suggestions for time of day of SRT treatments?

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Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 670
   Posted 7/2/2010 12:53 AM (GMT -6)   
I'm starting IGRT SRT on August 4. In 2 weeks I'll talk with the doc and staff about all the arrangements, including the time of day of the treatments. If I have my choice, do any of you who have been through the process have a suggestion of what time of day is the best?

I'm in a metropolitan area, 25 minutes from home to work, and about 25 minutes from work to the radiology site. Probably 30 minutes from home to the radiology site outside of rush hour traffic. I was leaning toward late morning, when there will be the least amount of daytime traffic, and it will be easiest to get back to work. My work is supportive if I start needing to take some time off each day - I figure I have enough sick leave to take off 3 hours per day for 8 weeks if I need to (and blow all my sick leave for a year). Not my plan, though.

Thanks, Jeff
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09: 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear
PSA after, 2010: March, 0.17; April, 0.17; May, 0.24; June, 0.31
Starting salvage IGRT on August 4


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 7/2/2010 1:49 AM (GMT -6)   
Jeff,

I can't offer much advice re fitting in work as I don;t have an employer.

I kinda envy you being able to select a time.

I could not specify what time I had my sessions each of the 33 was at a duiffertne time, all but one were in the afternoon, but were at any time between 13.00 and 16.30. And I only got told on the Thursday of each week at what time the sessions for the next week would be.

As for travelling I avoided rush-hour traffic etc by going by train, okay so some trains were busy and others were almost empty, but all but three arrived at the right time. The train ran next to the motorway and it was intersting to note that on EVERY day the traffic was backed up, some days as much as ten miles, so I was glad not to be stuck. Others I met in the waiting room who did come by car hated the traffic and had to allow a lot of extra time for blocked roads, so that often if they were not dealyed they arruived as much as an hour eaerly.
So i guess it depends on how busy the raods are where tyou have to go. May be have a practice drive round of the route at a couple fo different tiems. (And also know thwe alternatioves to cover for when there is a problem)

Another aspect to take into consideration when picking a time is related to what your bladder does at different times of the day. Are the gaps between bathroom visits always the same? Is it always as full? etc

You have to have your RT when your bladder is full and drink water about an hour before hand to ensure that this is so, but I found that my body did not produce pee at the same rate per hour for every hour of the day.
On the one hand it's no good going for RT and not having a full bladder and on the other hand it's no good lying on the table and bursting before they are finished.

This is all about the bits inside you being in the right place at the right time for the rays to hit the nasty bits and avoid as much as possible of the healthy tissue. They will have worked out where to aim the rays on the basis of the images taken during the abdominal CT-Scan, (I also had to drink water and have a full bladder for my CT-Scan) thus I think the ideal situation is for your bladder to be in the same state during RT as it was during CT.

Can you do it after work or just before you're due to stop at the end of the working day so that you leave work early but don't have to go back afterwards and then if you need recovery time afterwards it's in your own time?

Alf
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 of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)
June 11th 2010 finished RT - main side effect tiredness, but also the occasional small leak


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 448
   Posted 7/2/2010 3:22 AM (GMT -6)   
Jeff,

I am retired, so did not have to worry about work. I stayed at a house of friends that was 30 miles from the hospital in Seattle. I had 5:30pm appts and it went like a breeze... It was a reverse commute. Never any traffic hangups... It was also easy to plan formy "full bladder". And after the treatment when I got home, I could relax and go to bed anytime as it was already in the evening.

Did not interfere with my "day"... Worked great for me...

pasayten
After 3-4 years of annual PSA 4-6, biopsy recommended
59 y/o
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
3/12/2010 Finished 32 sessions...  No side effects to date except a little
tiredness.  Slight changes in bowel movements the last week...  
4/8/2010  Some rectal prostitis, but no change in urgency.  No urinary effects at all.  Now just waiting for the upcoming PSA test in June.
6/7/2010 First 3 month PSA result after SRT = 0.02   WAHOO!  as good as could ever be expected at the 3 month mark!  Thank You Jesus!
 


