Question on IMRT

[Clippedwingz]

I initiated my 20 dose regimen of IMRT at Duke today on my Gleason 10, stage 4 prostate cancer (Mets in bladder neck and perineal area/seminal vesicles and some iliac lymph nodes).

Been on Xtandi and Orgovyx for 5 months which has shrunk all tumors and the radiation is to kill what’s left.

My question is during initial RO consult he said he would treat everything but the lymph nodes (leaving nodes for later because according to the RO it doesn’t make sense to treat those at same time). Orders from the simulation said only prostate being radiated.

I asked RO today about this change before starting first treatment and he said the bladder neck, perineal area, and seminal vesicles are all “in the radiation field” so are being treated at same time, but primary target is only the prostate. The bladder will get enough scatter at lower strength in process.

Does that make sense vs directly targeting the bladder neck? Just would hate to have anything get missed since I know I only get one shot at the radiation.

I normally trust the experts here at Duke, but this has me nervous.

thanks!

[GP24]

The radiation plan usually specifies different doses for the areas which will be radiated by the IMRT system. The prostate gets the highest dose. Other areas less dose to avoid side effects.

[Tall_Allen]

I don't understand why you wouldn't treat the entire pelvic lymph node area at the same time. A typical plan would entail 45 Gy in 25 treatments to the whole pelvic area with a boost dose to the prostate and the known cancerous lymph nodes and areas of known cancer in and around the prostate. The SOC for known pelvic lymph node involvement is 2 years of abiraterone and 3 years of ADT. I suggest you get a second opinion.

[Cenerus in reply to Tall_Allen]

I agree. My treatment was almost exactly what Tall Allen just wrote. I’m not sure why the pelvis is being ignored here. This seems too conservative.

[j-o-h-n]

Time to clip the doctor's wings?...

Good Luck, Good Health and Good Humor.

j-o-h-n

[Shellhale]

Husband had the same treatment, 20 IMRT high dose radiation to the prostate bed only. He is gleason 9 with lymph mets to retroperitoneal around 12 at dx. Nothing was lighting up on psma before radiation treatment only showed residual cancer in the prostate. I asked the same question about sterilizing the pelvis where the lymph nodes were. Our RO said they no longer treat it like that. If those lymph nodes were to show back up later you could radiate that area, he used the term wack a mole. It's been 2 months now and husband is doing well. Psa continues to decline its 0.5 no ADT only Xtandi. He also did hyperbaric oxygen chamber treatments throughout radiation to lessen side effects. We ended up buying a mild HBOT.