(snip PSA history)

I do hope that Art will be seeing a radiation oncologist, not another uro.

Ending in October, 2004, I underwent salvage IMRT (Intensity Modulated
Radiation Therapy) after failed cryosurgery. As the question pertains to
salvage radiation, I believe that I have something to contribute.

IMRT is the latest "external beam" radiation therapy. It utilizes multiple
beams of radiation which originate at various positions around the
patient's body. A "gantry" moves around the patient and metal leaves
can be heard moving about to preset positions, which is the shaping of
the radiation beams.

It is guided in the following two manners:

(1) Pretreatment "simulation" during which  x-rays are made in order to
document the organ positions. It will involve a Foley catheter, which is
used briefly to inject radio-opaque dye into the bladder. Also, a mold of
the patient's lower extremities is made. This is used during the tx sessions
to immobilize the patient (this is very important). The data obtained
are used to preset the mode of tx as to position, shape, time, dosage,
etc.

(2) Before each tx session (which is five days per week for ~seven weeks)
the position of the organs is determined with ultrasound. It is called
beta-Mode Acquisition and Targeting (BAT), and adjustments are made based
upon its findings. This helps to assure that the radiation goes where it is
desired.

As a matter of fact, in my case it was thought prudent to treat the
seminal vesicles and pelvic lymph nodes at the same time. IOW, more
than one organ can be treated during each session.

The sessions under the machine are perhaps10 minutes. There is no
sensation. I wasn't even bored; I could see a computer monitor which
showed the beam shape, time, dosage per cycle, etc. Fascinating.

SE's are different for each of us. In my case, I had mild diarrhea and
urinary difficulty, the latter being treated with Flomax. I was also rather
tired. Lost a bit of hair in the groin, which has returned. All in all,
I would characterize it as a piece of cake. Such SE's as there may be
usually begin after the second or third week.

*NB* I also began a regimen of ADT, using Zoladex, then Lupron, then
Trelstar, which continues to the present. The reason for the changes was
economic, except in the case of stopping Zoladex. That reason was simply
pain of the injection into the lower abdomen.

The rad onc might very well prescribe neoadjuvant (pre-tx) as well as
concurrent and post-tx ADT.

Of course, my story is just that: a story; anecdotal. Authoritative and
objective information can be found on the website of the Prostate Cancer
Research Institute at:
http://prostate-cancer.org/index.html

Also: a google search on IMRT will result in a host of hits.

Best of luck. Please let us know what's next.

Regards,

Steve J

"Never give in--never, never, never, never, in nothing great or small,
large or petty, never give in except to convictions of honour and good
sense. Never yield to force; never yield to the apparently overwhelming
might of the enemy.''
--Sir Winston L. S. Churchill

Arthur, the no. 1 question now is whether you have a local recurrence
or is it systemic because RT will cure the former but not the latter.
You cannot know for sure so you need to confer w/ your docs, study the
stats, and decide where you stand. At almost 72 you need to evaluate
your general health and life expectatancy - if you probably won't live
10 years anyway, you might seriously consider doing nothing right now.
Keep in mind that the rad-onc makes his living treating people so he is
likely to favor having RT regardless. As for IMRT vs. standard RT I can
only say that the rad-onc I saw at M.D. Anderson 4/04 told me that IMRT
was not necessary for salvage treatment.

I am having blood drawn for a PSA today and I suspect I'll go from .45
to over .6 but I have pretty much decided not to have salvage RT due to
seminal vesicle involvement. That and that I am losing my insurance and
would have to pay the $40-60,000 out of pocket.

Bill Denton
RP 2/12/02
PSA .45
Memphis

Hi, Art.  Welcome to the club.  Sorry for the relapse.  My relapse came
about 1½ years after RRP.  I did 35 treatments of EBRT between May and July
2002.

With the possible side effects explained to me, I began to prepare about
March.  Most notably, I walked more (3-5 miles a day, 2-5 days a week) and
drank more water.

As briefly as possible, one week before beginning, they put me on a table
and scanned me to find exactly where my organs were, at which time they
"tattooed" my midsection with small Xs.  These Xs were later to serve as
precise pointers for the "radiation machine".

On a Monday in May, they led me to another table that had a particle
accelerated built around it.  I took off tie, suit coat and pants, and shoes
and laid on the table.  The particle accelerated was guided around me and
shot particles through me at six separate points.  I felt nothing.

I did this 35 straight business days, finishing July 3, 2002.

Beginning on the first date, I went to bed one hour earlier and continued my
walking and drinking water throughout.

Due, I think, to my preparation, my side effects were minimal.  My wife said
I was fatigued, thought I did not notice.  I noticed slight looseness in the
bowels, so I ceased the Metamucil I had started a couple years earlier.  I
had slight burning during urination towards the end of the treatment.