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 7/2/2010 7:06 AM (GMT -6)   
Jeff, when John's PSA crept up and we were getting reading for SRT, the one thing the rad onc told us was that it was important for John to have a BM before each treatment so that the colon is not putting pressure on the bladder pushing it further into the radiation field. So, knowing your body's schedule might be helpful in planning the time of day for treatment.

In John's case, he was planning on doing the treatment first thing in the morning because he felt it would be less disruptive to his work day. For him, work is 7 miles from our home so driving during rush hour was not much of an issue.

If your employer is flexible, I would go with the schedule that works best for you. If traffic is an issue, then go with mid to late morning. During the summer - with school out - traffic might not be as much of an issue for you.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 7/2/2010 7:35 AM (GMT -6)   
Im_patient:
i'm a morning kinda guy, and my hospital/city circumstances are very similar to you, so i asked for the LAST appt time of the day.  i came in to work early every day, then left early, did my treatment, then the rest of the afternoon was mine.  i could run a quick errand (picking up a chocolate shake for instance), then go on home.  and if i didn't feel like doing a lot more than crash in front of the evening news, that was okay, and by suppertime, i was usually ready to jump up and do a thing or 2 around the house.   my work was very cooperative with me, and i felt like i was giving them the best combination of my hours...
worked for me anyway!
wishing you all the best: may the radiation do its damage, with minimal side effects!
bob
 

Age@dx: 55

5/05             PSA test 1.8  --12/19/07  PSA test 3.7  --7/25/08    PSA test: 4.7

8/26/08        1st Prostate Biopsy: 3 samples out of 6 have irregular cells

11/25/08      PSA test: 6.5

12/11/08      2nd Prostate Biopsy :  of 12 samples, 3 are cancer, and all other 9 are irregular.  original NJ lab sent samples to Johns Hopkins for special reading.  Gleason 3+3=6.  now:read book, and think about options: radiation, surgery, etc

1/22/09        Radical Retropubic Prostatectomy.  main issue was use of BOTH pre-donated units of blood during surgery, and then required 2 additional units in recovery, before going to room

1/25/09        Released from hospital. No drive, no lift >5 lb

1/28/09        Pathology results from removed tissue:  Cancer was seen on 10% of gland, lymph nodes & SV were benign, nothing seen outside of the prostate.  One area of cancer extended right up to edge, but not beyond.  Gleason was re-typed as 3+4=7, staged T2c

2/13/09        PSA=0.1

3/6/09          6week appt, start back to work Monday, 3/9.  script for Cialis

6/8/09          PSA=0.1

10/9/09        PSA=0.1

2/10/10        PSA=0.3 discussed possibility of radiotherapy and/or hormone.

4/7/10          PSA= 0.4  Recurrence of the cancer is probable. Referred me to RO

5/4/10                   First RT.  RO is recommending 37 treatments x 1.8Gy=66.6 Gy

6/25/10       Final RT. ended up w/ 36 treatments, 64.8 Gy


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/2/2010 8:19 AM (GMT -6)   
The first time in my life when I had radiation, had busy job, so I had my zaps at 5 PM each time, last appt at the clinic. I used my lunch hours to cover the time. Drove straight home, and then collasped. Didn't have to worry about going back to work that day.

This time, having radiation for PC, I was unemployed, so it really didn't matter. Since I dont sleep well at night, didnt want early appt, so I went at 2 PM, no traffic problems, and plenty of time to get back home an rest.
You have to think how you might feel 4-8 weeks into it, when the fatigue factor starts to show its ugly face, don't be fooled by how you feel the first week, that easy feeling doesnt always last for long for most.

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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 288
   Posted 7/2/2010 10:25 AM (GMT -6)   
I took the earliest available appointment in the morning which was 7 a.m. My rationale was being first or one of the first meant there was less likelihood of being backed up by accumulated delays. This helped me also plan my required water intake since I started from zero each morning then added my coffee and about 20 oz of water before treatment. Getting on the road about 6:15 a.m. helped avoid the commute. I am retired so I didn't have to worry about a work schedule and the side effects (which were minor for me).

