IMRT Questions

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gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 4/29/2010 7:26 AM (GMT -6)   
Hi all, my father is in approx. week 5 of about 7 weeks of IMRT.
One issue he is having is pretty bad burning on is skin, around his backside. I think they are putting hydrochortizone creme on a couple of times a day. Is there anything else that you guys would recommend? Anyone else have this issue?

Also, after the IMRT treatments are complete, how long to they wait before doing a PSA test to see the outcome of the treatment??

Thx!
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Foley Catheter
Casodex for last two weeks of November '09, then Lupron.
Suprapubic Catheter March 18th, but blocked right away, back to Foley...
Started IMRT March 25th, Chemo on hold due to catheter bleeding issues, etc.


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 4/29/2010 7:49 AM (GMT -6)   
Welcome Gibson,
I just completed my IMRT in March and waited 6 weeks for the first PSA. Found out yesterday it was showing a downward trend which is good. Now will wait another 6 months until my next PSA and hope that it continues to go lower. I did have some burning skin but havent used anything on it but it is irritating. Your Dad must have had it worse than me. Not sure what else he could do, but would ask his radiation oncologist for addtional help. Good luck and hopefully it will pass soon.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10, Completed 39 tx at 72 gys on 3/12/10
Great family and friends
Michael


gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 4/29/2010 7:53 AM (GMT -6)   
Thanks Michael.
With regards to your PSA, is that what they expected? I wasn't sure if it is supposed to be a slow decline, or if it is supposed to be undetectable after IMRT.
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Foley Catheter
Casodex for last two weeks of November '09, then Lupron.
Suprapubic Catheter March 18th, but blocked right away, back to Foley...
Started IMRT March 25th, Chemo on hold due to catheter bleeding issues, etc.


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 4/29/2010 8:12 AM (GMT -6)   
I had my first PSA after IMRT at 3 months.  It was the same as before treatments, however, the 6 month PSA was 0.00.  It takes time for the bad cells to die off.

Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)
11/23/09 Post IMRT PSA .18
2/12/10   Post IMRT PSA 0.00


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 4/29/2010 11:56 AM (GMT -6)   
Gibson.

I've just had day 4 of RT.

All is well so far, but they have said I might need some sort of cooling "sunburn" cream if my skin reacts badly.

They warned me not use any other creams of any sort on my skin in the area, I even have to use a very plain soap.

Do you know how many clusters your dad is having? I am having 7 so that the non-target tissue such as my skin only gets 1/7th of what the target area gets.

Is this type of burning like normal burns that can be helped with the application of something cold. (eg a wet wash cloth)? And where exactly do you mean by "around his backside"?

They are also not going to test my PSA until at least 3 months after RT finishes as they day the treatment carries on having an effect fior many weeks after it finishes (also the full nature of the side effects may not manifest themselves until weeks after treatment finishes.)

Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc.
Nov 17th 2009 PSA = 0.1
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist


gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 4/29/2010 12:07 PM (GMT -6)   
They are already putting medicated cream on him (he's an inpatient at the hospital at the moment).
The burns are on his bum. Most of the time he is in a hospital bed, so it hurts quite a bit.
Not sure if something like an aloe gel would be helpful once they are already using medicated cream.
Other than that, he still gets a lot of pain going through his penis...not sure if that is just the very large prostate pushing out, and the radiation. Frustrating. He's on 3mg injections of dilaudid hourly...
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
Foley Catheter
Casodex for last two weeks of November '09, then Lupron.
Suprapubic Catheter March 18th, but blocked right away, back to Foley...
Started IMRT March 25th, Chemo on hold due to catheter bleeding issues, etc.


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 4/29/2010 3:17 PM (GMT -6)   
I had 40 treatments my buns turn dark but did't burn finish Dec 12 1st test Jan 5 second test 3-10-10 psa the same did'nt change much but nerly 6 months out still have spot but begening to fade
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 4/29/2010 3:17 PM (GMT -6)   
I had 40 treatments my buns turn dark but did't burn finish Dec 12 1st test Jan 5 second test 3-10-10 psa the same did'nt change much but nerly 6 months out still have spot but begening to fade
DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 4/29/2010 6:11 PM (GMT -6)   
Hi Gibson,
 
I had IMRT as noted below. I did have some skin irritation and burning on my backside right at the top of my plumbers valley. It did not occur until about the 40th treatment and cleared up within days of completion. It was about the size of a silver dollar. I did not use anything on it other than a band aid.
 
Good luck to you and your father.
 
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
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
PSA 03/10 .32 18 months after IMRT Still on hormones


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/29/2010 6:30 PM (GMT -6)   
I find this entire conversation interesting. When I went through salvage radiation this past October and November, and started reporting side effects and burning issues, many regulars here that had undergone radiation reacted like I was the odd exception and that most people don't have issues. Just from reading this thread, looks like burning in general is more common.

I think that radiation clinics in general downplay radiation side effects the same way that some surgeons down play post surgery complications and side effects, i.e. incontinence and ED.

When I first started reported "burning" feelings in the first week, the clinic basicially said it couldn't be, because the IMRT was so targeted. Then when my uro (who has nothing to do with radiation) asked them about "scattering", where a certain amount of radiation "scatters" away from the targeted area(s), they denied that as well.

To make a long story short, when I was well into the 39 treatments, and burning was almost a daily affair, they changed their mind and admitted first to the "scattering" effect, and when the treatments were done, mostly due to the grilling from my uro, they admitted to the collateral damage that I have been suffering.

My uro has further studied post-radiation effects since the SRT effected me in such a negative way, and he said he has since learned, that post radiation people can suffer not only months later, and in some cases, some side effects can actually worsen months later, but in some cases, it can take years for the body to heal completely.

I say all of this, in hopes that people understand that radiation treatment is not always "a walk in the park" as I have heard some describe it. If it was for them, they were blessed and fortunate.

In my own personal case, having been through major radiation before PC, I asked the right questions with the clinic, but until I started showing real life side effects, they were slow to catch on to what was happening to me. That part still bothers me. Don't read me wrong, my 2nd post SRT reading is an amazing .04, which I hope stays that way, but it came at a price, that is still going on with me, and will continue from the sounds of it for months to come.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 4/29/2010 6:42 PM (GMT -6)   
When I started IMRT someone asked me if my hair would fall out and I told them no, it was image guided tx. Little did I know that my pubic hair would start falling out towards the end of treatment and continues to do so. David you are right about the scattering effect, but hopefully the effects will begin to diminish soon.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10, Completed 39 tx at 72 gys on 3/12/10
Great family and friends
Michael


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/29/2010 6:57 PM (GMT -6)   
Michael,

I was told to expect to lose my "pubes" too in the process, but don't think I lost a single hair down there, despite all the other damage. All part of our crazy treatments and how things vary so very much.

Even though its been 10 years, I still don't need to shave on the left side of my face at all, but could grow a full beard on the right side, this was the result of the neck/throat radiation that I had back then.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in

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