CSN Login
Members Online: 6

IMRT as primary treatment

senkoman
Posts: 8
Joined: Dec 2010

Hi folks, just joined the forum. Curious if anyone else chose IMRT as the primary treatment for their PC. I was diagnoised in April 2010 with PC. My PSA had risen from 3.2 to 4.0 in one year. Two biopsys later, 1 of 12 cores positive for PC. Gleasson 3+3=6 confined to prostate. Started IMRT treatments in August 2010 finished in October 2010 after 39 treatments at MD Anderson in Houston. No horomone therapy required. Side effects were minimal, tiredness went away two weeks after radiation treatment was complete. I was given Flomax to improve urine flow during treatment and I am still on Flomax today. Not sure I need it though. My first checkup will be January 4, 2011.

Anybody else use IMRT as their primary treatment? Any long term side effects to look for?

Thanks,

gkoper's picture
gkoper
Posts: 174
Joined: Apr 2009

Welcome to our community. You will find many men here willing to share their experiences & opinions. I finished 37 IMRT treatments a year ago. However, The reason I took the IMRT is that DiVinci surgery failed to get all the bad stuff. My numbers at diagnosis were a PSA of 4.0 (up from 1.9 in one year) & a gleason of 7 with 4 bad cores. Probably a little more aggressive then your. After a few months post surgery my PSA was up to .7. Had very little in the way of side effects during treatment & now a year later have no side effects & a steady 0.1 PSA. I have read though that side effects can come in up to five years.
All the best,
George

senkoman
Posts: 8
Joined: Dec 2010

George, thanks. I guess waiting to see what changes is the hard part. I am curious to see my PSA level next week. I just have not read a lot about men that have used IMRT as their primary treatment option.

Thanks again,
Rick

RADIATION HOPEFUL
Posts: 206
Joined: Dec 2010

Sir
Would you please tell me the hormone therapy you were on during the IMRT treatments if any? THanks

Julietinthewoods
Posts: 15
Joined: Dec 2010

Senkoman,

My husband is currently a little more than halfway through IMRT as primary treatment. He will be having 45 sessions, as he is a Gleason 7. He has had no side effects to date. So far, in fact, the worst part of the whole business has been the two biopsies.

We, too, will be watching for long-term side effects with some apprehension, although I realize the chances are low. I have been curious about the progress of others who have chosen straight IMRT, and wish you the best.

Juliet

VascodaGama's picture
VascodaGama
Posts: 1535
Joined: Nov 2010

I am an IMRT survivor, but like George I had it as salvage treatment. Unfortunately IMRT wasn’t a sure treatment yet at my time (2000) and the RT side effects from older machines were horrifying to me. But the capability of IMRT in delivering modulating rays to concave shaped tumours (the prostate) stroked my attention.

I had SRT (IMRT) to the pelvic area and prostate fossa, for a total dosage of 68Gy in 37 fractions, in 2006; I never experienced incontinence or pain, and never felt fatigue (played golf on weekends) or nausea. I had a sensation of burning pain on my fifths’ week of treatment when urinating and the stool became much liquefied with traces of blood (proctitis). These side effects were treated and gone in three month post treatment.

Surely the experiences on side effects from radiation treatment as prime or salvage are different. And that also depends on the type of equipment and planned irradiation dose and isodose coverage. IMRT machines incorporated with IGRT can assure less damage to surrounding tissue by shortening the tolerance between isodoses coverage areas and therefore fewer side effects can be expected.
Short-term, long-term and combined side effects are scaled before treatment starts and they are considered as a continuous process for a long period of time. However some of them can become permanent effects, the most common are Erection dysfunction and Proctitis.
Late side effects, not so much commented in our posts, are problematic because they are known to exist but there are fewer reliable data to quantify them. Late ulcerative proctitis and cancer have been associated to PCa RT treatment. There is a book named “Radiation Pathology” by Luis Fajardo (Amazon sells it) explaining about late side effects where the author says that a radiation caused tumor could appear between 8 to 25 years after initial exposure.

When preparing myself to SRT (two month before), I started a fitness program and changed my diet to assure more income of calcium, and took during 4 months a bisphosphonate weekly tablet. I believe the above was behind my recovery from RT.

I wish many years of Zero-effects to my survivor comrades.
VGama

Julietinthewoods
Posts: 15
Joined: Dec 2010

I've been thinking a lot about what lies ahead for my husband. VGama, did you read the suggestion to supplement/alter diet with calcium in the Fajardo book? I might be concerned about a kidney stone risk in men.

Anything you can share that you have learned would be greatly appreciated! Thanks....

