1st IMRT session aborted

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John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/29/2009 5:57 PM (GMT -6)   
Today I was to have my 1st IMRT session after seed implants 6 weeks ago. The Radiation Oncologist aborted the treatment because he could not tell the difference between the gold markers and the seeds. The Doctor who did the implants will review the CT scan with the radiation Dr tonight.
Has anyone experienced this before? Should I be concerned?
 
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/29/2009 6:01 PM (GMT -6)   
John,

Never heard of that happening before, thats the whole point of the gold seeds, as they supposedly stand out sharply in contrast. Be interested in hearing what they decide on that, is he going to try again?

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 6/29/2009 6:34 PM (GMT -6)   

Hi John,

I had IMRT only and when the gold seeds, or fiduciaries as the tech called them, were placed I asked if I could see the CT scan taken to do the initial location. The fiduciaries are unmistakable on the scan. There is bright light at the location. I do not know what the radiation seeds look like so I cannot comment on them. You might ask if you can see the films of the placement of the seeds and fiduciaries.

At least you radiation tech had the good sense to call off the treatment. I am sure you have read the latest on the VA in PA.  

Best of luck to you.

Don


Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and 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.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
 
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/30/2009 11:50 AM (GMT -6)   
Radiation Oncologist called this am and said they figured it out. Two of the gold seeds were close together and along with the palidium seeds created a starburst on the CT scan.They redid the radiation plan and I'm good to start on Wedns.
Glad the radiation tech aborted the procedure when he wasn't sure of what he saw.
I was a little concerned after reading the horror stories of the Pa VA cancer group and the botched brachythepies. I did have one seed that went into the bladder during the procedure, the urologist retrieved it. Now I know why they always have a urologist working with a radiation oncologist during the procedure. I wonder if this was standard procedure at the VA.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/30/2009 12:48 PM (GMT -6)   
Sounds like good news John, least you can move forward. Good eye on the dr., better safe than sorry.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 6/30/2009 2:41 PM (GMT -6)   

John:

I'm glad it worked out and that the mystery was solved.  Good luck for the rest of your treatment plan.

Tudpock


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 6/30/2009 11:22 PM (GMT -6)   
The professional behavior of your docs should give you comfort. Professionals do make mistake, but they stop when they notice them, understand them, correct them and move forward.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

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)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, IMRT to start mid-Aug

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