SRT-- how many GY (for those who did SRT)

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compiler
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Date Joined Nov 2009
Total Posts : 7197
   Posted 1/12/2011 4:14 PM (GMT -6)   
I may have asked this before. I just saw the radiation oncologist.
 
He said I would be getting 68.4 GY.
 
Two questions:
 
1) How much GY did you get?
 
2) Was it determined (the amount) after he did the measurements or before.
 
Mel

James C.
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Date Joined Aug 2007
Total Posts : 4462
   Posted 1/12/2011 4:16 PM (GMT -6)   
I have had no measurements, just an initial consult. The doc said he would do 66 gys, and he was basing it on my Gleason, my post surgical path report and their standards of treatment.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

Galileo
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Date Joined Nov 2008
Total Posts : 696
   Posted 1/12/2011 4:21 PM (GMT -6)   
I had 70.2 Gy over 38 sessions. I'm not sure at what point the dosage was determined.

I go back to see the radiation doctor next week. It's been nearly 5 years since diagnosis and surgery, and 4 years since RT now for me. I'll probably have a blood draw tomorrow.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) Jan-Mar 2007
PSA 9/2007 and thereafter <0.1
pcabefore50.blogspot.com

Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 1/12/2011 4:23 PM (GMT -6)   
Same as James, no measurements, doc said he was going to do 66 gys
Age 54 (2006) PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
RRP 11/3/06 Post-Op Biopsy, Gleason 6 (3+3), T2c, right apical margin positive
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 7/10 - 0.02

dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 1/12/2011 4:30 PM (GMT -6)   
68 Gy for mine.
I do not know if or what he measured but he did the CT scans and worked up a plan and told me it would be 68.
I am at 2 yrs post SRT and just had another <0.04
YEA!

good luck
David
Age 55
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09
05/14/09
1st PSA after SRT <0.04
12/03/09
2nd PSA after SRT <0.04
06/03/10
3rd PSA after SRT <0.04

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/12/2011 4:33 PM (GMT -6)   
So there's  no confusion, I got 72.0 over 39 sessions, the dr. had considered as much as 80 gys at one point, then backed it off.  Their big concern was the pre-surgery PSA velocity issues, and post surgery readings.

Post Edited (Purgatory) : 1/12/2011 3:50:04 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/12/2011 4:50 PM (GMT -6)   
b
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 1/12/2011 5:17 PM (GMT -6)   
I Had 66 Gy, but have no idea how this amount was determined. It seems to have done the trick thus far. I stated SRT at PSA .1.  6 weeks after completion it was .05 and since then (2 years) <.04.
 
Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1,
Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Jan 11) <.04

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 1/12/2011 5:21 PM (GMT -6)   
Here is some interesting information, from :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848745/

This is an interesting, extensive article. Some quotes:



"Optimal radiation dose required for patients with post-RP PSA relapse remains unknown. Most published studies used a radiation dose <70 Gy for salvage RT, due to the concern for radiation morbidity. It is plausible that a higher radiation dose may yield better treatment outcome. King suggested a dose-response relationship in salvage RT setting (85). He estimated that 66.8 Gy would give a 50% chance of achieving PSA relapse-free rate at 5 years and that the proportional gain in PSA relapse-free rate would be 3.8% per additional Gray within the steep part of the tumor control probability curve. Bernard (86) and King (76) described in their retrospective series that a higher radiation dose was associated with improved PSA relapse-free rates. In recent years, the adaptation of more sophisticated techniques in radiation delivery such as intensity-modulated radiotherapy has allowed escalating radiation dose to the target, while minimizing toxicity to the surrounding normal tissues. De Meerleer recently reported, using intensity-modulated radiotherapy, that a dose of 75 Gy could be delivered with a low risk of serious acute and late radiation toxicity in a salvage RT setting (67)."

