First, let me say that I am sorry to hear this disappointing news. I'm glad you are jumping on this as early as possible while you have the best chance of a cure with salvage radiation. Early treatment can make a big difference.1. What are the questions to ask each center to determine who has the latest/best equipment and experience?
As long as you are getting treated in Birmingham, why not go to the University of Alabama Hospital? There may be other closer places you can go. Here are some questions to ask about
1. How large a dose do you propose for the prostate bed? (should be near 70 Gy)
2. Do I need concurrent or adjuvant ADT? (see below)
3. How do you decide whether to treat the pelvic lymph nodes? If so, at what dose? (50 Gy) How do you plan to prevent bowel toxicity? How will you account for the separate movement of that area and the prostate bed?
4. What kind of machine do you use? (e.g., Truebeam/RapidArc, Tomotherapy, Vero, etc.)
5. What is the actual treatment time for each treatment? (faster is generally better)
6. What kind of image guidance do you propose? fiducials/Calypso transponders in the prostate bed (best answer)? Using the fixed bones or soft tissue only?
7. How will prostate bed motion be compensated for? Cone beam CT? Moveable bed?
8. What measures do you propose to spare the bladder and rectum? What dose constraints do you set?
9. What side effects can I reasonably expect? How should I deal with them?
10. How will we monitor my progress afterwards, both oncological and quality of life?
11. How many salvage radiation procedures have you done?
12. How has your practice of salvage radiation changed in the last few years?
13. What's the best way for us to communicate if I have a question or issue?2. While I don't want HT and the surgeon says it's not indicated, should I be concerned NOT to have it?
Yes, you should be concerned not to have it. To be fair to your surgeon, that question is outside of his specialty. Recent evidence has proved that it can indeed affect survival. Please read the following:Combining ADT and salvage radiation therapy improves outcomes3. Should I ask for bone/abdominal scans or are my numbers too low to pick up?
Yes, you should have a bone scan and CT to check for gross metastases first. That can change your treatment plan completely. Sophisticated scans like PET scans are not used in your situation because the entire prostate bed must be treated anyway, no matter what they show, so it is a waste to do them.3. Any other questions that I should ask?
prognosis, expected side effects of treatment, and measures you can take to prevent or deal with those. Be sure to tell your doctor about
any co-morbidities (e.g., diabetes), metal parts you may have (prosthetics, pacemaker), and any supplements you may be taking. Avoid anti-oxidants. Do as much exercise as you can - do not
"take it easy."
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 7 year results
treated 10/2010 at age 57 at UCLA
•PSA since treatment:
1/11:3.9 5/11:3.0 8/11:3.7 5/12:1.2 9/12:1.3 5/13:0.4 6/14:0.5
• SEs of treatment:
after 2 wks: mild urinary & rectal - last 1 wk
1 yr after: mild urinary