Hindsight Is 20/20

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axle
Regular Member


Date Joined Feb 2011
Total Posts : 35
   Posted 4/12/2011 6:01 PM (GMT -6)   
When guys do radiation therapy does the Oncologist specifically set the radiation machine up to deliver some radiation to the seminal vesicles?
 
Also, is radiation targeted onto the bladder neck?
 
I am asking this because I have a collegue that is away from work currently doing Proton Therapy. 
 
I have read information here that leads me to believe that basically all surgeons now remove the seminal vesicles during a prostatectomy but that was not always the case.  It seems pretty clear that SVI, EPE, and/or a positive margin increases ones chances of BCR.
 
I am wondering how the different types of radiation therapies deal with PC that has spread a little beyond the prostate.  Logically to me one would want the radiation doses to be delivered as wide as possible but not so wide that it damages the bladder or other organs.  Do the radiation oncologists have more detailed information regarding the cancer location and extent than a surgeon does?
 
thanks,
Rob

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3887
   Posted 4/12/2011 6:56 PM (GMT -6)   
I had HDR brachytherapy and IMRT.   The radiation targeted the gland, seminal vesicles, and a margin of 5-10 mm around the gland.   The IMRT also targeted the lymph nodes.
 
I am sure the bladder neck and rectum recieved radiation, but I know that the plan was to deliver very little to those areas.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 4/12/2011 7:26 PM (GMT -6)   
Radiation is given to the entire prostate, including the uretha, seminal vesicles. It is also delivered 5mm to 15 mm to the bed depending on the radiation plan.
The radiation oncologist has exactly the same information as the surgeon.
There are some radiation oncologists, like Dattoli, that deliver a higher dose to the tumor and a lower dose to other areas. Most radiologists deliver the same dose through out the prostate.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Swimom
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Date Joined Apr 2006
Total Posts : 1732
   Posted 4/12/2011 10:59 PM (GMT -6)   
Axle,

It's actually the other way around. Seminal vessicle sparing surgery has become more the norm today.....meaning they spare a portion of them. Radiation, above my pay grade so I leave that up to those who know more.
 Hilarem datorum diligit Deus

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/13/2011 7:13 AM (GMT -6)   
How much actual truth do you wish to hear? It boils down to best guess scenario in all treatments....no way of knowing if you have micro mets in any particular region of your body, even with clear margins, clean surgical pathology...some get BCR or found uncured...because of the huge unknowns in PCa...it is a best guess assessment. Scans today are lacking in what they can do. To many imprecise variables even in pathology although this area of expertise is rapidly getting better with recent technologies.

PNI- perinureal invasion is possible blood path for PCa to travel anywhere from your gland...doesn't mean it did travel..but could...you can have had your pathology found with PNI and be a cured patient and vice versa...remember biopsies can miss plenty of areas in the gland..those could harbor not only different Gleason grades/scores, but different PCa variants potentially and PNI issues. Thus it is over the top complex and never simplistic...however since we look to experts as to what to do...this is the land of simplistic choices we currently have, as what you can see as choices. It is going to get down to more of the genetics, genomes and celluar level as to how to attack the PCa using new technologies and way better pathology. Right now we get to deal with best guess...crapshoot mentality for treatments.

How many doctors know this: www.yananow.net/24Variants.pdf  (you might be shocked) Or look at some pathology prior 18 variants known:  www.webpathology.com/case.asp?case=23    (photos on pathology)
Plenty of people believe PCa is just one type and all the same...no way.
 
Not sure how many doctors will tell you this kind of information, as it doesn't promote alot of confidence. My onco-doc is straight forward on the totality of PCa which is refreshing to see.
Dx-2002 total urinary blockage from PCa emergency room, bPsa 46.6,
12/12 biopsies all 80-95% vol., Gleasons found 7,8,9's, scans appeared clear, ADT3 prior to Neutron & Photon radiations, DES since 2004-5.

Post Edited (zufus) : 4/13/2011 6:22:37 AM (GMT-6)


JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3887
   Posted 4/13/2011 7:17 AM (GMT -6)   
The HDR plan I underwent was in line with John T's comment about Datolli. The areas that were known for cancer received a higher dose than other areas. In HDR this is done by varying the dwell time. The dwell time is the time the radioactive pellet is left in a specific area. In each of the 15 catheters used the placement and dose of the radiation can be significantly different even within the distance of any one catheter. I understand this to be one of the HDR advantages in that it is more conformal to the tumour both in the shape of the radiation cloud and the strength of the radiation in specific areas.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 4/13/2011 10:39 AM (GMT -6)   
Axle,

I did BT and IGRT combo. Plan was the same as for JNF above. IGRT was designed to treat 5-10 mm around the gland with minimal dose to the bladder and/or rectum.

As pointed out by zufus, there are no "absolutes" with any of these treatments.

Joe
Age 68 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 12/9/10 - 0.1
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