IGRT with enlarged prostate ?

Kongo said:

Good Support Team
carnut,

It sounds like you have a great support team. Urologists as surgeons always like to cut. I've read that 90% of urologists recommend surgery for even low risk prostate cancer. Of course radiologists like to put you in the microwave.

From my personal experience and from what I have read, the side effects from radiation consist of an increased urgency to urinate. This is caused by the inflammation in the prostate which causes some minor swelling caused by the radiation. There are drugs like Flomax that address this very well but keep in mind there are some ill effects to these drugs as well. I felt some minor urgency on the last day of my five treatments and treated it with Advil and had no more issues. I had a prescription for Flomax but never used it. While urgency seems to be the most common side effect, only about 20 percent of the men receiving radiation experience it and as your doctor suggested, it tends to pass within a few weeks when the prostate settles down.

I had the gold fiducials implanted for my CyberKnife treatment. They allow for tracking the movement of the prostate during radiation. A CyberKnife session lasts about 45 minutes and the prostate can move about quite a bit, actually, so they do real time tracking and the computer adjusts the robot arm delivering the radiation to compensate. If the prostate moves outside the limits the machine actually shuts down until the prostate moves back on target. Prostate movement is caused by breathing, goas movement in the colon, and pressure from the bladder. In IGRT the sessions are much shorter and they adjust the machine before radiation using the fiducials and real time x-rays then basically hope the prostate doesn't move too much during the short time you are getting zapped. While CyberKnife is more accurate, I don't really think the small amount of spillage you might get with the IGRT system makes much difference except that men who have radiation from systems that are not real time tracking tend to have higher rates of urgency, at least according to my radiologist who obviously is biased toward his equipment. You may want to ask your doctors about the details of how they track and develop the radiation patterns. I personally found it quite fascinating.

Modern radiation such as IMRT or SBRT (IGRT is a form of IMRT--CyberKnife is a form of SBRT) are pretty much without serious side effects.

Frankly, if you can live with your BPH now then you can probably live with it following radiation treatment. I think it's improbable that the prostate would continue to expand from the fibrous BPH cells after radiation but that's another question I would ask about. If the BPH is not going to get any worse, the odds are overwhelmingly in your favor that your quality of life will not deterioragte significantly after radiation.

I don't know how old you are but if you are a young man and think that you may ever want to have children after treatment, be sure to bank some sperm in advance.

K

Good Support Team
Carnut

I would be careful with their “...assistance and support in any decision you make”.
Just as Kongo comments those doctors like their “trades” and their assistance may fall short of yours expectations if you decide other than “cutting” or “microwaving”.

I would suggest you to get second opinions from a medical oncologist recommended from other sources, before deciding.

The best to you.
VG

Enlarged Prostate
Hey Carnut,

I had an enlarged prostate (70 gram)and PCa. One treatment option I had was brachytherapy. In order to do the brachy the doctor would have had to try to reduce the size of the prostate with Hormone Therapy. Maybe you could do the HT before IGRT?

I finally chose surgery and one of the benefits I had was better urinary function (the enlarged prosate had me going several times during the night and very slowly when I did go).

With your numbers, have you considered Active Survelience?

Similar History
I'm 55, dx in early 2011. My stats were almost identical to yours, with the exception of my prostate being an enlarged 58 gr. After the usual opinions and mind gymnastics, I chose radiation and went through 45 courses of IMRT/IGRT, finishing toward the end of August 2011. No ED problems at all, no fatigue and only a couple days of minor bowel issues I'm not even sure were related to the radiation.

I did have some pretty annoying urinary side effects (burning, urgency, hesitancy, etc.) that developed a few weeks into the treatment, but my Oncologist prescribed Flomax, which took the edge off, making them fairly easy to tolerate. Side effects were gone within 6 weeks after treatment. I chose to stay on a smaller dose of Flomax and my plumbing's working better than it has in 10 years.

