kettering nomogram predicts a 64% chance that you won't have your PSA go up for 6 years after treatment if they include hormone treatment with the radiation. It is 40% without hormone treatment. If your PSA does start going up you have another 2 to 20 years on hormone treatment and then 2 to 10 years on chemo/experimental treatments.

http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx

If you do start looking at statistics it is important to look at the "death from prostate cancer" and not disease progression or just death number(it will include heart attacks, stroke etc.). It is easy to think your chances are not good when in actual fact your chances of dying from prostate cancer are still pretty low. If they took your prostate out then they think they can keep you alive for a long time otherwise they just close you up without doing the operation and put you on hormone treatments.

Re: 3D-CRT

Thanks to everyone - will let you know how I go.
Rene

Re: 3D-CRT

Update
Have just finished 7 weeks of Radiotherapy and everything seems ok except the frequent urination. Peeing once an hour sometimes more (at night). This is driving me nuts so any help would be much appreciated.
The Radiation Oncologist put me on Flomaxtra but it's not making things better.
Cheers
Rene

Re: 3D-CRT

Rene,
Have or do you get ultra sounds at the Urologist? This is now a fairly inexpensive way to find out if you are retaining urine.
They lube you up just over the pubic area and rub the small hand held sensor until it beeps. The machine then prints out the volume of your bladder.
If you are having trouble emptying, your doctor may be able to prescribe medication that can help.
Between radiation, hormone, and late soft tissue damage, I know what a pain the sleep interruption is.
Good luck - p (Alaska, USA)

Re: 3D-CRT

Thanks Patrick
Haven't had an ultra sound yet but will ask the Oncologist about it when I see him.
Just a couple of questions if I may.
How long does this frequent urination last, it's been 4 weeks since I finished the radiation and it's driving me mad?
What sort of things can I do myself to make sure the bladder is completely empty?
Thanks
Rene

Re: 3D-CRT

I hate to respond to your latest question Rene because, in my case it isn't good news.

When I had radiation seed implant in 10/07 followed by external radiation in 12/07 & 1/08 the Oncologist told me that I should see significant recovery from urination symptoms in three to six months.

I read many stories on this site and discovered that it can take as much as two years and, for me, that was accurate, although there was a bit of recovery each month during that time

I'm now two and a half years post radiation treatments and am 95% improved.

Please remember that every case can be different, but, it will get easier as time allows.

Re: 3D-CRT

Thanks Phred
Thanks for being honest, I cope better when I know what I'm dealing with.
Is there a medication they can put me on in the meantime?
Anyone else out there been through this and what are your experiences?
Cheers
Rene

Re: 3D-CRT

Rene,

I'm afraid I can't be much help predicting "how long it will last". Seems like it depends on individual tolerance to radiation and the amount of surrounding tissue (including the bladder) affected.

With me it started subsiding about three months after treatment only to return 2 years later in the form of strictures and an irritated bladder. After having a "mild" TURP last August, it took 8 months for the pain to leave. As of today, I can sleep 3-5 hrs. at a stretch and have my incontinence (result of TURP) return to about 95%.

Meds prescribed for urine flow were Flomax and Rapaflo (not at the same time). I have discontinued these. Meds for bladder spasms were Enablex, Detrol (both discontinued), and Toviaz.

I also went through 8 weeks of Hyperbaric Oxygen Therapy but don't expect any insurance help with this treatment unless this becomes a chronic problem.

I'm due for a PSA shortly and I'll post those results but so far that has been the best news.

The one thing you should know is that with time things will get better especially if you do your Kegels and other activity that increases blood flow to the area.

Good luck - p (Alaska, USA)

p.s. Also watch what you eat or drink during this time as the Urinary system is very sensitive to certain things. Your doc should have a list of what those things are!

Re: 3D-CRT

Thanks Pat, much appreciated.
Rene

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