"For salvage RT, further study is needed to address optimal radiation dose required for patients with PSA relapse. In parallel, more advanced techniques in radiation simulation and delivery need to be explored in order to minimize radiation toxicity to the surrounding normal tissues, while escalating radiation dose to the target. Another unresolved question is whether regional pelvic nodes should be irradiated along with the prostate bed, and the current RTOG 0534 study is addressing this question"

Mel

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/12/2011 6:30 PM (GMT -6)   
Mel,

With the newest delivery system like you are talking about, I am a bit surprised that aren't talking at least 70 gys. Again, I am not your doctor.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 1/12/2011 6:41 PM (GMT -6)   
Mel,  My radiologist is using 68.4 Gy just like you.  He based my treatment on my pathology and surgical report.  The 68.4 is based on a Dana Farber Harvard Cancer Center standard treatment protocol.  He would not deviate from that protocol unless there were some underlying condition.  I am about halfway through with my treatment and have not had any SEs yet.  My equip. is just like yours and Fairwinds. 
 
Carlos

Dx 2/2008, age 71, PSA 9.1, G8,T1c. daVinci surgery 5/2008, G8(5+3), pT2c. LFPF, good QOL. PSA <0.1 for 2 yrs. PSA rose to .2 at 30 months, started SRT 12/15/2010.

Fairwind
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Date Joined Jul 2010
Total Posts : 3628
   Posted 1/12/2011 7:24 PM (GMT -6)   
I am a "High Risk" patient, Gleason 9, very poor post surgery pathology (6 week PSA 0.9, positive vesicle) I sought out an aggressive "all or nothing" radiation oncologist..He was the head of Radiation Oncology at a large Denver hospital. The hospital had just recently installed the latest Varian Rapid-Arc Novalis linear accelerator. He told me something like this..."In view of your history and good overall health and physical condition, I would like to treat you as if you never had surgery. The best chance for success will come with the highest dose possible. With the new machine and very careful treatment planning, I think 80 Gy over 40 sessions will work for you. If it doesn't, at least you will know we did everything we could.." I am getting 33 treatments over a slightly wider area than the last 7 will be. These last 7, referred to as a "boost" will be tightly focused on the prostate bed...I will ask my R-doc tomorrow if this very high dose is exposing me to undue risk. I completed treatment #18 today...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/12/2011 7:53 PM (GMT -6)   
So Fairwind, you are undergoing a full 80 gys? They backed me down from 80 to the 72, and they used the same logic, since I had BCR so fast after surgery, they wanted to got at it like there hadn't been a surgery.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6893
   Posted 1/12/2011 8:07 PM (GMT -6)   
I think mine was 70.2, but it is in my thread (below).

I'm not sure what "measurements" you are talking about. They did a CT planning scan, spent a week with the information, and did the treatments. There was no "negotiation" that I know of - there was never an "estimate" or "provisional" number.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3780
   Posted 1/12/2011 8:22 PM (GMT -6)   
Fairwind -- along with the lupron that's pretty aggressive treatment.  how are you feeling man?
 
ed
 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 1/12/2011 10:15 PM (GMT -6)   
David:
 
If you read all the responses, you will see that in this too there is no one definitive answer. I didn't really question the GY number as I just don't know enough about this.
 
After reading all the responses, I still see no reason to question it, but I might just ask anyway!
 
Mel

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 1/12/2011 10:27 PM (GMT -6)   
I had 66.6 over 37 sessions. 1.8 per.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/12/2011 11:31 PM (GMT -6)   
Mel,

I never said or expected all the answers to be the same, my -point to you, was how could this doctor already tell you the dose when he hasnt even officially started working with you actively, and hasn't developed a working plan for your treatment, that was my point.

David
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 428
   Posted 1/13/2011 2:19 AM (GMT -6)   
At the initial consult, I was told it may be around 66 gys and 34-35 sessions...

