DX'd localized G9 (PSMA Pet clear) in Sept '22. Choose SBRT + 18m ADT as treatment. Finishing up SBRT(week of 12/9/22). My questions are:
1. How do we know that the RT was successfully executed/delivered? I understand the timeline and how to monitor the outcome of PSA recurrence. I want to know if the RT matched the actual plan that the Dr developed for my treatment. How do they verify that?
2. Is there a document that details the actual RT treatment plan, and is that available to the patients? I'm just curious about the hand-off between the Dr and the Radiation Therapist. I've spent my career in the high-tech/software business, focusing on how teams deliver software to customers..etc, and just interested in the process.
3. Is the SoC follow-up just to wait 3 months and test your PSA, eventually trying to find the nadir over a 2-year period? Is everyone pretty much following this for RT?
4. What other questions should I be asking my doctor post-RT treatment?
Any other insights and guidance for me during this stage of my journey would be greatly appreciated.
Mark
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SierraSix
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1. The delivered always matched the plan closely, if they used fiducials or gating. That's what image guidance and intra-fractional tracking assures.
2. You can ask your RO for a copy of your treatment plan. He probably doesn't get many patients asking, and in my experience, they are proud to show you-- it's what they do. Once they (and the physicist) do the plan it is in the computer that guides the beams. Apart from set up, the radiation tech does little.
3. In my case, nadir was reached after 4 years (I didn't have ADT). Everyone is different. In your case, you will be at nadir by your 3 month PSA test. You can reasonably expect your PSA to increase when your testosterone comes back. As long as it doesn't hit 2.0, there is no reason to expect recurrence.
4. With your diagnosis, I would expect you also received whole pelvic radiation to get the microscopic spread into your pelvic lymph nodes. Excellent results from the POP-RT trial:
You can ask them to perform a "DICOM export". Depending on the treatment planning system used (Eclipse, Pinnacle, Monaco etc.), this may not be difficult for them. The issue would be for you to view these DICOM-RT objects in a way that makes sense to you. Ideally, you would need to be able to view this DICOM objects -> RT-Plan, CT Images, RT-Structure set, RT-Dose. There are some free applications out there that can do that. Either way, I think it would be interesting. You can always ask for screen captures, worst case.
Questions. 1, get a bone density test (DEXX), 2, ask if you are immune compromised (and wear face masks everywhere regardless). If your MO wants to put you on denosumab (for bone loss) denosumab is also helpful with regard to bone mets.
Not questions. Exercise your arse off (I have), not a few hours a week, but rather daily. Weight bearing and resistance only -- swimming does not count. Leisurely walking does not count. Lose weight to get BMI to normal range. Eat vegan but be sure to get enough protein to support exercise. ADT makes the body lose muscle and bone. ADT means you stand no chance of overcoming bone loss with calcium, vitamins and food alone.
Besides its anti-muscle loss (aka sarcopenia) effect, I find extended challenging exercise a great way to handle the incessant stress of living with PCa.
Many people do none of this and survive quite a while with PCa, but this is the _advanced_ PCa group. (and I presume you have that since SBRT and ADT are SOC for that.) (SOC is doctor jargon for standard of care, ie the treatment plan.)
Even if you know and understand the plan, how do you know that all the equipment was functioning perfectly during your treatments? How often do they calibrate or check the equipment, if ever, after it is installed? Seems like the most one can do is monitor PSA or get PET scans afterward to get some indication of your treatment's fidelity to the plan, assuming that the plan was effective to begin with. I guess you could have an autopsy done someday, but you wouldn't be around to see the results. 😁 🦊
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PARP inhibitor Olaparib, phase 3 study findings (PROpel)
MRI prior to HDR Brachy and HDR intensity.
PSA holding low!!
Introduction and asking for help interpreting latest scan results and thoughts on future treatment plan please.
