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Veteran Member

Date Joined Nov 2009
Total Posts : 7269
   Posted 12/28/2009 11:37 AM (GMT -6)   
Having read quite a few comments on IMRT, I have a question.
We know for surgery, the skill/experience of the surgeon is very important. This is why I will be having surgery under Dr. Menon in Detroit (about 135 miles away). Hopefully, the surgery will suffice. But... if not...
Is the same true for IMRT (regarding skill level)? I ask because if down the road I needed IMRT, I MIGHT choose to go to UMICH Med. Center. But that is 125 miles away. It would require a LOT of time (I think 5 days a week for many many weeks) in travel. I possibly would look into staying in Ann Arbor for those treatments. On the other hand, we do have a significant medical center locally. So, I would much rather stay here. I could be home and travel 2 miles for treatments! But of course I'd want to insure the best possible odds for a successful treatment. So, back to my question: is there a crucial skill level here. In fact, if it is, by whom? The radiologist? Or the Center itself.
Finally, is IMRT something they can figure out in Ann Arbor, set the specifications, and then have it done locally?
Mel (still learning about stuff!)
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.  
History of BPH/prostatitis. PCA-3 test: 75.9 (bad news, guaranteeing I have to do....): Biopsy on 11/30/09. Result of biopsy:

5 out of 12 cores positive. Gleason 4+3. More specifically: 2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10


Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 12/28/2009 12:08 PM (GMT -6)   
The radiation oncologist is not the one pulling the switch on the IMRT or other radiation machines. They have highly trained and licensed techs and operators for that. Most centers have full time RN's on duty too for medical complications or issues. The radiation doctor is the one that determines the dosage, mapping, and the millions of details that go into determining the "how to" part of one's radiation treatment.
They do monitor daily and weekly, how it is being administered, and if needed, they can modify or adjust things along the way, though my doctor told me that was a rare event, as they put so much time into the mapping and planning part themselves.

My rad doctor went as far as reading every surgical note I had in the past 10 years, including non PC related surgeries, she read the entire file on my previous 3 episodes of porocarcinoma, and how it was operated upon and the subsequent radiation treatment I had 10 years ago.
I feel she really did her due dilligence in deciding what was best for my situation.

As I was being treated, she was in constant touch and communications with my uro/surgeon, and no, there is no connection in any way between the two of them.

For salvage radiation, you typically will have anywhere from 30-45 daily treatments, so yes, it can spread it out to as much as 9 weeks. I lived within 15-20 minutes of my clinic, so that was handy during the 2 months I went. Going to one far off would only add a lot of expenses I would think, and keep you away from home and the things you like to be around. My opinion.

So you want a really good radiation oncologist at the least, mine had over 25 years experience, and she said that perhaps 80% of her patients are men with prostate cancer, so that sounded pretty experienced to me.

But despite that, in the end, all my treatments were being delivered by people with 2-4 year college degrees, and varying amounts of machine time experience. My main operator had been with the clinics big Novalis IMRT machine since it was installed 4 years before, so that gave me a comfort factor too.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 12/28/2009 12:39 PM (GMT -6)   


Salvage RT can be done locally with no problem, just make sure the center has the latest euipment and the radiologist is experienced with PC. The planning is usually done by a physicist located somewhere else that you will never meet.

If I were getting primary treatment I would be more selective as tumor volume and irradication are primary concerns and the doses are much higher and have to be delivered more accurrately to reduce side affects.

There are definately differences in radiologists and I would ask around to insure you are not getting a bad one.


64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


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