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Medical Forum / Diseases and Disorders / Prostate Cancer / July 2005Questions re: 3-D conformal salvage radiation
I just had a second opinion to consult a radiation oncologist. How much do you, guys, know about this technique as used for this purpose? How old is it? How many years of data have accumulated in respect to its short- and long(er)-term side effects? What has the data shown? I haven't seen practically any literature on that. My preop PSA was 6.3, RRP in October 2000, Gleason 4+3=7, negative margins and lymph nodes, but an extracapsular focal extension. Until April 2003 PSA was undetectable (<.03, as reported by the local lab), but since then it's risen to .1 presently, having doubled within the last year. Obviously, I dread the side effects of radiation treatment, but I've sat on the initial recommendation of my surgeon (who, btw, is the principal investigator of the salvage radiation study published in JAMA last year) for six months. And now, having had the second, concurrent opinion, it seems to be the time to "pull the trigger", as Curtis Palmer is fond of saying. Thanks. "How much do you, guys, know about this technique as used for this purpose? How old is it? How many years of data have accumulated in respect to its short- and long(er)-term side effects? What has the data shown? I haven't seen practically any literature on that." Sy, 3-D conformal is one of the names for the standard radiation treatment in use today and for many years. Virtually all the info you will find on RT is about 3-D conformal. There is also proton and Intensity Modulated RT (IMRT). I consulted a rad-onc at M.D. Anderson and he said that IMRT was not necessary for salvage treatment. The key is the simulation, which is the process of planning and targeting the dose, and the dose itself. He recommended CT-based simulation and 70 gy. I believe that the jury is still out on the merits of HT along w/ RT. Bill Denton RP 2/12/02 PSA .45 Memphis >Sy, 3-D conformal is one of the names for the standard radiation >treatment in use today and for many years. Virtually all the info you [quoted text clipped - 5 lines] >gy. I believe that the jury is still out on the merits of HT along w/ >RT. Thanks, Bill. From having looked at several websites it appeared as if 3-D conformal was a new (fairly new?) form of the external beam RT, but not clear how new. I also read about IMRT at the M.D. Anderson site. In fact, the rad-onc I'm supposed to see has done both his residency and fellowship at M.D. Anderson, for whatever that is worth. Why did your rad-onc say that IMRT isn't indicated as salvage treatment? The local rad-onc group's protocol lists the CT-based simulation, but I don't know about the dosage. What has been your own experience? SY SY, it's a breeze to go through if you prepare. My strategy was: 1. Walk a lot (3-5 miles, 3-5 times a week) 2. Sleep more (1 extra hour each night) 3. Drink a lot of water (probably more than a gallon most days) These things will help you with good cell regeneration, fatigue, urinary burning, diarrhea, etc. There is no pain and it takes almost no time. I supervise 25 people and 3 first-level supervisors and the only one that realized I was gone every morning for 35 mornings was my boss and that's only because I told him ahead of time.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > I just had a second opinion to consult a radiation oncologist. How > much do you, guys, know about this technique as used for this purpose? [quoted text clipped - 16 lines] > > Thanks. Thank you, Steve. I'm very worried, I guess. :( >SY, it's a breeze to go through if you prepare. My strategy was: > [quoted text clipped - 9 lines] >morning for 35 mornings was my boss and that's only because I told him ahead >of time. Really? Lessee... you were 8 years older than me when we made our forays into the OR. In that case, a year before you were born, the US incinerated a large number of Japanese using an atomic bomb. When you were 36, some wayward techs incinerated a few Russians in Chernobyl. When you were 39, similar techs at Three Mile Island tried to incinerate half of Pennsylvania. And for almost five years, you've been reading how the radiation we use medically kills everything in its path. And who knows what you learned in medical school. And now, at 58, your docs are suggesting that you allow them to point the nozzle at what's left of your privates? Yeah, I guess you're scared. But, I promise, the hardest thing about radiation is waking up and getting off the table. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > Thank you, Steve. I'm very worried, I guess. :( > [quoted text clipped - 11 lines] > >morning for 35 mornings was my boss and that's only because I told him ahead > >of time. Don't know, Steve. Frankly, I don't even think much about anything at the moment. I was ignoring my PSAs for awhile before the biopsy referral and my fondest wish is to somehow ignore everything now. Other than right before the next PSA, I managed to pretend that I was off the roller-coaster, and now I feel like I was being hoisted there again against my will and it's going to be one nauseating long ride. I've got to get a grip on myself. >Really? > [quoted text clipped - 10 lines] >Yeah, I guess you're scared. But, I promise, the hardest thing about >radiation is waking up and getting off the table. Yeah, I remember being there... > Don't know, Steve. Frankly, I don't even think much about anything at > the moment. I was ignoring my PSAs for awhile before the biopsy [quoted text clipped - 18 lines] > >Yeah, I guess you're scared. But, I promise, the hardest thing about > >radiation is waking up and getting off the table. External radiation is a snap! Stop dilly-dallying and just do it! Your life is at stake. Bev > Don't know, Steve. Frankly, I don't even think much about anything at > the moment. I was ignoring my PSAs for awhile before the biopsy [quoted text clipped - 18 lines] > >Yeah, I guess you're scared. But, I promise, the hardest thing about > >radiation is waking up and getting off the table. Well, after the negative MRI and CT scan, I had my rendez vous with the radiation oncologist yesterday. As I'd fully expected, he concurred with what my surgeon recommended in April and another urologist in June--salvage radiation. Never mind that my last PSA (in May) was "only" 0.1, still it tripled as compared to the spring of 2003 (RRP on Oct. 