Extra SRT ... do it or not!

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Regular Member

Date Joined Jan 2010
Total Posts : 44
   Posted 3/1/2011 9:35 AM (GMT -6)   
I was originally setup for 33 treatments / 66gy.According to the Doc, I have been
doing well and he is suggesting 2 extra treatments giving me a total of 70gy. I
have been doing well with very little to no fatigue, but I am having bowel
problems. Small volume with lots of trips (10 per day) to the restroom and
burning. Today will be treatment number 33! I’m looking for opinions here … Should
I take the option of the two additional treatments or stop at 33?

Looking foreward to hearing from you!

Regular Member

Date Joined Jan 2010
Total Posts : 44
   Posted 3/1/2011 10:02 AM (GMT -6)   
Background … I had robotic surgery on 1/7/10 and reoccurrence was confirmed in Nov. 2010. My PSA was 0.04 post surgery and it was up to 0.30 in Feb 2011 prior to radiation. They are aiming at the prostate bed but are not certain where the reoccurrence has actually occurred.
Dx Age:58 PSA 8/06 8.74, 10/09 7.46, 12/22 6.50 Needle Biopsy 11/10/09: 16/16 cores positive 2 - 85% of tissue

Gleason score 7 (3+4 with tertiary pattern 5). CT,Bone, and PET scans all negative.
Da Vinci laparoscopic prostatectomy performed on Jan. 07, 2010 at IU Simon Cancer Center… Indianapolis, IN Prostate size: 42 g Gleason score (primary + secondary): 4 + 3 = 7

Primary pattern (%):4, 60% Secondary pattern (%): 3, 35% Tertiary pattern (%): 5, 5%

Histologic type: Adenocarcinoma Variant histology present: No Multifocality: Yes

Extraprostatic extension: Yes Seminal vesicle invasion: No Cancer at surgical margin:No

Bladder neck involvement: No Lymph-vascular invasion: No Perineural invasion: Yes

Catheter removed Jan-19-10 Dry Nights 1 pad/day as of 2/4/10 Baseline PSA 2/3/10 <0.04

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2209
   Posted 3/1/2011 10:14 AM (GMT -6)   

I had 66Gy (33 sessions)
I was about to ask about your stats when you posted the follow up with the info.

Your stats are vaguely similar to mine, but perhaps just a tiny bit worse.
(By worse I means things like 4+3 instead of 3+4 and the PNI. Your biopsy was pretty conclusive too!) I was told that 66Gy was the standard protocol for my stats, maybe someone with slightly worse stats needs a little more. However, my post op PSAs were worse than yours. I'd say it could be very marginal whether or not the extra Gy will make a difference, partly becasue if will start making me wonder if I should ahve been given more, even though waht they agve me seems to have done the trick.

With me too they said the only way to proceed was to presume that the cancer was in the prostate bed. (Thus the SRT was almost used to test this theory, so that when my PSA went downafter SRT the conclusion was that the assumption about the location of the cancer had been right - and this was also why they did bot give me HT at the same time as the HT could have made the PSA go down reagrdless of where the cancer was.)

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 CT
66Gy 28 Apr to 11 Jun 10
Tired + weird BMs
14 Sep 10 PSA <0.1
12 Jan 11 PSA <0.1
Erection OK

New Member

Date Joined Dec 2010
Total Posts : 7
   Posted 3/1/2011 10:53 AM (GMT -6)   
Larry, I am almost finished my SRT of 72 Gys. I too had PSA of .3 after 4 years of watching after surgery (had some slight positive margin, no other invasion). My Doctor believes that I should get the maximum dose that I can tolerate and has set 72 as the target - if I develop too many side effects he will reduce by a session or two (1.8 Gy/session). Treatment 35 today and just have a similar bowel issue as yours, but is manageable- no other issues.

RRP 9/06, PSA 7.4, T1c, Gleason 3+3, a little positive margin- nothing else bad, post surgery psa <.1, 1/08-.08, 3/08-.09, ......12/09-.20, 11/10-.28 (abbreviated). Age 64

Veteran Member

Date Joined Feb 2010
Total Posts : 3771
   Posted 3/1/2011 11:06 AM (GMT -6)   
Larry -- this sounds like a question that only your doctor can answer.  good luck!
age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 3/1/2011 11:15 AM (GMT -6)   
I too have just completed a 40 treatment run, 1.8 Gy per treatment, for a total of 72 Gy...My bowel symptoms were JUST STARTING to develop at the very end, the last few treatments..Just a little itching and tenderness, no increase in frequency..My last 5 treatments were referred to as "boost", the beam more tightly focused on the prostate bed than the first 65 treatments...I was treated on a Varian Novalis RapidArc machine, which claims to reduce unwanted side-effects significantly.. I suffered urinary urgency and frequency (from needing to go every 4 hours down to 1.5 hours) but I am slowly recovering and am back up to 2.5 - 3 hours 2 weeks after my treatment ended. my treatment was combined with HT, my R-doc wants me on that for 2 years....But we are going to have a long discussion about that...My post surgery PSA was 0.9. It is undetectable now..

The LAST thing you want to do is seriously damage your rectum / anus and it sounds like you might be approaching that point.. I would talk this over carefully with your R-doc...Perhaps he can adjust his treatment plan a little to take the "heat" off your bowel area....
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Post Edited (Fairwind) : 3/1/2011 10:23:56 AM (GMT-7)

Regular Member

Date Joined Mar 2010
Total Posts : 46
   Posted 3/1/2011 11:41 AM (GMT -6)   

Hi Larry,

My hubby (also Larry!) had 39 treatments - 72 Gy last summer.  His last treatment was right before Labor Day.  Midway through the treatments he developed radiation proctitis with symptoms similar to yours, and was referred to our gastroenterologist.  He prescribed a course of Mesalamine enemas, which are very small, given at bedtime and held overnight if possible. 

Results were excellent and all was found to be back to normal when he had a colonoscopy in November. He's had no problems ever since.

Good luck,


Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 3/1/2011 1:44 PM (GMT -6)   

3 radiation doctors I spoke with prior to SRT strongly felt that dosing in the 70-72 gy range was far more effective than dosing <70, if the person's body can tolerate it.

I finished 39 treatments totalling 72 gys in November of 2009, and had a terrible time of tolerating it. I had severe problems with another bout of major radiation 10 years prior, so I am real sensitive to it.

If you are doing well, the extra gys may be a plus, but only you and your doctor can decide that. If you don't do it now, you won't get another chance to add any. Before my radiation treatments started turning sour, they had consider jumping me from 72 to 76 grys and adding another 6 days ,based on what happened, I would have never made it.

Good luck you

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

Veteran Member

Date Joined Nov 2009
Total Posts : 7187
   Posted 3/1/2011 3:18 PM (GMT -6)   
Barring any PSA pleasant and shocking surprise:
My doctor is suggesting 68.4 total (38 sessions at 1.8 per).
I will be utilizing the same equipment you are (Varian Trilogy RapidArc).
The set-up will not involve a urinary catheter but will involve a rectal one (just the set-up).
I do have bowel problems (constipation at times) and I have hemmorhoids. I am hopeful I won't have SE in that area.
I was told that I am very likely to have extreme urgency with urination, starting at about the 3-4 week point but it will go away after the end of SRT.
I gather this is your situation?
Also, were you told to drink water before the procedure each day?
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!
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