After my scans and such and after they determined the programming, they told me 64 gys, 32 sessions of 2 gys each, and to come in with a full/nearly full bladder.

pasayten
3/2007 - Dx 59 y/o - 12 point biopsy - Left 0/6 Right 1/6 Gleason 3+3 T1c
4/2007 - DaVinci RRP performed - Gleason 6 T2c Nx Mx
PSA 7/07 0.01, 6/08 0.02, 12/08 0.03, 10/09 0.13
11/09 Consult BCR and rec for SRT
1/2010 IMRT SRT - 32 sessions 2 gys for 64 gys total.
6/2010 3 mth PSA post SRT 0.02
1/2011 10 mth PSA 0.01
My Extended Signature

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 1/13/2011 7:46 AM (GMT -6)   
David:
 
I can't answer that. Perhaps there are standard guidelines/recommendations (?).
 
Perhaps it will change after they do the scans
 
Mel

English Alf
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Date Joined Oct 2009
Total Posts : 2211
   Posted 1/13/2011 8:30 AM (GMT -6)   
I had 66 Gy over 33 sessions.
When I asked why those numbers, they said that 66Gy was the standard treatment plan according to their protocols for someone in my position. I assume they have some sort of mathematical model and entered my data about post-op PSA Gleason score and pathology (eg SVI) quantity and location of tumour, and the post-op PSA record and velocity that revealed the BCR.

From the way they spoke of how they had worked out how to give "just enough, but not too much" I was left with the impression that years ago they used to give a higher dose.

I assume that radiologists have been aware that with many other types of cancers the patient is not surviving for as many years after initial treatment the way PCa guys do (and breast cancer too).
ie put bluntly I'm guessing that if you die of say lung cancer 3 years after high dose RT it is not relevant that the high dose you received might have caused another cancer had you lived for another 10/15 years, whereas if after my RT I could live for another 20 years it would be a bit unfortuante to develop another cancer after 10 years becasue they gave me too much RT. But equally I don't want the PCa to come back after only 5 years becasue they didn't give me enough. So I'm assuming they have worked out their protocols on the basis of the guys who "went before".

Alf
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
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 1/13/2011 9:11 AM (GMT -6)   
Mel:  I had 68.40 total, with 52 being full pelvic and the rest obviously strictly prostate bed.  My Rad Onc explained that the reason for the full pelvic was I had no positive margins and they wanted to expand the field as much as possible.  Although it is commonly called full pelvic it actually is targeted at the seminal vessels tightly bunched around the prostate area.  It obviously worked because soon after finishing the radiation I had an abdominal/pelvic CT for another issue and one of the comments was "seminal vessels atrophic in the prostate area".
 
Another interesting thing about my radiation was that a rectal balloon was inserted before each session, too say the least it wasn't very comfortable but the doc. explained, in his opinion, it stabilized the area to be radiated and protected the back wall of the rectum from any radiation.  Most of the guys who have proton therapy have this done, I have heard of only a few guys on this site also having it done.  It wasn't an option at the clinic I went to they believed so strongly in it that you either got the balloon or went somewhere else.  I'm one year post radiation and have no problems whatsoever.  The Doc. I went to said that the real rewards of the balloon deal will show up 3 to 4 years down the road, so we'll see.
 
You can google the treqtment if you would like more info.
 
David
 

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3655
   Posted 1/13/2011 11:16 AM (GMT -6)   
Great information in a very recent study by DA Kuban et al at MD Anderson released in 2010 that showed EBRT at 78Gy as better than 70Gy. You can read the study at the Prostate Cancer Info Link and at the NIH site. Probably the MD Anderson site would also have it.

I recollect that I received 78 Gy for the EBRT delivered by IMRT. As I was feeling very good throughout I asked my rad-onc why don't we do a few more. He was very clear that over 78Gy significantly increased side effects. While some get as many as 80Gy they also report much worse side effects. He also sited studies that indicated 78Gy as superior to lesser doses and that today's more modern machines (IMRT and IGRT) allows a greater sode than in the past without worse side effects and considered it as the optimal dose for me.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 1/13/2011 11:34 AM (GMT -6)   
JNF-- Was that your primary treatment?
 
Mel

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/13/2011 11:55 AM (GMT -6)   
JNF, your post is helping make a point for me. I heard a lot about using a min. of 70 gys with IMRT to give the best possible cure rate. No one I talked to in advance, reccomended less than that.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10
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