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Thread: What I Need to Know About External Beam Radiation Treatments

  1. #21
    HighlanderCFH, I like BeeMan had big concerns when I read this study after completing (IMRT). So I did some research on the old vs. new equipment and also talked with Onc about this as he has the old (EBR) and the new LINEAR ACCELERATOR as well. Here is what I learned. The (EBR) shoots a proton beam of radiation to a specific AREA and whatever is in line with that beam gets radiated. The LINEAR ACCELERATOR still shoots a proton beam of radiation but it has real time imaging combined wit a CT scan that allows the CT to overlay the real time image thus getting 100% perfect alignment every time. The beam still goes completely thru but it's able to effectively hit a target the size of a pin head every time, so the unwanted tissue damage is now significantly reduced. So having a full bladder is not a necessity it's just the way it's always been done. However, a clear colon is necessary as the aligning process is much more difficult and you wont have the squirts every day. The LINEAR ACCELERATOR even matches your breathing respiration to maintain alignment. When I showed the Onc the study you posted his remark was the same as yours "SKEWED". For the exact same reason you had mentioned (EBR) is old technology and the numbers are correct for (EBR) not for LINEAR ACCELERATOR I hope this helps the ones who are on the fence about their options and the ones who have completed (IMRT) Rob
    53 yrs. 6' 4" 285 lb. in general good health
    Feb. 2014 PSA 17.5 DRE BPH no lmps. local Uro confirm PSA, DRE, bone scan neg.
    ct scan neg. biopsy confirm(adenocarcinoma)12/12 cores gleason 4+5=9 @115 gr. (70%-100%) involved. no perineural invasion Mar. 2014 start HT (lup/cas) (surgery not an option due to size, and chance of spread to nodes)May 2014 start (IMRT) rec. 3 tatts (alignment) 45 days 9 pos. 20 sec. ea. (linear excel.)@ MOJAVE RADIATION ONCOLOGY CENTER Jun. 2014 start (flomax) 2xd urination issues, big help! July-9-2014 finish (IMRT) follow up in 2 wks. PSA in 3 months No serious side effects from (IMRT) stamina and urination (minimal) HT cont. (NO FUN) PSA as of 9-18-14 2.02 (Nadir) Stop HT retest 3 mo.
    I work harder @ staying positive than I do @ beating CANCER!

  2. #22
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,186
    Great comments. Thank you.

    Your post should help new patients be aware to ask what type of radiation equipment a doctor has if radiation is the chosen treatment.

    This is what makes this such a valuable forum.

    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  3. #23
    Quote Originally Posted by LIBMRDUCKS View Post
    HighlanderCFH, I like BeeMan had big concerns when I read this study after completing (IMRT). So I did some research on the old vs. new equipment and also talked with Onc about this as he has the old (EBR) and the new LINEAR ACCELERATOR as well. Here is what I learned. The (EBR) shoots a proton beam of radiation to a specific AREA and whatever is in line with that beam gets radiated. The LINEAR ACCELERATOR still shoots a proton beam of radiation but it has real time imaging combined wit a CT scan that allows the CT to overlay the real time image thus getting 100% perfect alignment every time. The beam still goes completely thru but it's able to effectively hit a target the size of a pin head every time, so the unwanted tissue damage is now significantly reduced. So having a full bladder is not a necessity it's just the way it's always been done. However, a clear colon is necessary as the aligning process is much more difficult and you wont have the squirts every day. The LINEAR ACCELERATOR even matches your breathing respiration to maintain alignment. When I showed the Onc the study you posted his remark was the same as yours "SKEWED". For the exact same reason you had mentioned (EBR) is old technology and the numbers are correct for (EBR) not for LINEAR ACCELERATOR I hope this helps the ones who are on the fence about their options and the ones who have completed (IMRT) Rob
    Just to correct 2 slight misconceptions. First,Tomotherapy is just a brand name of a form of IMRT. IMRT is just a modern form of EBR but it's still EBR.
    Second, The treatment beams of these machines are high energy x-rays (gamma rays), not proton beams. The two are VERY different and they ALL are linear accelerators (LINACS).
    Proton treatment is EXTREMELY expensive and the jury is still out as to whether it has any real advantage over EBR.
    In today's world, the issue is not so much the equipment used but the location and stage of the disease versus the training and experience of the radiotherapy team.
    Age At Diagnosis: 59
    Pre-Op PSA: 4.5
    Diagnosis: Prostatic Adenocarcinoma
    Surgery: Retropubic Radical Prostatectomy (RRP) 07/16/2012
    Stage: pT2c,pNO,PMX
    Gleason Grade: 4+3=7 (Not-So-Good Cancer)
    Extraprostatic Extension: Neg.
    Lymph Nodes: Neg.
    Seminal Vesicles: Neg.
    Positive Margins
    Tumor Quantitation: <5% Of Prostate
    Tumor size: 1.1cm.
    High-Grade PIN
    Perineural Invasion: Present
    Post-Op PSA: 0.4
    Completed 35 sessions adjuvant IMRT on 12/13/2012
    PSA as of 01/10/2013: 0.2
    PSA as of 04/12/2013: 0.1
    PSA as of 07/10/2013: <0.1
    PSA as of 10/08/2013: 0.1
    PSA as of 01/15/2014: 0.2
    Still holding at 0.2 7/15
    0.3 as of 12 month ago.
    0.8 as of 9 months ago.
    1.8 as of 6months ago.
    1.6 as of 3 months ago
    7.3 as of 05/15/2017
    Bone Scan 06/08/2017 Negative
    9.3 as of 06/14/2017
    0.8 as of 01/22/2018

