Having endured major radiation twice in 11 years, each time, I was told the dosing was based on the facts of that particular patient. Both times I went through the same radiation clinic, and the planning was based on my particulars. They don't do a standard dose. This time around, due to my quick surgery failure, and because of my PSA velocity issues, they went for the higher dose of 72 gys via 39 treatments. In the world of SRT, that's a high dose, though they do go up to 76 gys. With RT as a primary treatment, they go to 80 or a little over.
With radiation posioning, most people's bodies couldn't handle a dose larger than 2 gys a day regardless, the side effects would be greatly increased. That's why they don't do 3 or 4 gy daily dosing.
Surgery is strictly a mechanical act on the body, but radiation is another matter, and how each person's body can tolerate radiation and how its delivered is very unique.
I am afraid that some men take the prospect of radiation too lightly, and may end up jumping the gun in a SRT situation. If one needs it, then of course go for it, as its your final curative attempt for a surgery guy.
My terrible ordeal with SRT is not as rare as some think. I have read radiation horror stories that make what happened to me look like child's play. The percentages of bad outcomes may be low, but they still happen.
It's all in the planning phase, at least that is how it's suppose to work.
The advantage of IMRT supposedly is the narrow controlled beam, but after things started going downhill with mine, the Rad dr. finally admitted that due to a particurally narrow prostate bed, yes, a lot of scattering was taking place.
When I had radiation pre-IMRT, in the old days (year 2000 lol), they had to design special shields for me to protect parts of me that they didn't want the radiation to hit, including this weird contraption that protected my vocal cords. And the face mask I had to be strapped into each day was horrible.
David in SC
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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10