EBRT - Is it the right thing and what to expect?

[JazzMan42]

After DX in November 2018 with Stage IV and Gleason of 5+4 and 4+5, and 5 years of ADT of Lupron (then Orgovyx), prednisone 5mg, and Zytiga 250mg with low fat breakfast, my PSA stayed stable at 0.4 or 0.5. At end of 2013, PSA started rising to latest value of 0.84. Had PSMA PET Scan March 5, 2024 which showed mainly "dense uptake in the right prostate". More details in my profile.

Referred to RO who discussed radiating right lobe of prostate with either 55/20 or SBRT 7x5. My own research indicated high probability of urinary and bowel side effects which scare the heck out of me. I had an earlier TURP in 2018 and suffered urinary issues which were no fun.

My questions to this learned group are:

1. Is radiation the best bet at this juncture? I am 81.

2. Which EBRT procedure would be best? IMRT, VMAT, SBRT, other?

3. What are possible side effects and how does one deal with them?

4. Should I consider spacer gels to protect rectum?

My own understanding of the radiation process is minimal and I hope you guys can shed light on it for me.

Many thanks,

David

[Tall_Allen]

1. Is radiation the best bet at this juncture? I am 81.

Debulking the cancer in the prostate has proven benefit in slowing progression: prostatecancer.news/2018/09...

2. Which EBRT procedure would be best? IMRT, VMAT, SBRT, other? All about the same. SBRT is the most convenient.

3. What are possible side effects and how does one deal with them?

prostatecancer.news/2018/10...

Exercise!

4. Should I consider spacer gels to protect rectum? If no danger of extraprostatic extension. Late term rectal side effects are very rare with modern technology.

[JazzMan42 in reply to Tall_Allen]

TA, thanks for your speedy and comprehensive response. If I may, a couple of follow up questions: 1. Is IMRT better to minimize side effects? 2. Can the RO determine in advance if I have extraprostatic extension? If I do, do you recommend spacer gel? Thanks.

[Tall_Allen in reply to JazzMan42]

1. No. They are all the same in terms of side effects.

2. MRI or biopsy is how they can guess at EPE, which precludes use of a spacer gel.

[vintage42]

I think radiation is best at 81 and even younger. I feared the trauma and discomfort of surgery and found radiation to be a non-event although time consuming.

IMRT would be 20 sessions and SBRT only 5. IMRT can do a field plus targets while I think SBRT is very focal for one target. For just one target, I think SBRT is now preferred. Possible side effects are irritation of the bladder or rectum. Radiation has gotten so good that those should no longer happen. Spacer gel is not offered everywhere, can have complications, and might not be necessary depending on the relation of prostate to rectum and proficiency of the RO.

In 2021 at age 78, I had 30 IMRT to the prostate without spacer gel. The PSA nadir reached 0.93 but then rose to 5.71, and I had recurrence and metastasis. In 2023, I had 30 IMRT to the whole pelvis and one node.

I did not have any side effects either during or after both radiations. However, effects of radiation such as bladder cystitis can take many years to develop.

I did get both recurrence and mets after the first radiation, which I don't blame the radiation as much as my not being prescribed ADT. Be sure to get ADT from the beginning. I have now been taking Orgovyx and Abiraterone (Zytiga) for a couple of months, with negligible side effects, and the PSA has dropped to 0.04.

Radiation and ADT may have been feared in years past, but have not affected my quality of life at all.

[JazzMan42 in reply to vintage42]

Thanks for your take on EBRT. I hope my experience is as good as yours.

[mababa in reply to vintage42]

Ditto JazzMan’s comments. (And thanks EdBar for similar reassurances.) I’ve had serious trepidation about my upcoming RT in May, due to anticipated SEs mentioned. My RO recommended a spacer, so I’m headed in that direction (Barrigel). I’m on my second month of Orgovyx alone, although my MO once mentioned adding Zytiga when the original plan was to start Lupron. I will likely opt for an ADT holiday later this year after RT. Best wishes to all.

[EdBar]

SBRT is easy peasy, I’ve had it done twice over the last couple of years to tumors on two different ribs, 3 sessions and your done and it has been effective last PSA was 0.08.

I had IMRT to my entire prostate and a couple of nodes about 10 years ago, shortly after my stage 4 dx. It was 40+ sessions over several weeks but also very effective and very easy treatment just a hassle going to the radiologist every day. SE’s were mainly fatigue and some burning during urination which went away not long after radiation was over.

Of all my treatment forms and there have been many, radiation is probably is among the easiest, especially SBRT.

Ed

[JazzMan42 in reply to EdBar]

Thanks, your response gives me comfort especially "easy peasy".

[MarkS]

I'm currently undergoing VMAT RT. It appears to be a superior version of IMRT. With IMRT, the beam is fixed and consequently 2D. With VMAT, the beam revolves 360 deg round the body and consequently gives more of a 3D effect, concentrating the radiation where it matters rather then on surrounding tissue. I also had a spacer which I think was really worth it and a 10 min job with local anaesthetic.

The RT treatment is fairly easy. The main issue I had was ensuring my bladder was at the right volume (at least 200ml full) though that has become much easier now as I have refined the technique. Other than that, try to keep the exercise up, my SEs are low as a result.

[JazzMan42 in reply to MarkS]

Thanks for the info, will help in my questions to the RO.

[j-o-h-n]

Bring and play your Sax when being fried...........It can come in handy if you've got to pee during the session...........

Good Luck, Good Health and Good Humor.

j-o-h-n

[JazzMan42 in reply to j-o-h-n]

Great idea......it may even improve my sound!!!

[j-o-h-n in reply to JazzMan42]

But remember.......... "Rust Never Sleeps"........

Good Luck, Good Health and Good Humor.

j-o-h-n