    'Archaeologist of The Forum Archives'


    "Every day above ground is a good day". -- Scarface




  4. #24
    Hi BeeMan, How are you feeling after completing the (IMRT)? Are you still on HT? Are you experiencing any side effects that are new? Prior to my (IMRT) it was explained to me that I would lose most if not all of my body hair. Well I had seen and talked to people with various types of cancer and they all lost their hair after Radiation Treatment, so I figured I would as well. However, I had no loss of hair during or after treatment. How about you were you able keep it or lose it? OK, last question, if you could go back before (IMRT) with what you know now, would you make the same choice or take another option? Very personnel I know but I appreciate your directness with these issues. Thank You, Rob
    53 yrs. 6' 4" 285 lb. in general good health
    Feb. 2014 PSA 17.5 DRE BPH no lmps. local Uro confirm PSA, DRE, bone scan neg.
    ct scan neg. biopsy confirm(adenocarcinoma)12/12 cores gleason 4+5=9 @115 gr. (70%-100%) involved. no perineural invasion Mar. 2014 start HT (lup/cas) (surgery not an option due to size, and chance of spread to nodes)May 2014 start (IMRT) rec. 3 tatts (alignment) 45 days 9 pos. 20 sec. ea. (linear excel.)@ MOJAVE RADIATION ONCOLOGY CENTER Jun. 2014 start (flomax) 2xd urination issues, big help! July-9-2014 finish (IMRT) follow up in 2 wks. PSA in 3 months No serious side effects from (IMRT) stamina and urination (minimal) HT cont. (NO FUN) PSA as of 9-18-14 2.02 (Nadir) Stop HT retest 3 mo.
    I work harder @ staying positive than I do @ beating CANCER!

  5. #25
    Senior User
    Join Date
    Apr 2014
    Posts
    127
    I met with the radiology oncologist the 17th to discuss options. going with the 8 weeks of salvage radiation. the 22nd i go for another CT scan and get fitted for some kind of a body mold if I understand the doctor right. on Eligard since 6/12/14, the ht is kicking my butt, mainly the hot flashes and ankle swelling. at 30 days post surgery my psa was .06 and rising, at 120 days .10 after a month on HT my psa was back down to .05 getting old is not for sissies, just as i was getting a handle on my ed the ht comes along. hoping I don't have lingering side effects from the radiation, my Dad had incontinence from both ends after radiation. i know he was older but still in the back of my mine, his quality of life changed forever. I am general good health, soon to be 65, 5'11" 195 lbs, go the fitness center 4-5 times a week. my regular oncologist and urologist say i will stay on HT for 3 years. i doubt i can take it that long, i will give it a year and then decide. the 3 doctors are all working together and say this is the best treatment to cure the cancer.

