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Posted 10/10/2019 6:41 AM (GMT -7)
I had a conversation with my RO on Tuesday this week after my 10th treatment. I know he told me prior to the start of SRT that I would be getting 6800 Gy at 200 Gy per treatment over 34 treatments. The area covered would be the prostate bed and lymph node area, too.

Anyway, I could swear I'd seen people out here getting larger dosage than 6800 Gy. I questioned him yesterday and he tells me that this (6800 Gy) is the standard dosage. I told him that this was "my last shot at a durable remission" and that I did not want to get "shortchanged". He rolled with it well, and explained that the higher dosages I see are for primary RT treatment. I'm not so sure. How about it? Any of you SRT guys get more (much more) than 6800 Gy?

J
Posted 10/10/2019 7:47 AM (GMT -7)
I got 72 Gy’s (7200) over 39 treatments for Salvage radiation, I believe that is standard at MSKCC
I am not a doctor, just another guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... tinyurl.com/qgyu3xq
Posted 10/10/2019 8:10 AM (GMT -7)
SRT - 39 fractions - 70.2 GY
RALP 08/08/17 G7 (4+3) TP 5 < 5%. GGrp: 3 pT3b pNO/pMX EPE focal left posterior/SVI present left/Bladder neck-neg. Margins uninvolved. Scans neg. Decipher: Intermediate/.57 PSA: 04/30/15- 2.83 06/26/17- 7.24
PSA post-op : 6 wk/3 mo/6 mo/9 mo - <.010/12 mo - .018/13mo .021/14mo .028/15mo .031/16mo .025 HT 12/18 SRT 01/19. End HT 05/19 SRT 03/19. uPSA 06/19 <.010 T-16
Posted 10/10/2019 8:31 AM (GMT -7)
70 Gy's, 35 treatments. MDAnderson Houston
YOB 1957 Dx.3/2014 PSA 5.9 Bx 7 of 12. 3 G7’s (3+4) 4 G6’s (3+3)
DaVinci 5/2014. T2C 50% involved, 28gm, -EPE, -SV,-LN, +2 margins (apical, lateral).
No incontinence, ED –75% recovered, using VED and Cialis.
PSA at 1.5 months .008, 3m<.006, 6m<.006, 9m .009, 12m .008, 16m .014, 19m .023.
SRT IMRT 12-16-15 thru 2-5-16 70gy 35 sessions. No ADT.
PSA post SRT, 3m .02, 6m .009, 9m .006, 12m .008, 15m and currently <.006
Posted 10/10/2019 8:34 AM (GMT -7)
70 GYs 34 treatments, Stormont Vail in Topeka

