I am status post RP and am scheduled to meet my Rad Onc to discuss radiation treatment with or without ADT. Can anyone suggest some questions that I may need answers to?
Also - what does the schedule for radiation treatment usually look like? Is it daily for 45 days(just an example) or do you break it up? On one week, off the next.
Here are some suggestions for questions to ask of your radiation oncologist. Text in brackets "[...]" are my comments to you rather than questions for your radiation oncologist.
- How will you find the areas to radiate?
Will you just be guessing where the cancer might be based on previous experience? Do you intend to look at imaging scans in hope of finding where it is?
If you plan to look at imaging scans, what scanning techniques are best, e.g. one of the various PET scans? Do I need new scans?
[Note, if the rad onc can't offer any of the best scanning techniques, there is also a possibility that he has no experience reading them and doesn't know how to incorporate them in his treatment - in which case you might consider going to a different rad onc. We tend not to want to embarrass our doctors by asking questions about what they don't know, but you only get one shot at salvage radiation and it has to be the best you can get. So I suggest that you be polite, but ask the hard and embarrassing questions.]
- How soon can you schedule the radiation?
- Do you plan to use neoadjuvant and/or adjuvant hormone therapy?
["Neoadjuvant" means starting before the main (radiation) treatment. "Adjuvant" means during, and usually continuing after, the treatment.]
How long would you want me to be on HT before radiation and how long after?
Can I start the HT ASAP in order to prevent any spread of the cancer while we're waiting to schedule the radiation?
Do I need to get any scans done now, before the HT starts, so that the HT won't mask the presence of cancer in the scans?
Will you be doing additional scans during the treatment?
- How many grays ("Gy") of radiation would you use?
How much of that would be to each of the targets?
How many Gy per day?
What would be the tradeoffs in using higher or lower doses?
[The obvious tradeoff is efficacy vs. adverse side effects. It's an important question that you need to think about as well as the rad onc. However it's hard for you to think about because you haven't experienced the side effects and don't know what they're like - you probably have to trust the rad onc, so you will be trying to figure out how seriously he has thought about the question. Ideally, you want him to be able to say that studies have shown that having more than X Gy provides only a small extra extra benefit but begins to show a significantly larger side effect profile, so he plans to use X.]
- How many days of radiation and days of off time will you require to do it?
[If you have scheduling concerns, for example if you are working and want to be able to get the radiation done early in the mornings so you can get to work as soon as practicable, ask about that.]
How do you accommodate holidays, vacations, or other delays for you or your staff?
[If he is planning a two week vacation in the middle of your treatment, you'd like to know that another good rad onc will be accessible and have all of your records if the radiologists (it is technicians rather than the rad onc himself who usually operate the machines) continue the treatment in the primary rad onc's absence. If you go on HT, it might be practical to postpone the start of treatment until after the end of the planned vacation.]
- If I have serious side effects during the treatment, what will we do?
Treat the side effects and continue? Stop and resume later? Stop and give up? Keep going and grin and bear it?
What are the worst side effects you've seen?
What can be done to minimize the chances of them?
- What long term side effects should I expect?
[Some short term side effects will be felt for months after treatment. Long term are the ones that last years.]
Erectile dysfunction?
Rectal scarring, proctitis?
Urinary difficulty or incontinence?
Bowel incontinence?
[I expect a rad onc to say that all of these are possibilities and some (ED and rectal scarring) are quite likely. If he says that MY patients don't have those problems, I would be hesitant to trust him.]
How well do you think you can spare the urethra, bladder, rectum, other sensitive structures?
- How many cases of prostate cancer do you treat per year?
How many are salvage radiation?
[Ideally, you want someone who is doing this on a regular basis and has lots of experience - though that's not a guarantee of competence.]
Thank you Alan - I put these in a notebook for my visit. I appreciate you taking the time to respond.
Alan, thank you for this info. We meet next week with my husbands RO, who proposes repeat radiation to positive inguinal lymph nodes. As my husband has 3 pad a day incontinence since his radiation 11 years ago, as well as colon problems, more radiation worries me.
I had my meeting last Thursday and I asked almost every question. The Rad Onc seemed very appreciative of me having questions beforehand. We were able to have a productive and thorough discussion.
I have 45 rounds starting Monday totaling 70 Grys. Will be done April 27th. The Rad Onc is a block from my office and have scheduled the treatment during my lunch break. So that's good.
Thank you - I felt much more in control of things asking those questions. All my best to you and yours.
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