Juliet

VascodaGama's picture
VascodaGama
Posts: 1535
Joined: Nov 2010

Hi Juliet,

Thanks for pointing out about the risk of kidney stones, due to too much calcium. In my preparedness I never tried to exceed recommended levels of body-food compositions. I usually looked more for balanced intakes in the diet and care for possible lack of nutrients, etc., that treatments could put me in risk of. Since 2000 that it became practice of having my lipids, etc., checked every 6 months (urine checked every year). The only supplements I take in on/off periods, since 2001, are Vitamin E 400mg and Selenium 200mg. In 2006 I started a big cut of salt in my diet (as lesser as possible), but never abstained from any food.
I live in a hot and dry region of Portugal (Algarve) and drink lots of water every day which makes me pee a lot too. A play of golf makes me sweat a lot but I balance it with 1.5 to 2.0 liters of water in the 4 hours of play.

The book Radiation Pathology is very much for the professionals. It is a good book for the ones that would like to study about radiation and its consequences in the anatomy of the cells. There is no reference to prevention methods but it indicates the damage caused to cell’s DNA and the time required to recovery. Each body tissue (prostate, bladder, hipbone, etc.), have a different ration of sensibility to radiation, in terms of the risk to DNA damage. Those tables can be correlated with best diets for each particular organ that may be affected in certain radiotherapy. Here logic prevails and you do what you most believe. Bone cancer was my highest concern so I took preventive measures for any bone loss.

I would like to note that radiation therapy such as IMRT or CK, or even a CT scan, etc., are modelled to direct irradiation within the risk levels, established by radiologist studies at reliable institutions and authorities (RTOG, ASCO, etc). In prostate cancer the treatment aims to kill cancer cells in that body tissue (prostate), therefore delivering high doses (hyper-doses with CK) it will destroy the whole organ. The surrounded tissues are at a lesser risk of the same damage because of the precision in delivering the rays. Our participation in this affair is to help in the recovery of cells (with external intakes) that may have been damaged due to internally scattered radiation and leakage radiation (peripheral), if any.

I appreciate your involvement in the care of your husband. Our wives confer us the best support we could get when confronting this bandit.

I wish the best to your husband’s case.
VGama

senkoman
Posts: 8
Joined: Dec 2010

Well tomorrow I will have my first 3 month follow up so I am anxious to see where my PSA is at post treatment. Juliet, I finished my treatments in October. As a little peace of mind for your husband, I have not had any side effects. Two weeks after treatment the tiredness went away and I have not had any issues with my bladder or bowels. I hope things go well for your husband.

Rick

Julietinthewoods
Posts: 15
Joined: Dec 2010

Rick, hoping your results were good! My husband has just four treatments left (of 45), and his doctor has given him a referral form for his first PSA test. I was surprised to see that it is not recommended for six months. Since your first draw was at three months post-treatment, I'm a bit concerned.

Juliet

mrspjd
Posts: 689
Joined: Apr 2010

Juliet,
I have not posted on this thread since my husband's (pjd) primary tx was a combination of ADT (hormones) and IMRT (including another high dosing radiation procedure called HDR-B.) PJD's Gleason at dx (Feb 2010) was a 3+4=7, with locally advanced T3 PCa and his follow up protocol is different because of the addition of the ADT.

When IMRT is the sole primary tx, (without addition of ADT), follow up PSA, Testosterone, & DHT testing is usually done at about 3 months after tx completion, then every 3 months for at least the first year in order to establish a trend early on. However, it could take over a year or longer post IMRT tx for the PSA to stabilize and reach a nadir. A PSA bounce effect (fluctuation) within limits, is not uncommon, until there is a consistent reading. With a pre tx G7 (and not knowing the other stats of your husband's dx), I, too, would be concerned about waiting 6 months for the first follow-up testing. I suggest that you both talk with your rad onc and PCa oncologist to understand why they are waiting 6 mos--then I would insist on beginning testing at 3 months after IMRT completion.
Best to you both,
mrs pjd

Julietinthewoods
Posts: 15
Joined: Dec 2010

mrspjd,

I appreciate your taking the time to share that. I thought that I had found an explanation once before on this forum of what to expect post-IMRT, but have been unable to find it again. Since my husband has not been given hormone therapy, would he still need the Testosterone and DHT testing? That has not been mentioned to us at all.

Quickly, his stats are: Gleason 7 (3+4), stage T1-C, PSA at diagnosis, 6.7.

Thank you again!

Juliet

mrspjd
Posts: 689
Joined: Apr 2010

Hi Juliet,
PSA trend will be the most important number to track in order to determine successful outcome after completion of IMRT txs. IMO, having a baseline T & DHT, if it hasn’t already been established and, even tracking those #’s in addition to PSA (little or no add’l cost in the lab work), may be important, especially if any drugs such as 5 alpha reductase inhibitors like Avodart (dutasteride) or Proscar (finasteride), are recommended later.