Not primary treatment

My Biopsy
My PSA Curve
Previous PSA
Curve
Treatment Path
My Story
Posted 10/10/2019 8:54 AM (GMT -7)
normally they only do enough Gys to get you to start to glow in the dark and then they know they are done.
I'll be in the shop.
Age 59, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17 .3 4/18, .4 11/18
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
Posted 10/10/2019 9:08 AM (GMT -7)
Currently undergoing SRT 72Gy in 40 treatments.
· Age at Dx: 60
· PSA: 01/2012: 6.7
· Biopsy, 18 cores, Dx, Gleason 4+3=7 in 4 cores: 01/2012
· open RP: 03/2012
· Post-Op Report: pT3a pN0 MX, Gleason downgraded to 3+4=7, Margins-, SVI-, Focal EPE+.
· PSA: <.03 for 4 years, 6/17 .04, 7/18 .07, 1/19 .11, 8/19 .18.
9/19 started SRT
Continence: pretty lousy, I leak a lot
ED: total
Posted 10/10/2019 11:09 AM (GMT -7)
I have read from 68-72 is the normative range. Less than 68 is less effective. More than 72 gets markedly more toxic.
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 and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta
Posted 10/10/2019 2:55 PM (GMT -7)
My RO was pretty insistent that 67Gy via IGRT was appropriate for ART to prostate bed with me. The dosage limit is typically 1.8 Gy per day to minimize collateral damage from what I was told for ART/SRT and a higher dose over a shorter time period was not appropriate for ART. Seems to be a pretty controversial issue with conflicting studies like everything else with PCa. Too much radiation can reduce a patient’s longevity as well so not a simple issue.
Posted 10/10/2019 3:25 PM (GMT -7)
70.2 grays (1.8 grays for 39 treatments), with ZERO side effects during and after treatment.
Age 60, mpMRI 8/18/13 negative
biopsy 9/5/13, PSA 6.2, 13 core of which 6 are postive
pT2pNO
left laterial base 10% G6(3+3)
left laterial apex 10% G6(3+3)
right base 15% G7(3+4)
right laterial base 15% G6(3+3)
right laterial mid 60% G6(3+3)
right lateral apex 20% G6(3+3)
daVinci 11/11/13
path T2c N0 Stage IIB
PSA 0.1 to 11/15 then 0.2
11/15 IGRT 39 sessions 72 grays. ZERO problems.
Posted 10/10/2019 4:03 PM (GMT -7)
Currently undergoing SRT @72 Gy over 40 treatments
8/2017: Age 57: PSA 10.5, FPSA: 9%
8/2017: MpMRI 2 lesions PIRADS 4
10/2017: Biopsy 3/16; G6 (AS Recommendation)
11/2017: 2nd opinion: 4/16; G(3+4)
3/2018: RALP G(3+4, tertiary 5) Apex bilateral, G(4+3, tertiary 5) Base, Extensive EPE, Bladder Neck Invasion (+) , PI(+), Margins & SV (-) , LN (0/10), pT3aN0
6/18: uPSA: .022; 9/18: .043; 1/19: .063; 4/19: .096
5/19: Casodex/Lupron; ART - Upcoming
Posted 10/11/2019 5:05 PM (GMT -7)
ART for me, 68.4 gy, 38 sessions

I have final follow up with RO next week and can ask. I think that the slightly higher numbers are to cover a larger area due to longer time post-op
60 now, 59 DX, PSA = 16. 8/18 DiVinci RALP Morristown, NJ-left base bulge and 1 nerve removed - Post Op Surgical Path 3+4, tertiary 3, 10% grade 4, margin -, ECE+, 1 SVI+, bladder -, LN - (0/12), pT3b,N0; 1st post op PSA 11/18 <0.006; Decipher 0.7 (high); Adjunctive RT (IMRT) completed 3/2019, 38 sessions; 68.4 GY. uPSA 6/19 <0.006 Labcorp
Posted 10/11/2019 6:47 PM (GMT -7)

NorCol said...
SRT - 39 fractions - 70.2 GY

Same here, 39 Tx, 70.2 Gy ART (7020 rad, 1.8 Gy per fraction)
2014-15: PSA's 9, 12, 20, 25, Neg DRE's, false neg TRUS biopsy
6/16: New Uro, MRI Fusion biopsy, 6 pos Rt Base (15-40-100%) G8(4+4)
8/16: DaVinci RP, multifocal EPE, PNI, 11 LN-, 53g/25%, BL SVI, Grp4, pT3b
1/17: Started Lupron ADT, PSA's ~.03
5/17: AMS800 implant, revised 6/17
8/17: 39 tx RapidArc IMRT (70 Gy)
4/18: Dx Radiation Colitis & more
1/18 - 7/19: PSA's <0.008, T~12
Posted 10/13/2019 11:41 AM (GMT -7)
"The area covered would be the prostate bed and lymph node area, too." You probably mean 6800 centiGy or 68 Gy.

You should not radiate the lymph node area with a higher dose, you could radiate the prostate bed with e.g. 70 Gy. When radiating both, some doctors make second radiation plan to put an additional dose to the prostate bed. I would not be keen for higher doses, the risk of lasting side effects is higher too.
Posted 10/13/2019 10:08 PM (GMT -7)
72 Gy in 40 fractions.
Age 60 at dx 7/2017 biopsy G8 (4+4), 5/13 cores
RARP 8/2017 (Patel), pT3a N0 M0, 30% tumor; EPE+, SV-
PSA 1/2016, 2.9; 4/2017, 7.2; 9/2017 (post-RARP), 0.13; 10/2017, <0.05, 1/9/2018, 0.09, 2/23/2018, 0.08.
SRT 72Gy, 40 fractions, finished 5/8/2018, plus 12 months ADT, finished 2/2019
May 2019 uPSA <0.02, Aug 2019 PSA <0.13
Caution: I’m not an MD and don’t know what I’m talking about.
Posted 10/14/2019 5:08 AM (GMT -7)
Looks like I'm the oddball here. 66 Gy at 33 fractions. That was way back in 2008.
Born 1936. Dx Aug 06.
PSA 7.9, G 3+4=7, 2 of 8.
open RP Nov 06, pT3a, 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. in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1,

