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EBRT versus IMRT

HillBillyNana's picture
HillBillyNana
Posts: 107
Joined: Jun 2009

The November PSA was 0.62 - down from 0.64 back in August. There are two cancer treatment centers in Fort Smith. I found info online telling that one of these treatment centers has the ability to do IMRT. The one we are going to does not do this (unless they have recently started it). I know if we ask her she will probably say they can do a fine job with what they offer. I want to go to the other place just to have another doctor looking at the situation. My husband is hesitant to go elsewhere for an appointment. I have no argument about these two types of treatment. And since he has not wanted to discuss it until today, I have let up on my research. I did check with the Ablatherm clinic in Canada. He is not a candidate for that because he has had RP. In the info I read it said it could be used after RP. Anyway, I am appealing to the group: If he does radiation, will it be one of these? Is one better than the other one? Side effects?

THanks for all your info.

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

I can only tell you of my PCa experience. I was diagnosed in March of 09. Two months later I had Davinci surgery. 6 weeks later my PSA was 0.3. By Oct. it was 0.7. I opted for IMRT radiation that consisted of 37 brief treatments ending in Dec. The first PSA was 0.3. The last two have been 0.1. So far,so good. Don't know how everybody on this forum gets their PSA result in 2 decimals such as 0.13? Anyway side effects were slight increase in urine frequency & urgency for a few months. None now 11 months after IMRT. Can't say about other forms of radiation.
All the best,
George

lewvino's picture
lewvino
Posts: 1010
Joined: May 2009

Some labs have an ultra sensitive PSA test. Others use the Standard.
That is the diff between 1 or 2 decimal points.

Larry

ob66
Posts: 225
Joined: Apr 2010

There is controversy on PSA readings post op. Dr. Patrick Walsh and others feel the "ultrasensitve" PSA readings cause undue anxiety with the patients, and prefer not using same. My doctor insisted on same. 10 months post daVinci I went from .05 (two readings at that level) to .07, at which time they used the input to send me for RT immediately. Did RT with a lupron assist and my last PSA was 0.01, or zero (not detectable). So the difference is difficulty and expense of the test, coupled with increased possible anxiety on the part of the patient vs. having a more accurate reading. But bear in mind, that there is a statistical +/- with all these tests. Hope this helps gkoper.

HillBillyNana's picture
HillBillyNana
Posts: 107
Joined: Jun 2009

WE went to the radiation doctor today. She says her clinic can do anything the other clinic can do. Says IMRT can only be done if there is a prostate. So it can't be done after RP. She was nice enough but didn't seem to welcome my questions. My husband had made up his mind before we got there that he would do the radiation. So we are getting ready for 35 treatments. She gave us a funny look when we told her the urologist said 2 or 3 weeks. Like it was unheard of. I am glad the decision is made and now we just have to get it done. We set the appointments at 3 p.m. so it would interfere with our life schedule as little possible. We do have a commute. Right at 50 miles up and 50 miles back. But at 3 p.m. we should be able to make it home before dark. Just hope this goes as well as the radiation doctor implied. Will keep you posted.

IB

BRONX52
Posts: 156
Joined: Apr 2010

HI--I hate to disagree but if your doctor told you that imrt can only be used if you still have a prostate I would be looking for another doctor.It's simply not true! I had a radical prostatectomy in feb of this year and in april I started IMRT radiation treatments(minus my prostate) I had a total of 38 sessions. I would just advise you that the radiation treatment field is very competetive. They will do almost anything to get your business. I find it hard to believe they would tell you that about imrt. In fact, if you google imrt I think you'll find that in most cases imrt is more accurate than ebrt. Good luck !!

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Nana,

I agree with Bronx on this one. IMRT can certainly be done after RP and is one of the most common radiation treatments for recurring PCa. There is a twist though and that is if the doctor is wanting to radiate the entire pelvic region then I could understand why they are wanting to do the older EBRT as it could be done faster than IMRT. The problem with EBRT is that it is not as accurate in its placement of radiation so there is more radiation delivered to the bladder, colon, testicles, penis area, etc., which has the potential for more adverse side effects.

If it were me, I would go with the IMRT.

Best of luck.