2000). I wondered about repeating PSA, but he compared it to endlessly repeating the pregnancy test, hoping for the opposite result. He suggested that, because of the last low PSA value, the prognosis should be very good and SEs are infrequent and can be managed. He appeared to mention impotence separately as a possible SE that is likely to be permanent. Overall, he called what he said his "standard speech" and that's what it felt like. Bhah-blah-blah. He mentioned that there have been numerous studies of EBRT and I really intended to ask him about the specifics: what about the 59 years olds, about Gleason 4+3, negative margins, extracapsular extension, specific PSAs, specific radiation dosages, etc., etc., etc. But I didn't ask any of it, feeling that what is available wouldn't be enough anyway to influence my decision in a clear, rational way. He did suggest that though this isn't an emergency, but still I shouldn't wait too long. So I told him that I'll think until Monday, already knowing what my answer will be, has to be. But the experience still rattled me enough that I marched right out, completely forgetting to even stop and pay my HMO co-payment. SY It's hard for me to get out of the 'anything 0.1 or less is good mentality', but when graphing your numbers, they are going up almost at a 45-degree angle. I don't know if it's quite like a pregnancy test, but there dies seem to be something growing. I'm sorry for that. But EBRT is a breeze. I'm sure you've already been told this, but anecdotally, I drank gallons of water, slept one hour per night more and did a tremendous amount of walking and I squeaked by with almost no SEs at all. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > Well, after the negative MRI and CT scan, I had my rendez vous with > the radiation oncologist yesterday. As I'd fully expected, he [quoted text clipped - 24 lines] > > SY Thank you, Steve, for your support. Interestingly, having read about your experience, I specifically asked the rad oncologist about drinking a lot of water and he replied that he wouldn't, in fact, recommend it. I should 've pursued it further with him, but I let it go. If it's a good thing, indeed, I've got to start training myself to make it a habit now since I usually don't drink any water during the day. He concurred about the excersise, but again didn't make a big deal of it. Exercise is something I don't do to any appreciable degree now (at the moment, my excuse is that for the last three months I've been dealing with my first ever sciatica "experience"), so it's something I've got to get into a habit of as well. According to the sheet I got with the lifestyle recommendations during the EBRT, there are lots of things I may have to change. >It's hard for me to get out of the 'anything 0.1 or less is good mentality', >but when graphing your numbers, they are going up almost at a 45-degree [quoted text clipped - 6 lines] >anecdotally, I drank gallons of water, slept one hour per night more and did >a tremendous amount of walking and I squeaked by with almost no SEs at all. I honestly don't recall anymore where I was told to drink water and exercise. But, I do recall the philospohy behind it. Radiation works on all cells within it's path. Good cells absorb water and don't burn as easily as cancer cells. The more exercise, the more good cells are reproduced. The more water in your system, the more effective your system is in getting rid of waste -- including dead cancer cells. The more exercise, the more efficient your waste elimination system is. More water in your kidneys and bladder, the more elimination and the more elimination, the less chance of radiation-caused urinary track infections. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > Thank you, Steve, for your support. Interestingly, having read about > your experience, I specifically asked the rad oncologist about [quoted text clipped - 23 lines] > >anecdotally, I drank gallons of water, slept one hour per night more and did > >a tremendous amount of walking and I squeaked by with almost no SEs at all. On June 24, Steve Kramer wrote, in pertinent part: (ka-snip) > ...... I supervise 25 people and 3 first-level supervisors and the > only one that realized I was gone every morning for 35 mornings was > my boss and that's only because I told him ahead of time. Um, lemme see; Steve was out every morning times 35, and none of his people noticed. Were I him I'd be worried about my job ;-) Regards, Steve J I like to think that I have them working like a well-oiled machine. :-) After 33 years in the organization, 18½ of which as a first-level and mid-level manager, I've learned a few things about preparing for management in absence of the manager. > On June 24, Steve Kramer wrote, in pertinent part: > [quoted text clipped - 12 lines] > > Steve J n June 24, Steve Kramer replied to me: > I like to think that I have them working like a well-oiled machine. > :-) > > After 33 years in the organization, 18½ of which as a first-level and > mid-level manager, I've learned a few things about preparing for > management in absence of the manager. "You can fool some of the people some of the time, and those are the ones you need to concentrate on." --Christopher Buckley Hee hee. Steve J ;-P You guys are so funny! Bev n June 24, Steve Kramer replied to me: > I like to think that I have them working like a well-oiled machine. > :-) > > After 33 years in the organization, 18½ of which as a first-level and > mid-level manager, I've learned a few things about preparing for > management in absence of the manager. "You can fool some of the people some of the time, and those are the ones you need to concentrate on." --Christopher Buckley Hee hee. Steve J ;-P There's a new article on radiation covering initial treatment, adjuvant therapy and salvage radiation in the July, 2005 issue of Mayo Clinic Proceedings, Volume 80, Number 7. The author is Thomas Pisansky, MD at the Mayo Clinic College of Medicine. Dave Perry Thank you, Dave. I'll see on Tuesday if our library carries it. >There's a new article on radiation covering initial treatment, adjuvant >therapy and salvage radiation in the July, 2005 issue of Mayo Clinic >Proceedings, Volume 80, Number 7. The author is Thomas Pisansky, MD at >the Mayo Clinic College of Medicine. >Dave Perry I'm scheduled for the EBRT mapping extravaganza for Monday. Round Two, I guess. Wish me luck.
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