As far as side effects down the road, who knows? It's all a big waiting game. I don't know if I dodged a bullet or if more side effects will develop later, but for now my PSA is going down and I'm happy with the choice I made.

Good luck!

carnut said:

My daughter is a RN,
My daughter is a RN, director of patient services at hospital in another state and she gave my reports to the urologist and radiologist there and their recommendations where surgery and radiation respectfully. Go figure. At least they are all consistence.

Kongo, At my age,62, I'm past the fathering children part. Had a vasectomy 30 years ago also. My urologist did tell me when we were talking the the prostate should not continue to get any larger after radiation.
If i may ask, what are your thoughts on treatment if in the unlikely event you have a recurrence. I ask the radiologist this and he said that usually if that happens that it would be 7-10 years down the road and it should be the same type cancer I have now. Considering that it should be a slow growing non aggressive as it is now we would consider my health and age and probably not do anything. I always thought that if the cancer returned after radiation it would be more aggressive. He said this is not the case. He also said that if a treatment was needed that cyro would be a possibility. Also hopefully in the next several years new treatments will be developed for radiated patients.

carnut,

Some men subscribe to the argument put forth by many urological surgeons that it is better to do surgery because if it fails you can always do radiation where if you do radiation first surgery is not an option. My personal opinion is that this argument is faulty on a couple of significant points.

First, if you have recurrence to either surgical or radiation treatment of what was considered "localized" prostate cancer then what you are really looking at is cancer that has metastasized beyond the prostate. Retreating the prostate by any method is not going to curb the spread of cancer outside the gland where prostate cancer tends to grow faster than inside the prostate. So it's really just an academic argument. When men who have had their prostate removed see a rise in their PSA it is because the cancer had spread to surrounding tissue or seminal vesicules or lymph nodes (fairly rare) or other distant organs. The follow-on treatment is to radiate the prostate bed where the most likely migration point is and hope for the best. Often this is a stop gap measure as it has probably gone beyond the prostate bed. With modern radiation techniques such as IGRT or SBRT the entire prostate is radiated. It's unlikely that anything there is coming back and when there is a rise in PSA it is almost always because the cancer had spread before the treatment.

There are some rare times that I have read about where a man who has had radiation as a monotherapy for localized prostate cancer sees a rise in PSA and a rebiopsy of the prostate reveals another tumor. In those cases I think focal cyrotherapy, as you mentioned, might be work. Other options could be HIFU or another round of radiation. It is possible to remove the prostate at this point but the surgery is more difficult because of scarring caused by radiation. There are surgeons who specialize in this technique so don't believe the argument some urologists use that it is impossible to do this procedure. It's simply not true.

The overwhelming majority of men who see a progression of their cancer beyond initial treatment are dealing with metatastic cancer which if left untreated will eventually kill them if something else doesn't get them first. Hormone therapy is probably what I would look out if I were to see a recurrence that could not be associated with the prostate. Hormone therapy and other techniques essentially kick the can down the road long enough so that you end up expiring of something other than prostate cancer. Since we have such a slow growing disease we are fortunate among other sufferers of cancer in that we die with our disease rather than from it. The number one cause of death for men with prostate cancer is heart disease.

Don't mean to sound pessimistic here, just trying to be realistic. True cures with prostate or any other cancer are elusive. You are fortunate to have discovered your cancer very early with many excellent treatment options that all have roughly the same effectiveness. The devil is in the side effects. I would make a decision choice not on what Plan B should be if Plan A doesn't work but on what is the best choice overall to treat my cancer with the least side effects.

In another post you indicated your urologist (the surgeon?) was nervous about being on AS for three months and you needed to decide something. Perhaps I was reading it wrong but that's BS. You should expect to be on AS for years and years not a few months and your low Gleason score, low PSA history, make you an excellent candidate for this. I suggest you consult with an oncologist who specializes in AS and get a second opinion. I would also commend the book "Invasion of the Prostate Snatchers" to you. Available at Amazon.

Good luck with your decisons.