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Veteran Member

Date Joined Nov 2009
Total Posts : 7270
   Posted 1/8/2010 8:31 PM (GMT -6)   
What is the difference between these two modalities.
Are there specific circumstances that suggest one vs the other (assuming radiation is the desired treatment, say for salvage purposes)?
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


Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 1/8/2010 11:03 PM (GMT -6)   
Hi Mel,

IMRT is an acronym for Intensity Modulated Radiation Therapy. IGRT is an acronym for Image Guided Radio Therapy. One is an adjunct to the other. The IMRT regulates the collimeters that shape the dose of radiation to the prostate. The IGRT is used to locate the prostate from treatment to treatment and keep the radiation beam aimed at the prostate during each session. There are three gold seeds called "fiduciaries" that are implanted prior to treatment using ultrasound. The seeds are the targets for the IGRT. Google Varian radiation technology and you will get a good crash course in the method and mechanics.

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 
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone

Veteran Member

Date Joined Aug 2009
Total Posts : 2448
   Posted 1/8/2010 11:30 PM (GMT -6)   

Great explanation. I would like to add one piece. Not all treatments of IG/IMRT use the makers.

I did not have any markers implanted before I began my therapy. MD Anderson Orlando utilizes the TOMO (for tomography) HI-ART machine.

I had two CT scans done in my preparation for the treatment. They then placed tattoos on each hip and 1 on my abdomen. Each time I go for treatment, I lie down on the table and am aligned with the tattoos and laser beams to insure that I am level hip and center line. Then the table slides through the device and a CT scan is done. It is compared by software to the originals that were used for targeting. The software makes any minor adjustments for delivery of the beamlets with any internals changes of my body due to full bladder, full bowels, etc.

A second trip through the machine delivers the radiation. In all the entire process takes about 14 minutes per treatment.

It is really petty cool stuff.

61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative
da Vinci 9/17/09
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT scheduled to begin Nov 30,2009 (74 days post surgery)

Elite Member

Date Joined Oct 2008
Total Posts : 25394
   Posted 1/9/2010 10:13 AM (GMT -6)   
And mine was non-TOMO IMRT. It took 7 tattoo on me. They had constant alignment problems, each treatment took from 20-55 minutes.
What Sonny had sounds way more efficient. I was under the Novalis machine, and it used 2 snap x-ray cameras. Once in place, they took snap pictures, and when the 2 x-rays were overlayed to the original, then they were good to go. Other lasers in the room and motion detectors made sure that I was always in the exact place I needed to be.

And with my method, they did use a body cast, that was moulded to my shape from the hips down. Did involve stripping and wearing a gown each time. But did not have to drink any water/fluids, and nothing was inserted up my back end like some do.

Unlike Sonny's description of one pass for radiation, the Novalis set-up indexes the entire machine around the table in 7 distinct positions, and from each position, radiation is administered.

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
Post SRT PSA: 1/10 .12
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

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