Oncologist recommends including the pelvic lymph nodes with SRT

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Regular Member

Date Joined Nov 2009
Total Posts : 485
   Posted 11/24/2010 11:38 AM (GMT -6)   
Both of my oncologists recommend including the pelvic lymph nodes (whole pelvis) with SRT.  They believe that treatment with the new Varian rapid arc will allow full pelvis radiation without the toxicity experienced with the older equipment.  Has anyone had any experience with this?  Would like to have as much info as possible.  I have a little time since I will have at least one more PSA before I do anything.

Diagnosed 2/2008 at age 71, PSA 9.1, G8 (5+3), stage T1c.
Robotic surgery 5/2008, LFPF at 6 wks.,nerves spared, stg. pT2c, N0, MX, R0, G8 (5+3)
PSA .12 at 2.5 years, rechk 2 wks later 0.2. All prior tests <0.1.

Regular Member

Date Joined May 2009
Total Posts : 476
   Posted 11/24/2010 4:31 PM (GMT -6)   

I had full pelvic SRT. I did not find my side effects different from those reported by others here who did not have pelvic radiation. For me (and everyone is different) this was an easy procedure. I got tired towards the very end. Got loose stool and urinary urgency also towards the end.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

Regular Member

Date Joined Nov 2009
Total Posts : 485
   Posted 11/24/2010 6:36 PM (GMT -6)   
Greg, thanks for the response. I take it from the lack of responses that whole pelvis SRT is not very common. Do you remember if bowel and urinary issues cleared up quickly? Again, thanks for the reply.

Diagnosed 2/2008 at age 71, PSA 9.1, G8 (5+3), stage T1c.
Robotic surgery 5/2008, LFPF at 6 wks.,nerves spared, stg. pT2c, N0, MX, R0, G8 (5+3)
PSA .12 at 2.5 years, rechk 2 wks later 0.2. All prior tests <0.1.

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 11/24/2010 6:43 PM (GMT -6)   
Hello Carlos,
I had the full pelvic treatment with the Varian technology due to suspicious lymph node swelling. Not Rapid Arc as it was not available then but the difference is in how long the treatment session takes. The first 25 treatments included full pelvic and prostate focal. They will not give you as high a dose in the pelvic region due to concerns about colon damage. about treatment 20 I had diarrhea and burning urination. Immodium and flomax fixed both. about treatment 28, the third prostate focal only treatment, the diarrhea cleared up and so did the urinary issue. Then around no 35 I started to lose a little steam but had plenty of time for napping. I kept up a workout routine at the gym for the entire time. I did slow my treadmill pace and lightened the weights the last two weeks of the treatment. It took about a week after the last treatment (#45) to start getting my energy back. However that was short lived as I was doing hormones also and was about nine months into that and started having fatigue that I believe was related to the hormone.
Best of luck to you.
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10

Regular Member

Date Joined Nov 2009
Total Posts : 485
   Posted 11/24/2010 7:02 PM (GMT -6)   
Don, Thanks for the reply.  I have always had an innate fear of radiation and having your comments (and Greg) helps a lot.  I have no doubt that I will take the recommended treatment, but I think I may be a little more relaxed about it now.  Thanks,

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 11/24/2010 7:32 PM (GMT -6)   
I am on board with the WPRT protocol. I was shown the studies by Harvard and Stanford that compared both salvage and adjuvant radiation therapy in post RP patients that were high risk. The comparison was whether there was significant improvement in biochemical relapse when they radiated the prostate bed only(PBRT) versus Whole Pelvic Regional Therapy (WPRT). WPRT was defined as prostate bed and regional lymph nodes. The results showed a nearly 100% improvement in the WPRT at 6 years at the time I elected to do it using IMRT.

I cannot tell you if RapidARC will show any significant difference in biochemical failure or in morbidity as it has not been around long enough to asses that. In fact IMRT has barely been around long enough to assess the long term morbidities that I might face. But I believe that it is probably that IMRT has improved greatly on it predecessor ~ EBRT. And if RapidARC shows any improvement over IMRT at 15 years, all the more reason to proceed.

Good luck with this. But I agree with your oncologists even though my only credentials are being an advanced prostate cancer patient for the last four years. That would be four years with no relapse to date...


Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

RALP ~ 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.

"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

Regular Member

Date Joined Apr 2008
Total Posts : 364
   Posted 11/24/2010 11:49 PM (GMT -6)   
 I had "full pelvic" SRT exactly 1 year ago.  During the radiation and the following year I haven't had any issues to speak of but most Radiation issues occur 3-4 years down the road I believe.  Not only did I have full pelvic but I also had a rectal balloon inserted each treatment.  Let me tell you that was something to look forward to. NOT!!!  A lot of proton places use the balloon but not many radiation places do.  I'm not sure why radiation clinics don't use the balloon  but the explanation of why they insert it sold me on the experience as uncomfortable as it was.
Good luck and try to exercise as much as possible.
54 y.o.
Diagnosed 4/10/08

DRE Normal


Biopsy- 12 cores, 4 positive highest 4+4=8

Bone scan, CT scan and Chest X-ray clear 4/16/08

Urologist suggested surgery 4/16/08

MRI on 4/24/08 clear no suggestion of lymph node involvement.