Hopefully, the IMRT txs will result in a successful outcome and no further tx or drugs will be necessary.
Best,
mrs pjd

PS I share your frustration in searching out previously read posts using the search box feature. I have found that sometimes those posts seem to mysteriously vanish, never to be found again. (Of course, this does not apply to offensive or inappropriate posts that have been flagged and removed by the CSN admin webmaster.)

harmikbatth
Posts: 1
Joined: Jan 2013

Hi 

I have a particular inquiry about ADT before Rt.

Actually my father has just recieved ADT and due to be recieve Radiation therapy.

Some doctors advise to wai for 2 months prior to RT and some say 12 days.

I am wondering did you take ADt before RT and waited for some time or not ?

His PSA is 11 and Gleeson Score of 3 + 5 = 8

Locally advanced cancer with no metssys or lymph node included.

 

Regards

 

Harmik Batth

 

senkoman
Posts: 8
Joined: Dec 2010

Juliet, I had my first 3 month checkup on Jan 4th. My doctor was pleased with the PSA result which dropped from a 4.0 pre treatment to 2.8. I still do not have any side effects to speak of. It has taken a couple of months to get my strenght back to normal. My wife and I have joined the Y and are determined to get in better shape. I did not have any hormone therapy before, during, or after my treatment. I hope to see the downward trend of my PSA on my next visit in April, I was told it could take at least a year for it to get below a 1.0. I'm glad your husband is almost finished. It is a good time to celebrate.

Rick

Julietinthewoods
Posts: 15
Joined: Dec 2010

Wanted to come back and post for anyone interested: My husband's first PSA (three months after completing nine weeks of radiation with no hormone therapy) is 1.4. Pre-treatment PSA was 6.7. We are pleased and hopeful.

The only side effect he ever experienced was a red rash across his backside which appeared at the end of treatment. It resolved fairly quickly and never hurt. Other than that, nothing.

Hope everyone else is doing well!

Juliet

VascodaGama's picture
VascodaGama
Posts: 1535
Joined: Nov 2010

Juliet
Thanks for posting about your husband's first PSA. The number is consistent with the treatment. Expect for lower PSAs and for some sort of bounce (ups and downs) before it gets to nadir.

Congratulations.

VG

mrspjd
Posts: 689
Joined: Apr 2010

Hi Juliet,

Thanks for the update and really glad to see such encouraging results. Congrats to both of you and hope you'll continue to let everyone know how things are progressing.

Wishing you and your husband all the very best,

mrs pjd

senkoman
Posts: 8
Joined: Dec 2010

Yesterday was my nine month check up following IMRT treatment. Happy to say my PSA was 0.8. I just hope it stays that way. The only side effects I have noticed so far is that I have to watch eating too much spicy foods. It is not really bad, you just have to manage what you consume.

Senkoman

VascodaGama's picture
VascodaGama
Posts: 1535
Joined: Nov 2010

Senkoman

Congratulations on the drop of PSA. I am glad to read about your recovery from the side effects.
At the 14th-month mark you may experience a bounce in the PSA graph which is part of a successful treatment. Hope for a continuous good progress.
I love spice food. What's the problem?

Thanks for sharing your case.
VG

senkoman
Posts: 8
Joined: Dec 2010

VG I too love spicy foods. My problem began when I would eat too much fiber along with spicy foods. I was eating a lot of high fiber foods, fresh veggies,fruit, high fiber cereal and fresh peppers from my garden. It was explained to me by my doctor, that the radiation can leave your colon tender. Too much fiber plus the peppers caused irritation with many trips to the bathroom. I just slowed down a little on all of the fiber and freshness and it went away. It seems as long as it is cooked, it's okay.

VascodaGama's picture
VascodaGama
Posts: 1535
Joined: Nov 2010

Senkoman
I also experienced proctitis in the first three months after IMRT. I had soft and liquefied stool (with traces of blood) to which I was recommended two types of medication; one to induce “solidification” and another to make it soft. However, my breakfast of the past 30 years includes Bran and that surely has substituted the “liquefied” medication.

In your case the problem could be proctitis or colitis. These are both causes from RT, similar, but have some different symptoms, particularly if pain is present. Just google the names to read for details.
I agree that you should avoid spicy food when those symptoms are more prevalent. However, fresh veggies and fruits are essential for the “curing” process. Bran is an essential component to my general body-health and I believe that it has done good in my recovery process.
You could consult with a nutritionist or get a book about diets for PCa after treatments.

Wishing you a complete recovery.
VGama

Mike L
Posts: 1
Joined: Dec 2011

I'm using it as my primary treatment. After 8 sessions out of the 44 planned I'm only experiencing fatigue.

Subscribe with RSS
About Cancer Society

The content on this site is for informational purposes only. It is not a substitute for professional medical advice. Do not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

Copyright 2000-2014 © Cancer Survivors Network