  6. #26
    Regular User
    Join Date
    Apr 2014
    Posts
    24
    I am on # 33 of #39 treatment; salvage radiation after having the prostate removed about a year ago. No real side effects so far.

    For those that have had the DaVinci surgery, note that you really will need to be sure your urinary functions are back to normal before doing this. You need to drink 14-16 oz of water an hour before the treatment.... and you need to 'hold it'. If you are 4 months or so post surgery... you may still be in the mode of trying to control your bladder too....

    And, I found that yes, they do a CAT scan before each treatment. Then, based on the view, they will adjust the treatment as needed. For me, I ran into issues of (1) not having enough urine in my bladder... (2) had too much poo in my colon.... and (3) I had too much gas in my colon...

    In each of the above instances, I had to drink more water, or relieve myself, and then wait in the office to be put back in the rotation. Not a big deal, just annoying.
    Over the years, PSA was slowly going up....
    Once past 4.0, it began to take off
    Jan 2013 5.4
    April 2013 7.6
    Biopsy 3+3 1 core pos 1 core maybe
    Robotic surgery June 2013
    Post 3+4 cancer close to edge but not broken through
    PSA Sep 2013 .01, Dec 2013 .02, Feb 2014 .04, May 2014 .07
    Salvage radiation 40 sessions begin July 2014
    October 2014 treatment is complete. Cancer free. PSA <.01 / not detectable

  7. #27
    Newbie New User
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    Apr 2014
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    5

    Thumbs up Strange

    I go to Olympic Medical "cancer center" which is part of Seattle's Swedish Cancer care and is by no means small, in fact one of the largest in the country and my Doctor said "WHAT?" Water drinking yes, the rest is very strange. The water has nothing to do with lifting, it is to push and move the colon out of position.

  8. #28
    Senior User
    Join Date
    Apr 2014
    Posts
    127
    I was told to have full bladder and empty colon if at all possible. only once in the 39 treatments did i have to wait too long and empty. then a big glass of water and a wait of 30 minutes before treatmant. Doctor also said to stop vitamins and avoid foods that causes gas. the few times i broke training on friday or saturday eating spicey foods, i paid for it with a burning bm.

  9. #29
    Regular User
    Join Date
    Apr 2014
    Posts
    24
    Aha... that reminds me.... Yes the burning BM..

    Stay away from the spicey foods!!!
    Over the years, PSA was slowly going up....
    Once past 4.0, it began to take off
    Jan 2013 5.4
    April 2013 7.6
    Biopsy 3+3 1 core pos 1 core maybe
    Robotic surgery June 2013
    Post 3+4 cancer close to edge but not broken through
    PSA Sep 2013 .01, Dec 2013 .02, Feb 2014 .04, May 2014 .07
    Salvage radiation 40 sessions begin July 2014
    October 2014 treatment is complete. Cancer free. PSA <.01 / not detectable

  10. #30
    Senior User
    Join Date
    Mar 2015
    Posts
    149
    I can chose between a local clinic or a 60 mile trip into Boston for salvage RT. I prefer to go to Boston. Can someone comment on their experience with driving to and from treatments? This is also local coach service into Boston which reduces my driving to 6 miles for days I do not want to drive. I'm in very good health.
    July 2012 DRE normal but the test was shallow and quick, no PSA
    May 2013 Doctor retired, new Doctor
    May 2013 PSA 5.7, DRE with significant hard lump left side
    July 2013 Biopsy 10 of 12 cores scored 4/4, CT abdomen, bone scan both negative
    Nov 2013 DaVinci prostatectomy at Beth Israel Deaconess Boston, non-nerve sparing - surgeon went wide, age 63
    seminal duct, urethra, and 3 of 26 lymph nodes positive, Gleason upgraded to 4/5 =9
    Post op exams 3/14 <.01, 6/14 .01, 9/14 .05, 11/14 .1
    Lupron injec 11/14 30 day, 12/15 90 day, 3/15 90 day, 6/15 90 day (T heads up after 9/15)
    With HT exams 12/14 <.1, 3/15 <.1
    Salvage IMRT 3/31 - 6/4/2015 34 X 2GY= 68GY
    6/2015 PSA <.1 (still on HT)
    9/2015 PSA <.1 (still on HT)
    12/2015 PSA <0.01 no HT, T normal

 

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