Where are the IMRT folk?

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Regular Member

Date Joined Jul 2008
Total Posts : 50
   Posted 8/26/2008 12:02 AM (GMT -6)   
I notice a lot of the posts are from people who have chosen surgery for their treatment - am I missing something?
It is my understanding that IMRT and Surgery are equally effective in treating prostate cancer.  I am under the impression that ED is less likely with IMRT once you stop taking the HT.  Also, I am hearing that incontenence is seldom a problem with IMRT.  The negative things I hear about IMRT are that you don't find out right away if all the cancer was destroyed;  that there is some sensation of being tired towards the end of treatment, and that you may experience some temporary diarhea that can be easily controlled by meds.  Where are all the IMRT folk and what negatives am I missing here?
DX 7/08 2 of 12 cores positive, GS 3+4 and 4+4, PSA 6.7
8/08 Bone Scan negative, and MRI of Prostate and area with contrast "material" suggest the cancer is only in the prostate.  I have an appointment with the Medical Oncologist tomorrow and suspect he will start me on HT.

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 8/26/2008 2:50 AM (GMT -6)   
Hi Hopeful,
I have done both treatments. There is still a lot of studies to be completed to show if IMRT, Proton, Cryo, or surgery is best, though there is more studies showing that in more cases surgery is. For now the gold standard is surgery as it offers something the others do not. And that is a more difinitive pathology after treatment. While it is true that all treatments can be equally effective in localized cancer, there is a huge 'what if'. What if the cancer has left the prostate? Surgery will provide a better guage on that because the specimen is examined and it will show if that is likely true. And if it is, there is still a better recourse than IMRT alone. But if the cancer is local, IMRT, proton, and cryo can get it knocked out. If it isn't you find out later, and perhaps after it has grown out of control.

That stated, we need more information. Surgery is well established and can provide more information. One other issue is PSA bounce ~ this one tipped the scale for me. You get tested every 6 months after treatment. And with radiation your PSA can rise, sending concern and anxiety higher. With surgery it goes to undetectable, and has to stay there. Another factor is age. Younger patients tend to do better with surgery. If I had to do it all over again, I would still lead with surgery. I know it has more side effects on the front end. But for me it was the right choice.

Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:

New Member

Date Joined Jul 2006
Total Posts : 13
   Posted 8/26/2008 8:29 AM (GMT -6)   

I was diagnosed in May 2006 and had a Gleason of 4+3. I was told that the radiation therapy jointly with HT wold have a considerably better outcome than surgery. He gave the percentages but I did not write them down and my memory is not very good. I received 45 radiation treatments and simultaneously 8 months of HT. In May 2008 my PSA was 0.52 the doctor declared me cancer free and cured. My PSA in October 2008 was still good at 0.55. The difference is well within the accuracy of measurement.

I have had one side effect. Early in the radiation treatment I developed a radiation burn in the penis near the head and it hurts when I pee. This problem has not cleared up yet after 2 years. I would like to know if anyone else has had the same problem and what was the outcome.

This forum is great but has been primarily for surgery patients since I started reading it back in middle 2006. There was a forum which was more balanced but it has been discontinued.


Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 8/26/2008 9:46 AM (GMT -6)   

Hi Hopeful,

I am on treatment #34 of 45 for advanced PCa. My local urologist did not recommend surgery due to indication of spread to the lymph nodes. I got a second opinion from the Mayo Clinic and the urologist there recommended surgery, radiation, and hormones. Mayo experience is that patients who undergo surgery improve their odds even if they must follow with radiation and/or hormone versus radiation and/or hormone only.