SRT completed (33 days-66Gy) 19 Dec 08.
PSA: All 6 monthly tests to date (June 19) <.008 - 10+ yrs post SRT.

Post Edited (Magaboo) : 10/14/2019 6:20:14 AM (GMT-6)

Posted 10/14/2019 10:01 AM (GMT -7)
Negotiated hard with RO to bump up to 68gy. He was hesitant but complied with my wishes.
DX 9/2011 @ age 50, PSA: 2.1, 10/6/2011 RP Da-Vinci
4-3 Gleason, PT2C, -SV, -Mar,+PI, NX... <.02 first 4+ years
Start SRT@ PSA 0.25, 38 Sessions-68.4 Gy, Finished 02/1/17
PSA: 5/17-.12, 8/17-.031, 1/18 - 1/19 <.006,
Posted 10/15/2019 8:27 AM (GMT -7)
My RO originally planned 66 Gy for SRT.

I asked him to increase the dose based on this info, which links to a paper:

https://pcnrv.blogspot.com/search?q=SRT+gy

The RO had 25 years of experience but was new to my treatment facility. He said the 66 Gy was based on the treatment facility guidelines, and that he had always used 70 or 72 Gy.
Dx: Feb 2016, age 52
PSA: 15.1, 10/12 cores
Davinci RP: Apr 2016
T3bN0, Gleason 3+4, Tertiary 5
EPE+, BL SVI+, MAR-, PNI+, PIN+
May 2016 PSA 0.03
Prostvac V/F - Start July 2016
PSA steady at 0.03 for 12 months
Oct 2017 PSA 0.08
SRT+HT - Jan 2018, IMRT (70 Gy), Lupron 6 mo
Posted 10/15/2019 12:15 PM (GMT -7)
68.4Gy in 39 treatments 1.75Gy/treatment.
I had my share of side effects - fatigue, a lovely radiation sun burn, and best of all radiation proctitis at the end - that was a real treat.