HillBillyNana's picture
HillBillyNana
Posts: 107
Joined: Jun 2009

Bronx and Kongo thank you for your replies. It is always a shock to me that the medical field is so corrupt. But I do know it is all about the money. I called the Hembree Cancer Center here in Fort Smith. THey encouraged us to get a second opinion. I now have a phone call in to the Sparks Center. They will call me back in an hour. My husband has a great sense of loyalty and hates to leave the original doctor for another one, but as I told him, "this is your body and we know she has lied about at least one thing" - We can get in for the second opinion Monday or Wednesday of next week. I am frantically looking for more info on the differences of these two treatments. If it is the speed of the treatment that is most important to the doctor then that makes me feel like the patient is not the most important. Thanks so much.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Nana,

I wouldn't know if the doctors are corrupt or not and after way too many years with different assignments at various agencies in Washington DC I've learned to never confuse incompetence with a conspiracy. Most doctors recommend what they are most familiar with and tend to try to steer you in that direction. As lay people, most patients still think doctors are always altruistic and looking out for our best interests. In fact, I think while most doctors do think of our interests when it suits them, they also think of theirs, and prostate cancer is very big business.

I am sure you're keen to put this next step in the rear view mirror but given your husband's relatively stable PSA over the past several months, it likely wouldn't hurt to take a breath and get enough second opinions to put your mind at ease that you're getting the best possible treatment for YOU and not the most convenient treatment for any individual doctor.

I understand the loyalty thing, but this is about your husband...not the doctor.

Best wishes for a decision and subsequent treatment that is best for you.

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

is a liar or very ignorant. My guess is her specialty is the older EBRT. I would lose her.

ob66
Posts: 225
Joined: Apr 2010

You are getting better advice here than from your doc. I had daVinci in June of 2009, and just finished IMRT RT in August, 37 treatments. So what you were told, as others have helped you with, is just plain wrong.

HillBillyNana's picture
HillBillyNana
Posts: 107
Joined: Jun 2009

I have spent the morning looking and talking about Pca treatments. The big dilemma whether my husband is a candidate for IMRT. The nurse from ACS explained that External Bean Radiation Therapy covers a lot of procedures. IMRT is one of them. To make a long story short, my husband has decided to go ahead with the first doctor. We had an appointment set up to get a second opinion on Monday and then the ACS nurse called and explained about every case being different. Of course we know that. But she had no data on whether IMRT had fewer side effects. The cancer cells (not a tumor) are not visible except on the Prostascint, so it would be necessary to 'guess' where they are. That means an area around the prostate site has to be treated. The radiation doctor we saw yesterday said this particular urologist/surgeon usually puts in clips so they can tell where the prostate was. I am satisfied with my husband's decision, because he did let me explore a few things and even agreed to the second opinion until we talked with the ACS nurse. Then he felt that the EBRT would be as good as the IMRT, if indeed the other doctor would do the IMRT. In my experience with my own cancer and now his cancer, I am a little disturbed by the fact that all the options are not presented to cancer patients. In the first place he opted for surgery because the doctor said it was 'the gold standard'. So now we go to the next step. Radiation. 35 treatments. Another irritation to me is: They tell him it is important to make all of his treatment appointments and not miss a one. THEN they turn around and say they will be closed 2 days for Thanksgiving and 1 day for Christmas and 1 day for New Year's!!! They can cancel appointments but we can't. That puts us at 8 weeks instead of 35.

The radiation doctor did say this is a slow growing cancer and it would probably not be the cause of my husband's death. Husband is much more concerned about the possible side effects. He is a very active man and hopes to stay that way for a long time to come. We are 65/72 and enjoy traveling and the outdoors. This cancer is a very inconvenient matter. Many men on this board have suffered much, much more than my husband. And I get tears in my eyes reading about their experiences. It is wonderful that you are all a support for each other.

HillBillyNana's picture
HillBillyNana
Posts: 107
Joined: Jun 2009

One more little irritation I experienced yesterday. I asked the doctor about HIFU. She waved my question away with her hand. She said, "Oh I don't know anything about that" I said, "well, we have been reading about it and I know it is not approved by the FDA in the U.S." She said, "Yeah. If it is not approved by the FDA you'd have to go to Europe or something." Is it possible she doesn't know anything about HIFU?

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Yes Nana, it's very possible that your doctor doesn't know ANYTHING about HIFU.

Most doctors only know and recommend the field of medicine that they practice and, due to concerns about malpractice, will generally not advise you about anything else except to tell you that other things exist and that YOU should look into them if you're interested.

As you already learned, surgeons recommend surgery and claim that it is the "gold standard" for PCa, but I do not think that that is true any longer and whether you need surgery or not really depends on the nature of your cancer. But, that's moot now, since you husband has already had RP.

Based on my research, HIFU has been used as an alternative to surgery for early stage cancer patients but I do not know if it can or is used for post RP radiation treatment. That would be something you would have to look into if you're interested.

I do know that HIFU costs about $25k (out of pocket and is not insured because it is not FDA approved and is considered an "experimental" treatment) and is offered in Canada and by US physicians who will treat you in the Caribbean or in Mexico.

Good luck!!!

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