My local urologist and oncologist agreed that radiation and hormone treatments were my best option. I had this recommendation confirmed by a third opinion from an oncologist who is the lead doctor at a cancer center in Savannah, Ga. After some time evaluating the pros and cons and reading at least three books on PCa. ( First one was a general reference, second was focused on brachytherapy + IMRT, and the third was focused on proton therapy) I chose to go with the local urologists recommendation. As you stated my research indicated little difference in the results for advanced PCa treated with surgery or radiation. The operative word is "advanced". Localized PCa is very treatable with either modality. One research paper that I read indicated that "debulking" or removing the original tumor had a slight advantage over radiation only when evaluating reoccurence of the disease. In 50% of the cases when PCa reoccurred it was in the prostate tissue that was not completely destroyed by radiation. That means that 50% of the cases were from other sites indicating micrometastasis that was not detected prior to the treatment. Ask your doc about the Prostascint scan as it is focused on detecting cancer cells in the blood and could add a little more info on potential spread if all other tests for you are negative. My doctor did not recommend this because it is expensive and he felt that it would only be further confirmation of previous tests.

If there is no evidence of spread in your case I would take a long look at the surgery. I know this is a difficult decision as I was back and forth like a ping pong ball when I was where you are just nine weeks ago. The doctors do not make it any easier as there is no clear front runner and each doctor trends towards his or her speciality. I was impressed that my urologist, also a Da Vinci surgeon, would step aside so quickly and recommend Oncology. Speaks well of him I believe.

I will recommend another site to you for additional information on EBRT. The site is prostatepointers.org and it is arranged by treatment modality. I.E. hormone, EBRT, surgery, wait and see. I got a good deal of feedback from others who have had similar experience to mine and it helped me with my decision process. Like this board it is fairly active and if you post an inquiry you will receive replies within 24 hours.

Good luck with your journey. If you have any specific questions about my case I will be glad to answer.




Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.

Regular Member

Date Joined Jul 2008
Total Posts : 123
   Posted 8/26/2008 9:58 PM (GMT -6)   

There are one or two of us IMRT guys that post! I can only tell you my experiences; I don’t claim to be an expert. I’ll leave that for the MD’s. I was diagnosed @ 53 in November ’06 (3+3, psa 4.8). Discussions with the Uro, Rad Onc, and a few weeks of research led me to belive that IMRT had (statistically) about as good an outcome as surgery. Oddly, my Uro (and potential surgen) stated that he’d go for IMRT if he was in my shoes. Anyway, I considered the “nobody has long term data for IMRT” argument, and “you can’t really tell without removing it” school of thought and possible QOL issues and decided to go the IMRT route. I had 41 treatments in Jan. and Feb. 2007.

During the eight weeks of IMRT I had a few days (like one or two) of diarrhea and during the course of treatments figured out what would bother my tummy and what would not. After three weeks of so I developed some issues with urinary frequency, but Hytrin took care of that over the course or 4 or 5 days. I worked the entire time, but felt a little beat the last two weeks or so. I don’t believe I ever found a reasonable explanation for the fatigue. In my case I think it was somewhat stress related, that and getting up at O’dark thirty to get to my 6:45 am treatments for eight weeks. My energy was back after three weeks or so.

QOL issues: No ED issues. No leaking. I did develop a urethral stricture in October of 2007, probably caused by the radiation. No bowel problems. The stricture was treated with a dilation followed by three weeks with in a Foley catheter, and then a course of self-catheterization (to keep things open) that stated at three times a day and is now down to once every 3 or 4 days. No big deal and I’m peeing like I did 20 years ago. That’s it.

As you can see by my information below, my last psa was up. I will not know until December if is just a bounce or not. Bounces are fairly common. We’ll see!

Keep reading, check out the “psa bounce”, talk to your Doc’s and be comfortable with whatever choice you make.

