SBRT treatment

[Brightman]

I am about to have SBRT on my T10 vertebrae for metastatic prostate cancer. I will have 3 intensive treatments, far better than the 25 sessions I had in 2017 on my prostate, with a full bladder! I have 4 main questions, firstly how have others coped with having arms above shoulders for about 30 minutes. I found this quite difficult with the CT simulation I had last Friday to create my unique body modelling bed. Secondly, I am wondering how long it will take for my PSA to come down after the treatment and go back to my nadir of <0.01 I have had for 4 years after radiation, chemo and continual hormone therapy. Thirdly, what side effects have others had to secondary radiation? Lastly, my radiation oncologists said that he will probably have to put out ‘spot fires’ of more cancer spots in the future. So, how soon have others had more spread after such treatment. All other places of spread in my bones seem to have disappeared until this one appeared? Thanking you for any responses.

[Bcgkelly]

It took about 10 months for my PSA to fall to its lowest level after treatment. The side effects I had were fatigue and very bad IBS & bowel difficulty but in my case they were treating a lymph node right by my bowel. Best of luck.

[Break60]

I had no problem with SBRT as the three sessions were only about 10 minutes each.

[Timfc]

I had one session of SBRT to T9 nearly 3 years ago. No significant side effects. I really don't know if it worked because ADT has been good at controlling T and PSA, and I have had no further imaging.

[Tall_Allen]

Spot radiation to bone metastases isn't at all like prostate radiation. Expect no side effects. There may be some extra pain for a week or two, which will go away as inflammation subsides.

[Brightman in reply to Tall_Allen]

According to other respondents who have had SBRT and my radiation oncologist, each session will be 30+ minutes each. When I had my 25 sessions with radiation on my prostate 4 years ago, each session was about 10 minutes. Because my cancer is on the T10 vertebrae, the oncologist said that radiation would be close to my esophagus and my spinal cord, so I will have a sore throat and difficulty swallowing. Also a sore back. He also told me that I would be fatigued, especially from about 6 weeks after my radiation is completed and it will last for some time.

[Tall_Allen in reply to Brightman]

The speed of each session is dictated by the linac used. Some, like CyberKnife, are very slow, lasting up to 45 minutes. I had Truebeam with RapidArc and never had a session beyond 10 minutes. Fatigue is directly related to the number of treatments:

prostatecancer.news/2017/11...

Inflammatory reactions go away after a week or two, and your pain should diminish after that.

[middlejoel]

Brightman, does bone treatment always require a full bladder?

[Brightman in reply to middlejoel]

Only when there is radiation on the prostate and surrounds I presume.

[RS265]

SBRT session duration will depend on the number of targets. My sessions have always been 30+minutes and whilst not comfortable I was always focused on keeping my body calm and still. ( You will have a set of small skin tattoos that are used for targeting control)

In Australia, the practice is to retest PSA at 6 weeks post SBRT as cells take time to die and stabilise.

Side effects - nil. Go for a coffee afterwards.

My three oligeometastatic areas reappeared elsewhere so quickly (under the six weeks) that my Radiation Onc thought they had mistargeted. We reran SBRT on the new targets and it happened again. At which point I started ADT.

ADT drove my PSA to undetectable so I got an 18 month holiday, but my PSADT was pretty steady at 12 weeks.

Another round of GA68 PET testing and yet again three oligeometastatic areas. Opted for SBRT again with similar results to first round. Nailed those, but within six weeks had a new set. Why do this? There is research that suggests SBRT primes an immune response so I don't see it as wasted treatment and it kills all non circulating PCa cells be they naive or resistant.

Buying time, one step at a time.

[Brightman in reply to RS265]

Thanks so much for your reply. I live in Australia too - in Adelaide. Yes I have the tattoos! I have been on 6 monthly Eligard since I was diagnosed in May 2016 & with radiation & chemotherapy since then, the 3 of my bone metastatic areas had disappeared, except for one on my T11 vertebrae, which still seemed to have shown slightly on my scans I have had each year since then. I am sorry that yours has reappeared. I am hoping mine will stay away as long as possible. Take care& best wishes.

[Oct18]

I am getting ready to have the same thing to my tailbone. Thankfully I just have to lay flat but two years ago I had to lay sideways for 30 minutes with my arms above my head and I absolutely hate taking any kind of medication like Valium. But in this case I took one Valium before treatment to my ribs and a spot on my neck which required me to wear a mask . I Could not have done it without the Valium. I took A small dose, I think 5 mg about 20 minutes before my radiation and it relaxed me enough but at the end of the session my arms were asleep. Just try to get an a Zen like relaxed state of mind. For me it is prayer that relaxes me. .

[Brightman in reply to Oct18]

Thanks so much for your reply. They have suggested I take some Panadol but I will see how I go after the first session. I do have some Valium so I may have to resort to that. With severe arthritis in my shoulders, the planning session was quite painful and yes my hands went to sleep as well. I can zen out at times, so hope that works this time too. Worth the pain for the gain is my motto with all my treatments I have had this far!

[Rocketman1960]

Had SBRT at C5 lymph node. 3 sessions. Treatment successful. Would not hesitate to do it again on a search and destroy mission. Once the mold I made the sessions go pretty quickly. Fascinating technology!

[j-o-h-n]

Hands over their heads? Ask anyone in the Polish army...... All kidding aside when I had to hold my arms over my head to get my medical tattoos it turned out to be painful. Next time I had to raise my arms over my head for a MRI I asked them to place a small pillow under each arm (more tolerable).....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/02/2021 5:47 PM EST