Good luck,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 01/19/10 started 39 sessions 70.2gy, psa at 6th week salvage IMRT up to .4
Post SRT psa at 10 weeks (5/31/2010) down to .2


alicomp
Regular Member


Date Joined Feb 2010
Total Posts : 40
   Posted 7/2/2010 10:47 AM (GMT -6)   
My husband's oncologist suggested early in the morning to avoid delays that occur later in the day. He has an 8:30 appt. It takes us 35 minutes to get there, but we leave about 7:00, get to the hospital in plenty of time with not too much traffic, and go to Starbucks for about 45 minutes. The only issue, as one person mentioned, is that Harvey is a night person and is not getting much sleep because he has to get up early and can't fall asleep early. He is pretty tired most days, not from the radiation, but from lack of sleep. Today is the half-way point. Four weeks to go.
Good luck.
Husband dx 12/09
Age 60
PSA 4.5
Biopsy 8/12 cores positive; 5% - 50%
Gleason 3+3
DaVinci at UNC 3/9/10
Gleason 3+4 with tertiary 5
% of prostate involved with tumor 20%
Not confined to prostate; surgical margins positive for carcinoma, left mid prostate
Perineural invasion extensive
pT3A
pNx
pMx


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 7/2/2010 1:01 PM (GMT -6)   
I am currently undergoing IGRT and working full time. My treatment is at 1030 each morning. Like you, it is about 20 minutes from my office to the hospital. I originally wanted my treatment at the end of the day. That way I could use one hour sick leave, get treated, and get ahead of rush hour traffic on the way home. With the fatigue I am now going thru, that would have been ideal. Unfortunately, the hospital had no afternoon openings. So now I use one hour sick leave and my lunch hour to cover the time. If fatigue becomes a factor, it is really hard to work thru the afternoon with a clear head. I deal with the public and I find myself not remembering what I said during the last interview. Not good. But, each of us handles this thing differently. Good luck. Squid.
*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*open Surgery October 22, 2009
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*ED - Yes 
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture. opened during cysto exam. Cath #2 in for 5 days.
*03/01 - bladder neck stricture. Dilated during cysto exam. Cath #3 in place.
*03/11 - Bladder neck surgery. Cath #4 in place.
*03/15 - Cath #4 out. Great urine stream. Unfortunately, incontinence back to post surgery level.
*04/14 - Six month PSA .21.
*05/15 - Incontinence basically under control.  99% dry.  Wear pad daily at work "just in case".
*06/10 - Started IGRT.   39 treatments scheduled.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/2/2010 6:04 PM (GMT -6)   
subic, good luck to you and the rest of your treatments, you are getting there, my friend.

alicomp - good luck to the rest of your husband's treatments too, it truly is an endurance contest. lack of sleep can be as devestating as true fatigue, neither are good for the body
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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 789
   Posted 7/2/2010 7:37 PM (GMT -6)   
Jeff, you may have to vary the times, as you may experience fatigue, as you get further into the treatment, it affected me, and most people here who have had radiation therapy.

Best of luck with your treatment.

Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept. Totally dry since catheter removed
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)
PSA 11th March 09 0.5
PSA 3rd August 09 0.6
PSA 25th November 09 0.6 (I am now 69)
PSA 18th Jan 10 0.6


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 7/2/2010 9:30 PM (GMT -6)   
I did mine at 10:30, so had the morning staff meetings, did the rads, then lunch and back at it. Just worked later to make the time up most days. By the last couple of weeks, I started having to slip in a nap to avoid falling over later in the afternoon. Still having to do that two weeks after.

Reconsidering, if I had a seriously fixed schedule, I would have gotten up and started work earlier, taken the 4:30 pm slot, and gone to bed when I got home (you won't make the late news anyway after a couple of weeks), but I would have likely had a few more water-torture accidents on the way home.

But with traffic and the like, 10:30 worked.

I only had two significant reschedules, so got a near od on water those days.

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 670
   Posted 7/3/2010 4:47 PM (GMT -6)   
Thanks all for your perspectives. It's good to see what others did and what they thought about their choice. Hadn't thought seriously about a later afternoon slot. Still will mull things over based on the good info here.
Regards, Jeff
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09: 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear
PSA after, 2010: March, 0.17; April, 0.17; May, 0.24; June, 0.31
Starting salvage IGRT on August 4

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