53 yrs
PSA 4.8
T1c – Gleason 3 + 3
IMRT 1/07 thru 2/07 (42 treatments)
PSA 6/07 – 0.76
PSA 12/07 – 0.36
PSA 6/08 – 0.72

Regular Member

Date Joined Jul 2008
Total Posts : 50
   Posted 8/27/2008 8:40 AM (GMT -6)   

Thanks for all the feedback.   I saw the oncologist yesterday.  He recommended Zoladex shots and Casodex orally.  At first it was apparent that they wanted me to take both the shot and the pill - after discussing the actual benefits of being on both, he agreed that it would be statistically insignificant and decided to play me on the Zoladex shots only.  At first it seemed I would be on the Zoladex for 6 months, but he felt 2 or 3 years would be the more benefical treatment.  I'll explore this further before deciding how long I should take the shots. It really is apparent that no one really knows which is the best way to go forward with treatment.  This probably isn't a bad thing if you think of it as indication of the amount of recent research and multiple treatment approaches.

So, I've had my first Zoladex shot and admittedly am waiting for side effects.  I don't feel anything yet, but then I had the shot yesterday 8/26/08 around 4:00 PM.  Next I will have a CT scan to prepare for my gold markers.


7/08 PSA 6.7

8/08 Biopsy 2 of 12 cores positive with Gleason 3+4 and 4+4

8/26/08 began Zoladex


Regular Member

Date Joined Apr 2008
Total Posts : 270
   Posted 8/28/2008 7:58 AM (GMT -6)   
I had a Lupron shot and it took about two weeks to kick-in. I don't know if Zoladex has the same kick-in time, but if it does I would suggest you enjoy those two weeks (romantically). Blessings to you! RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04

Veteran Member

Date Joined Sep 2006
Total Posts : 741
   Posted 8/28/2008 8:35 PM (GMT -6)   

Hey Hopeful,

I'm a rads guy and most happy with my decision.  I don't push my choice of treatment because I am not a medical person and I'm not qualified.  This is mostly a surgery place and lots of the guys really push their choice.  It's your life and your choice.  Don't listen too much to people like me who are not professional medical people.  It's difficult decision and worrisome.



August of 2006, PSA up to 4.2 from 2.7 one year ago. 
October free and total PSA 12% free and 5.0 total.
A month, or so later, 4.7.
Late in the year decide on Image Guided IMRT.
Begin 43 treatments on January 23, 2007 and finish on March 23.

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 8/30/2008 11:45 AM (GMT -6)   
Hi hopeful, wise advice from RBinCountry, it took a few weeks for my HT to kick in but when it did the libido took a nose dive. Now that I am one year into it, I am still impotent and have zero desire for sexual affection. As far as physical side effects I have not had to many other than faitgue, however the mental side effects for me have been tough. My mental acuity continues to go down. I forget things all the time and can't seem to make sense of things that use to be simple task. Hopefully after my three years I will get some normalcy back. I had 44 IMRT's and had few side effects with that as well.
Please keep us posted as to your condition.

peace and love
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores

Regular Member

Date Joined Jul 2008
Total Posts : 50
   Posted 8/31/2008 7:26 PM (GMT -6)   
Joe, I'm having a really difficult time wrapping my head around the idea that my libido will go - I'm also trying to imagine what that would feel like. I will avoid asking some of the questions I would like to ask due to the fact that this is an open forum.  Let me say this, even without an erection, women are attractive, and pleasing to the eye.  I would still find it "stimulating" to see my wife's... and I would still want to satisfy her, right?  PuhLeez don't tell me that an attractive female will be less meaningful (sexually / sensually) than a hamburger??? ARRHG!
I have horses and if we guild one after he has entered horse puberty, even without his dingle berries, he's going to try to mount a filly or mare which suggests a continuation of interest to me. Of course since I am not a horse, I can't be certain my analogy holds water -- then again, after all is said and done, I don't know if *I'LL* hold water.
What a horrible way to be put out to pasture -- I thought with all the kids grown and me in my 50's it was play time -- in a somber moment I asked my wife how she would feel about my having a decreased to non-existent libido.  She rolled her eyes and I think I heard her whisper "thank God!"

Post Edited (Hopeful203) : 8/31/2008 6:30:13 PM (GMT-6)

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