Best of luck

Rob
5/17 PSA 34.2 age 53
6/17 Dx by biopsy - 9 of 14 positive; Gleason 7 (4+3) 5% to 90% cancer
8/24/17 RARP, Dr. Canes - Lahey Burlington
4/8 lymph nodes positive, EPE, +margin 5 MM, SVI
pT3b; pN1; M0
10/24/17 PSA 0.13
12/11/17 18 months of Lupron
1/18 PSA <0.1; T=31; 4/18 PSA <0.1; T=21
SRT 3/14 - 5/7/18 - 39 fractions; 68.4Gy prostate; 44.5Gy to nodes
Posted 10/15/2019 2:01 PM (GMT -7)
I would be more concerned about adding ADT (hormone therapy) or not...
Progression-free survival is higher when ADT is added.
Did you discuss that with the RO?
DOB 1940
Dec 2012: GP felt a nodule and hardened prostate; confirmed by urologist
PSA: 11.9 ng/ml
Biopsy (3/1/2013): Several Gleason 4+5 loci (prostate=45 ml)
Stage: T2c
Transferred to RO
Casodex 1 month; then Lupron 5/13 through 12/14 (18 months total)
Jul-Sep 2013: SBRT (CyberKnife; 3 x 6.5 Gy) followed by IMRT (25 x 1.8 Gy)
Lowest PSA thereafter: 0.1 (3/20/15)
Latest (10/19) PSA = 1.4 ng/ml
Posted 10/15/2019 2:10 PM (GMT -7)
68.4 GY over 38 treatments. Seemed on the low side to me and no lupron first but the RO insisted that was the standard of care. Apparently it was too little because it failed fairly quickly.
Age @ Dx: 53- G-8(4+4) PSA: 3.5
5/2011 ORP, pT3a N0MX, EPE, +PNI, +margin, -SVI ED.
PSA:6/2011 through 3/2016 all <0.1. PSA 7/12/16:0.2
SRT 9/16 -IMRT 38 @ 68.4 Gy
Post SRT 1/18 .054. 5/18 0.150
5/18 0.2. 6/18 thru 9/18 all 0.2
12/18. 0.3 1/19 0.3 2/19 0.4 4/19 0.5 5/19 0.5 7/19 0.6 8/19 0.7. 9/19 0.8
Posted 10/15/2019 3:49 PM (GMT -7)
Senior Sailor, The RO gave me the option of 6-7 months of ADT (Lupron) and I took it. I am 7 weeks into the ADT and 3 weeks into SRT. I discussed the 6800Gy over 34 treatments with him today and he insisted this is the way to go. He stated that the 200Gy per treatment is slightly higher than those receiving 7000+Gy (170-180Gy) and that little increase in Gy per dosage makes up for the overall dosage. I actually mentioned you guys to him and what you were receiving. I am still not sold, but this RO Dr. is a leader in treating PCa and he is the Chief RO at a nationally known Cancer Center here in Philly. I got no choice but to roll with it now. J
Posted 10/15/2019 7:12 PM (GMT -7)
Finished my SRT in August 2019. Had 66 Gy at 33 fractions (VMAT Rapid Arc) + ADT ( 6 month)
Age 67 , PSA pre-op 4.79 , prostate bx 05/16 - G 3+3, 3/12(2 cores on the left 25% and 5%, one on the right 60%) RALP / nerve sparing / 09/06/16 ( no lymph node dissection done)Final post-op path G ( 3+4) , 20% of the gland ( apex, inferior, middle and anterior parts), PNI+ , No evidence of ECE of seminal vesicles invasion, anterior positive surgical margin (G3+3 at the margin)

Post Edited (Mos_Ser) : 10/15/2019 8:36:08 PM (GMT-6)

Posted 10/16/2019 12:24 PM (GMT -7)

JayMot said...
Senior Sailor, The RO gave me the option of 6-7 months of ADT (Lupron) and I took it. I am 7 weeks into the ADT and 3 weeks into SRT. I discussed the 6800Gy over 34 treatments with him today and he insisted this is the way to go. He stated that the 200Gy per treatment is slightly higher than those receiving 7000+Gy (170-180Gy) and that little increase in Gy per dosage makes up for the overall dosage. I actually mentioned you guys to him and what you were receiving. I am still not sold, but this RO Dr. is a leader in treating PCa and he is the Chief RO at a nationally known Cancer Center here in Philly. I got no choice but to roll with it now. J

Looks like an excellent protocol!
Best wishes for a long knock-down, if not knock-out, of our foe.

Post Edited (Sr Sailor) : 10/16/2019 1:27:01 PM (GMT-6)

Posted 10/16/2019 2:38 PM (GMT -7)
39 sessions, 70.2 Gy, SRT (7020 rad, 1.8 Gy per fraction) Radiation was a non issue, but the after effects of ADT (six months of Lupron and seven months of Casodex) were/are uncomfortable. After reading hundred of medical studies, I don't believe most patients derive ANY benefit from ADT.

Progression-free survival by taking hormones during RT is a myth that some RO's promulgate, hoping for improved results, but not paying for, suffering, or treating the consequences. It 'may' be beneficial for some high risk patients, with high PSA, but it isn't an 'across the board' benefit for most of us, IMO.

Caveat Emptor, brothers!!!
72years old @ Dx, LUTS for 7 years
Ulcerative Colitis since 1973
TURP 2/16
4 cores; G 3+3, one G3+4
RALP 7/17 G3+4 Organ confined
pT2c pNO pMn/a
PSA .54 4 months post RR
ercMRI & DCFPyL PET Scan @ NIH/NCI
1" tumor in cavity at apex,
IMGT 70.2 GY, 2ADT, over 5/18
Radiation proctitis & Ulcerative Colitis flared
PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
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