Why radiation with such a low PSA? If it's post-RP, then it's "salvage"
radiation. Something about the result of the RP is not optimum.

What is to be treated via the RT?

What "units?" Grays?

I underwent 76 Gy (Grays) of IMRT ending October 2004. This does not
make me an expert, though. I must observe, though, that the contemplated
dosages seem rather low. This may be a function of what is to be treated.

Included was 45 Gy to seminal vesicles and 40 to pelvic lymph nodes.

It was "salvage" after unsuccessful cryotherapy.

Can't comment on fatigue, as I was also on adjuvant ADT. I have clocked
18 months of 0.01 ng/mL PSAs, even though I stopped ADT as of the March
(monthly) injection.

Had some urinary and fecal urgency for a few weeks. Inconvenient but
bearable.

I understand from others and my own experience that it is normally not
necessary to take time off work, therefore the time of day of the tx is
not important.

Once again, I recommend that MAP explore the authoritative website of
the Prostate Cancer Research Institute to learn more. See,
http://prostate-cancer.org/index.html

And last, my experience may very well not resemble that of anyone else
in the universe. We are all different. Therein lies the risk of
depending upon anecdotes of others to make tx decisions.

Regards,

Steve J

"The thing is to expect nothing in particular, but (to) be aware of the lack
of enforceable guarantees or enforceable contracts with
nature/god/entropy as to the condition or durability of our bodies."
-- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate
Problems Mailing List
Thank you, Brian.

I can't answer all your questions, but I'll share my own experience
with you for whatever that's worth.

I was told by two different radiation oncologists that, for my
case (radiation as an adjunct to high dose rate brachytherapy)
there would be no difference between ordinary 3D and IMRT
(which is a refinement of 3D).  Both proposed ordinary 3D.

I suspect, but I'm not knowledgeable about this, that there is
no difference in effectiveness between the two.  If either one
puts, say 66 grays on the target, then you get 66 grays either
way.  The difference is the intensity of the beam from each angle.
So if there's a sensitive area, e.g., the anus or bladder that might
be in the beam, IMRT can direct a bit less radiation that way by
directing a bit more though a different path.  At any rate, that's
my non-expert understanding.

Whether the IMRT or 3D is important or not may also depend
on the dosage.  The higher the dose, the more important it
may be to try to spare the most sensitive areas.  But your rad
onc knows vastly more about this than I do.

As to tiredness and working - I had radiation plus Lupron and
never missed a day of work and never felt too tired.  I got
radiation in the morning and went to work afterwards.  I was
in very good physical shape before treatment and continued
to work out during treatment.  My ability to workout declined
drastically.  I went from running 4 miles in 36 minutes to 1 mile
in 11 minutes before giving out.  But I guess I had enough
reserve energy that I never dipped into what I needed for
daily life.  I believe the loss of energy I did experience was
more than 50% due to the Lupron.

Other side effects included bloody ejaculation during sex
(such as it was with Lupron), aggravation of a pre-existing
hemmorhoid - clearing up a few weeks after treatment, and
urinary restriction due to swelling of the tissue around the
urethra - causing frequent urination (up 7 times a night at
the worst of it.)  That lasted about 5 months but was much
relieved by Flowmax.

I may also have had some reduction in potency, but it's
hard to tell for sure.  Getting older has that effect even
without treatment.

My big questions for you are the same as Steve's questions.

Are you really sure you need radiation at all?  You haven't
yet seen a PSA rise.  It's conceivable you could go for the
rest of your life and never see a rise.  If radiation will help
you, it will probably help more if taken early than late, but
you may not need it.

And secondly, is 66 "units" (grays?) enough?  You might
do some Pubmed searches for salvage radiation doses
for prostate cancer, and look at the cancer.gov and some
of the prostate cancer websites for more information.

As I understand it (and I may not understand it at all), you
can't treat a small amount of cancer with a small dose and
a bigger amount with a bigger dose.  There's a certain minimum
dose before the radiation starts to do real damage to any
cancer cells whether there are few or many of them.  Over
the last decade or so, the recommendations for minimum
dose have gone up.

Good luck.

   Alan

My husband had 5 weeks of EBRT on an IMRT before his brachytherapy. He got
in the morning, went to the local hospital, jumped on the table, then went
to work, (he was only a few minutes late each day) and put in a full day
behind his desk. By the end of his 5 weeks he was going to bed about an hour
earlier and he took naps on the weekends. His is not a heavy physical job
but it is a high stress "must be accurate" type of job. He works in a cube
farm as a computer programmer for a national company. He was 56 YO at the
time. He never missed work over it.
Bev