4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July. This treatment will not preclude me from surgery if I change my mind.

Decide to have DaVinci surgery after another consult with surgeon.

6/19/08- DaVinci surgery at University of Washington.

6/25/08- Path report, clear margins, no noted extension

9/12/08- PSA <0.02

12/05/08-PSA <0.02 Six months after surgery

3/02/09-PSA <0.02 Nine months after surgery

5/02/09-PSA .10

8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.

12/31/09- SRT completed, still on HT and will be for 2 years, PSA is <0.01

7/30/10- PSA still <0.01, on HT 1 year with 1 to go.

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2209
   Posted 11/25/2010 1:46 AM (GMT -6)   
Please correct me if I've misunderstood, but I am not sure if the Rapidarc machine is meant to be any better at damaging the cancer than the current/old equipment, I thought it was more about Rapidarc being better at not damaging the healthy tissue.
It is thus firstly about improving accuracy, as it scans before firing: any (small) changes in the location of things inside your body are accommodated.
Secondly Rapdiarc should be better as it is reducing the dosage given to healthy tissue by delivering the RT with a large number of very small doses spread over 360 degrees.
There is also a third element relating to patient comfort, as Rapidarc completes a session in less time.
Finally there is less need for a patient to stay very very still as the scanning locates the target rather than it being done by lining up tattoos with lasers.
For some cancers, such as brain tumours, the above improvements make a big difference to what the patient has to go through. (When I was waiting for my sessions of RT I always felt very sorry if another person there was having to have their head clamped to the RT table in a rigid mask.)

I would expect that those PCa guys treated with Rapidarc are, or will be, reporting fewer side effects related to collateral damage ,especially in the Bowel and continence area. I assume fatigue will be the same.

And if a balloon up the back passage could have stopped my back passage turning into a five BMs-per-day nuisance then I think I'd have opted for it.

Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
BMs weird
14 Sep 10 PSA <0.1
Erections OK

Regular Member

Date Joined Nov 2009
Total Posts : 485
   Posted 11/25/2010 4:48 AM (GMT -6)   
Tony,  thanks for the info comparing the WPRT protocol to PBRT only.  I had not been able to find much info on the subject.  Good luck on your continuing success. 
David, thanks for giving me something to look forward to after the holidays.  I do spend a lot of time at the gym and have been concerned about fatique.
Alf, I believe you are correct about the Varian equip.  The faster treatment simply allows the radiologist to treat more patients.  I can only hope that the claims of fewer bowel and urinary issues will prove out.  I see your young age and can't imagine having to deal with PCa at your age.   I wish you well.

Regular Member

Date Joined Aug 2010
Total Posts : 84
   Posted 11/25/2010 5:35 AM (GMT -6)   

Hi Carlos,

You may be concerned with RT but the procedure is simple and well tolerated. However, your nerve spare approach of 2008 may lose its purposes. The dosage and equipment will rule the outcome of success in both, cure and minimized side effects. Just as Alf says above you have chosen the best, a Rapidarc machine.

Every case is different but giving you an example; I had SRT (Variant-3D IMRT) four years ago for the whole pelvis and prostate fossa, in a total dosage of 68Gy in 37 fractions (every day except Sundays). The daily sections were easy to take and become a kind of a routine. One hour in advance I would drink lots of water to fill the bladder (it helps in minimizing the side effects), then I would drive to the clinic (50km far from my house). There, I would dress a light gown and lay face up on the machine’s stretcher while the beam head would move around me stopping here and there. All actions and movements were controlled by the staff in their computer screens live, in a separate room. It would take approximately 15 to 20 minutes (1 to 3 minutes under radiation). I never felt fatigue (played golf on weekends) or nausea. I had a sensation of burning pain on my fifths’ week of treatment when urinating and the stool became much liquefied with traces of blood (proctitis), although no skin burning marks. These side effects were treated with separate medicines during the three month post treatment, but apart from the partial loss of rectum sensation at discharge (stool is now more consistent), all physical symptoms have gone and I never experienced incontinence.

With newer equipment doctors plan for higher Gy dosages which can assure better results of success.

Wishing you the best


Age: 50 at Dx on May/2000; PSA=22.4;
6x cores biopsy positive; Gleason score (2+3=5)
RP in Aug/2000, PSA=24.2
Negative S-vesicles & lymph node (9); capsular penetration
Voluminous Adenocarcinoma, well-differentiated, Gs (3+2=5); pT3apN0
Post-op lowest PSA=0.18 on Oct/2000; Classified as Micro Metastasis
Jan/2001 PSA=0.26 Biochemical recurrence
AS (Watchful W.) until PSA=3.80 on Oct/2006; MRI & Bone scan negative
Nov/2006 SRT (3D IMRT; 68Gy / 37 fractions)
Feb/2008 lowest nPSA=0.05
May/2009 PSA=0.26 Biochemical recurrence
Oct/2010 PSA=0.95 (doubling at 9.6 months)
Nov/2010 ADT Cyproterone 100mg/day + Eligard 45mg 6-month depot
Asymptomatic, never incontinent, ED since RP
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