Radiation spot treatment

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kak
Regular Member


Date Joined May 2009
Total Posts : 85
   Posted 5/8/2010 8:43 PM (GMT -6)   
Hi: I have met spread to femor. No pain. My oncologist said he could do radiation if I start to have pain. Can anyone tell me what the radiation will do? Why would they not do radiation now?
AGe 54 diagnosed March of 2007
PSA 107

Gleason 8

Stage T2 or T3 (weren't sure was out of prostate capsule)

Bone scan march 2007 and Aug 2008 both clear

ct 2007 clear

started casadex/lupron March of 2007 (casadex only for 4 months)(lupron for 2 yrs)

Aug 2007 had 37 treatments (also radiated lymph nodes)

psa spr 07-107,went down to .34 by Dec 08, March 09 0.7, May 1.54,
Added casodex, PSA Aug 1.19, Psa Dec 09 5.65
Going for Bone scan and Ct Scan, than decide what to do with rising psa


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 5/8/2010 9:32 PM (GMT -6)   
Hi Kak, I have a lesion on spine. My Dr wants to do radiation right away. Concen is that tumor could damage spine causing pain and other problems. Don't know if the same concern exists for femur. You could get a second opinion.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 5/8/2010 9:34 PM (GMT -6)   
Did you have a biopsy to confirm mets to bone? Your PSA is pretty low still.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


kak
Regular Member


Date Joined May 2009
Total Posts : 85
   Posted 5/8/2010 9:46 PM (GMT -6)   
No haven't had biopsy. First bone scan was in December 09, and the second one in May 2010 showed more uptake, so in his opinion shows it is a met and the bone biopsy isn't necessary. One problem I have is my oncologist has just gone on leave for 3 months. Where I live there isn't an abundance of oncologists, in fact there is only 2 and they are extremely busy. also money is a consideration in going somewhere else. I intend to phone his nurse on Monday to ask the same question I have asked here. The only thing I can figure is that the radiation doesn't stop the met it just controls it and maybe risk of bone density damage I don't know just pulling reasons out of the air. Would be great is someone out there knows the answer.
AGe 54 diagnosed March of 2007
PSA 107

Gleason 8

Stage T2 or T3 (weren't sure was out of prostate capsule)

Bone scan march 2007 and Aug 2008 both clear

ct 2007 clear

started casadex/lupron March of 2007 (casadex only for 4 months)(lupron for 2 yrs)

Aug 2007 had 37 treatments (also radiated lymph nodes)

psa spr 07-107,went down to .34 by Dec 08, March 09 0.7, May 1.54,
Added casodex, PSA Aug 1.19, Psa Dec 09 5.65
Going for Bone scan and Ct Scan, than decide what to do with rising psa
Bone scan Dec 09 and follow up May 2010- met on right femor
Psa continue to rise, continue on Lupron and casodex


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 5/8/2010 10:56 PM (GMT -6)   
Hello.  External beam radiation targeted directly to the bone metastasis is often referred to as "spot radiation."  Is is very common with bone mets, when there is pain, and it can be quite effective.  The purpose is to kill the prostate cancer cells that are at that spot in the bone, and thereby relieve the pain.  Note that this is a paliative treatment -- unlike external beam radiation to the prostate bed, which is used as a primary treatment, with curative intent.  In other words, it can eliminate pain but it does not cure the cancer.  Another option you could discuss with your doctor would be radiopharmaceuticals, such as Stronium-89 or Quadramet, which are also used to address bone mets (usually where there are multiple bone mets).   It would also be worthwhile to ask your doctor about medications to addreess bone integrity issues, such as Zometa.  Best wishes.
 
 
 
 
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 5/8/2010 10:59 PM (GMT -6)   
The only reason for radiation to the bone is to allievate any pain. It will not cure bone mets; that's why your doctor wants to wait. Also ask your doctor why he is not using Casodex and Proscar (ADT3) as this is the established protocol for complete hormone blockade.
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 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.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/9/2010 12:51 AM (GMT -6)   
Hi kak,
Lesions in areas like the femur may be safe to monitor. I would continue asking key questions like whether estrogens might not be a better approach than androgen ablation or blockade. Your nadir never reached 0.1 or less so it is unlikely that ADT3 on its own will be effective. That stated, you can look at the old way of doing things, and see if it might bring you to remission.

Hang in there and stay positive! you still have lots of ammo.

Peace!

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


kak
Regular Member


Date Joined May 2009
Total Posts : 85
   Posted 5/9/2010 1:11 AM (GMT -6)   
I am on lupron and casodex.
AGe 54 diagnosed March of 2007
PSA 107

Gleason 8

Stage T2 or T3 (weren't sure was out of prostate capsule)

Bone scan march 2007 and Aug 2008 both clear

ct 2007 clear

started casadex/lupron March of 2007 (casadex only for 4 months)(lupron for 2 yrs)

Aug 2007 had 37 treatments (also radiated lymph nodes)

psa spr 07-107,went down to .34 by Dec 08, March 09 0.7, May 1.54,
Added casodex, PSA Aug 1.19, Psa Dec 09 5.65
Going for Bone scan and Ct Scan, than decide what to do with rising psa
Bone scan Dec 09 and follow up May 2010- met on right femor
Psa continue to rise, continue on Lupron and casodex


kuls
Regular Member


Date Joined Mar 2010
Total Posts : 57
   Posted 5/9/2010 8:47 AM (GMT -6)   

Hi Kak,

It is not uncommon for the Dr. to suggest waiting until you have pain before radiating the femur.  As others have said, the radiation administered at this point is not curative in nature, but is meant to provide symptom/pain control.  The dosage of radiation will be much lower than for a curative intent, and is usually given over a course of between 1 and 15 treatments (eg. 600-800 cGy in 1, 2000 cGy in 5, 3000 cGy in 10).

It is much more urgent to do radiation treatments when the tumor is in close proximity to sensitive structures/organs.  When someone has spine mets for example, it is important to treat before the tumor can grow and press on the spinal cord causing a "cord compression" which can lead to a host of problems....possibly even paralysis.  It's best not to wait until the met is causing problems, as they don't want it to get out of hand.


-Husband's 1st PSA done (age 45) at routine physical  PSA 3.8
-DRE at physical indicated no abnormality other than slightly enlarged
-Consult with urologist Jan. 2010---DRE negative, PSA 3.89
-Biopsy Feb. 10, 2010:  T1c, Gleason 3 + 3, 2/10 cores pos. (5% in one core, <5% on other core) 1% of core volume positive, gland size     38.84
-consult with "open" prostatectomy uro March 2010
-2 consults with rad. onc. for Brachy March, Apr. 2010....also discussed AS
-latest PSA reading April 8 4.63
-consult with "robotic" uro Apr. 12....tentative surgery date booked July 8
-Have also booked tentative Brachy date of July 20th.
-undecided as yet


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 5/9/2010 9:10 AM (GMT -6)   
kak - has your doc discussed with you the possibility of adding dutasteride (or finasteride) to your Lupron & Casodex?  Has he measured your DHT level?  If not, you might raise this with him & get his reaction.  Best wishes,
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

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