SRT including lymph nodes

[Jmr11820]

I’m starting SRT in a couple of weeks to include treatment to lymph nodes. Does treatment to nodes carry any significant side effects, other than those I can expect with treatment to the prostate bed?

[Tall_Allen]

Yes - there is a risk of bowel side effects, which will depend on your anatomy, and the margins they use. Also a risk of lymphocele/lymphedema. Didn't your RO go over this with you?

[Jmr11820 in reply to Tall_Allen]

Thanks for the response.

[Jmr11820 in reply to Tall_Allen]

We went over side effects to rectum, some fatigue, e.d. issues.... but not edema or anything specific to node treatment.

[Tall_Allen in reply to Jmr11820]

It's not a big risk, but there is one, especially if they cut out some lymph nodes during surgery. Visceral fat helps, if you have some.

[Jmr11820 in reply to Tall_Allen]

Interesting. None taken at surgery. Thanks again. Fantastic resource you are sir.

[Jmr11820 in reply to Jmr11820]

By the way, both my local RO, and Dr Mian at Cleveland Clinic prescribe no ADT for me. I mentioned it because you and I had talked about it a few days ago. It’s puzzling to me because I see studies, specifically one just recently that mention short term ADT along with RT, including lymph nodes, as being very effective. Dr Mian thanks that since imaging won’t provide any information.....that because of my very low PSA at this point and also because I did have a positive margin it is likely still local. He obviously gave a much more detailed analysis, those were the high points.Wanted to give you an update. Thanks again.

[noahware in reply to Jmr11820]

I don't want to sound too cynical, but you really should not be too puzzled, because you are talking to two ROs who are trained to use radiation, an inherently local treatment.

In a larger and more philosophical perspective, think what it would mean for them to recommend systemic treatment for anything: it would imply a possibility of systemic disease. And a further implication then, of having a systemic disease, would be that something like ADT might be MORE important, not less important, than something like radiation.

This could then lead to some patients (like me, for example) to start with a systemic therapy and leave radiation on the back burner (so to speak) as only a secondary option. That could not be too good for business, either for individual ROs or for that specialty in its entirety.

[RICH22 in reply to noahware]

soooo agree!!! ROs slant their views toward RT, uro-oncs slant theirs toward surgery and MOs are the most objective - that has been my experience.

but once you've already had RP, only a steady rise or any rise in PSA would merit attention. Were I in Jmr118's shoes, I'd be on Casodex already.

[Jmr11820 in reply to RICH22]

Rich,, you were treated systematically from the start, is that right?

[RICH22 in reply to Jmr11820]

ya, my decision, not the uro-onc's. he told me casodex, finasteride and tamsulosin just puts off the inevitable. been told many times "You're not treating your cancer" -- really? "Hormones only chase the cancer, never kills it" - well, who knows. they may be right... or they may be wrong. so i still have my entire prostate gland, except for the 20+ cores the biopsy took.

[Seasid in reply to noahware]

I agree.

[garyi in reply to Jmr11820]

I had SRT two years ago (my, how time flies) from the Chief of Radiation @ Cleveland Clinic, Weston, FL. He stated unequivocally that Cleveland Clinic rarely recommends ADT with SRT, and never for patients having low PSA's and G3+4.

I was fine with that, although I had previously started on Casodex and Lupron, with Dr. Anthony D'Amico. Darn it....

Cleveland didn't include a 360 cGY boost to my post surgery remaining, prostatic one inch mass, that D'Amico recommended, as per Cleveland's said SOP. I was disappointed with that and should have insisted on the boost.

Two years later and my uPSA has always hovered at around 0.075. Some cancer is still in there. Darn it....x2

[Jmr11820 in reply to garyi]

Hey, congratulations. 2 years out, sounds like you’re stable and in a good place.

[treedown in reply to Tall_Allen]

Tall Allen just curious on this statement about visceral fat helping is there a source for more info?

[Tall_Allen in reply to treedown]

Fat provides a safety margin - it's the one time extra fat is a good thing. Ask any RO.

[treedown in reply to Tall_Allen]

I trust you and don't have access to my RO anymore so was curious about more details as I lost most of mine prior to RT. Not a big deal as I can't change anything now. Thanks

[Hawk56]

I had SRT to the PLNs from July-Aug 17, 25 IMRT, 45 Gya. This was after surgery in March 2014 (T2CNoMX, GS 8, SVE, ECE and Margins negative, 10% prostate involvement) and SRT in March 16 aftger two successive readings of .2 then .3 .

MY PLN radiation was in conjunction with 18 months of ADT and six cycles of taxotere. A C11 Choline scan at Mayo in Jan 17 (PSA was 3.8) showed four PLNs, no bone or organ,

My radiologist used the results of the C11 Choline scan to build a treatment plan that included all PLNs with boosts to the four PLNs that lit up and wider treatment field around them.

I did not experience any SEs, testimony to the software planning system, the equipment and the skill of the radiology team.

When I did SRT in March 16 I asked about including short term ADT, say six months. I was told by my radiologist that there was not long term data to support it. I also asked about including the PLNs, no...SRT failed and it was off to the races with my PSADT andd PSAV saying I was in trouble.

Last time I let my medical team decide on treatment. That's why I went with the combined systemic treatment. I completed that regimen in May 18, PSA has been undetectable since then, labs are tomorrow.

Do your research, make your decision, inform your medical team what you want to do!

Kevin

[Afterglow]

I'm gleason 9 stage T3b undergoing 33 treatments SRT right now one year after my RARP because of BCR. Day 17 today.

They are targeting my pelvic lymph nodes and prostate bed.

Little bit of fatigue so far and a little bit of diarreah on 2 days so far (bad diet choices i think) and associated stinging, not fun, otherwise all good.

In Winnipeg Canada here my RO is also a MO and she was the one that recommended I should have ADT with my SRT so I was started on it the day of my appointment 1 month before the SRT started. I will be getting a second 3 month injection in June, after that has not been discussed.

It's not too late to start your ADT, and for a 6-12 month protocol, I believe the side effects are worth it. Go get your injection regardless what your RO said, it's your life not theirs and in the long run you will be happy you covered all the bases. Try to stay a step ahead, not a step behind.

[Jmr11820]

thanks for the feedback!

[Hawk56]

Here’s an interesting link on treatment of node positive PCa- urotoday.com/conference-hig...

[RonnyBaby]

For what it's worth, I had lymph node radiation to several 'hot zones' that were detected during scanning.

The dose was reduced (about 50% of the max the 'zone' could have administered) as part of a comprehensive plans to do the max radiation to the prostate itself (79 GY).

After the treatment I had a great deal of fatigue and some burning sensations during urination for about 2 weeks.

I was surprised at my fatigue - I had no idea I was going to be so tired.

The good news ?

@ 2 years post treatment - no residual side effects - everything seems to be resolved and I have zero (at least what I can feel or conclude) side effects from the rad treatment - other than ED which is common for many of us.

Wishing you the best .....

[Jmr11820 in reply to RonnyBaby]

sounds very manageable. nice result! thank you.

[Break60]

I had rectal bleeding after prostate bed radiation in 14 but nothing after nodes were done in 15. Doc I used for pelvic nodes was different and very careful using lower dosage , in 50 sessions . See my profile. Not all ROs know how to treat pelvic nodes successfully.

[Jmr11820 in reply to Break60]

Thanks for sharing your experience. I read your profile and see that you’ve been down a long road. Best to you in your journey.