Salvage radiation

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Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/20/2009 10:01 AM (GMT -6)   
I have been looking into salvage radiation options, since my PSA is rising after the RRP last June. I am getting confused between IMRT and IGRT. What's better? Does it make a difference? Any help is highly appreciated.
 

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 5/20/2009 10:34 AM (GMT -6)   
I'm under the impression that IGRT, helps positioning in case of patient and/or organ movement, whereas IMRT shapes the radiation field to better reflect the contours of the targeted area.

There is also proton beam, which operates on a different basis then photon therapy. (I'm also under the impression that IMPT (image modulated proton therapy) is being researched.)

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/20/2009 12:42 PM (GMT -6)   
Geebra,
IGRT is a more precise way if delivering IMRT photons. It is a good treatment for primary treatment of localized prostate cancer. Because of your situation, if it were me, I would elect to have standard IMRT. IMRT is precise enough to deliver dosage in the general prostate area. Most recurrent prostate cancer is so small that mapping treatment is difficult to apply and a best guess in many cases. IMRT will deliver well to the prostate bed and lymph nodes and will likely knock out that PSA climb...Also IMRT is regarded as quite safe and tolerable.

Tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 5/20/2009 1:00 PM (GMT -6)   
Tony,

Isn't IMRT and IGRT sometimes offered from the same instrument together?

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/20/2009 1:37 PM (GMT -6)   
The IGRT device is typically a CT Scan with the capability to deliver IMRT radiation. They physically look inside you and aim before each dose. The thought is that everything in the prostate area moves on a daily bases. Thus the mapping changes daily. IMRT 7 point devices don't have the capability of looking inside except via x-ray. But the point is that CT does not identify micro mets. Thus, IGRT is precise, but not as effective once the prostate is removed. Look at it like firing a bullet versus shot from a shotgun. Of course IMRT is more accurate than EBRT, it still will protect the bladder, rectum, and other organs sufficiently.

Tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/20/2009 3:14 PM (GMT -6)   
Thanks.
 
Squirm,
 
I checked into Protons, but at least in Boston (the nearest center in Northeast I was able to find) they don't do salvage treatments.
 
Tony,
 
I was aslo under impression that IMRT is standart treatment for rising PSA after RRP, but I saw dsmc's post and signature about IGRT salvage option: http://www.healingwell.com/community/default.aspx?f=35&m=1475394&g=1476212#m1476212, so, of course, I now have to know why one chooses IGRT vs. IMRT.
 
dsmc, if you are out there, I'd appreciate your thoughts on the subject.
 
 

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/20/2009 3:32 PM (GMT -6)   
You certainly can choose to do IGRT. But know that thus far, I am side effect free from IMRT. And better yet I am also undetectable. But i am certain the IGRT can get you there as well.

Good Luck.

dsmc is my Facebook friend. If he doesn't check in soon enough I can tap his shoulder and let him know you are looking for him.

Tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/20/2009 7:15 PM (GMT -6)   
Thanks, Tony.

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 5/20/2009 7:50 PM (GMT -6)   
Any decision as it relates to cancer is difficult however I will have to go with Tony on this one. I to had IMRT and had some side effects during treatment but now 20 months later I have none and my PSA is also undetectable. Please know that I care and would love to hear what you do and how you progress. Whatever decision you make will be right.

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
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
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 5/20/2009 10:11 PM (GMT -6)   
Hi Geebra, I think maybe it is the Docs specialty, if you will, and the equipment they have access to that lends to the decision. Tony is correct in that they do a cat scan daily to line up the treatments, after the scan they feed it into the computer and get the alignment for the RT. My treatments consisted of 50 zaps from 7 different points.On the lighter side I told my main girl that was doing my RT that I had had 1700 or so zaps and she cracked up and told me nobody had ever counted them before....lol. My Rad Doc showed me my plan after he had it worked up on a cat scan and it was very interesting in full color showing the planned attack.I believe either one would be fine. I had my first visit with my Uro/surgeon today since my RT and he was very pleased and said that he had a lot of guys with my results that never had any more problems over the last 15 or 20 years. I will not see him again until November for another PSA. Good luck to you and keep us posted.

David
Age 53
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09 YEA!
05/14/09
1st PSA after Salvage RT <0.04..... Another YEA!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/20/2009 10:49 PM (GMT -6)   
Thank you, guys. You are the best!

I am still trying to get an appointment with the Radiation docs. One in Central NJ, where I live and one in NYC, where I work a couple days a week. While I am waiting I am trying to figure out the logistical issues:
- Would I be able to continue to work? How long would it take evry day all in (getting there, waiting, the radiation, and back)
- Is it worth some logistical inconvinience to do it at Sloan Kettering vs. local hospital with good reputation?
- Once the treatment is decided, how long is the prep - plans, cast, etc?
- The NYC doc says he does not see anyone without MRI. Did you have to do any other tests? What about MRI? Is it the type with endorectal coil?
- If I do another blood test this Fri and have the reasults in a week, when do you think realistically the treatment would start?

I know this is a lot of questions, but I am trying to get all ducks in the row now...

Thanks a lot,

Greg

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 5/21/2009 6:19 AM (GMT -6)   
I worked every day except for a couple of weeks at Christmas. I was a little tired with the treatments and I am in construction.
I think I would opt for a local hospital just for logistics.
My prep was 3 weeks for the mapping. The cast, tattoos and cat scans were done in 1 day and the MRI another. I think it is probably a work load issue and would vary from clinic to clinic.
My doc said that the MRI was to be sure I did not have any other issues, cancers, etc going on.
I would think within a month, depending on their work load.
I hope this helps. This is just my experiences and there is lots of guys here.
Keep us updated and ask away.....

David
Age 53
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09 YEA!
05/14/09
1st PSA after Salvage RT <0.04..... Another YEA!


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/21/2009 10:54 AM (GMT -6)   
In that case David, if I tap you on the shoulder, it will just be to say Hi.

Tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

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