My MSK Precise / SBRT Journey -- Treatment #5

[Hope4Happiness]

Well, I am happy to say, I had my fifth and final SBRT treatment at MSK in NYC on 11/15. It was a great feeling to ring the "treatment completion" bell that they have set up there as I was on my way out (see pic).

Before the final treatment, I had a meeting with Dr. Zelefsky and his NP to discuss the plan going forward, and at this point, I'm basically having a PSA test three months from now. It'll be great to get my full energy back now and focus on exercising.

My final treatment was right on schedule, so I drank the full cup of water and was on the table under the machine about 35 minutes later. Again, the initial scanning/prep was about 10 minutes and then the treatment itself was about another 10 minutes.

As mentioned, the main side effects I had during the treatment were increased urgency regarding urination and an increased burning sensation during urination as the treatment went on (the burning really ramped up after treatment #3).

Prior to my fifth treatment, I submitted urine for a urinalysis to rule out any urinary tract infection (UTI), and that test came back negative.

My goal now is to take a deep breath and resume practicing my "mindfulness" -- I know with prostate cancer, there is always something to worry about and overthink, but now that I m through with this part of the journey, I've got to get my head back to "enjoying life right as it happens" and focus on what I can control.

I hope these posts have been helpful. I know a lot of men with prostate cancer spend a lot of time researching and reading about the scientific/medical aspects of treatment. I figured an "on the ground" report of the actual experience of going through a specific treatment would be helpful to those seeking firsthand accounts.

If anyone has any questions and is more comfortable contacting me through private emails, that is fine too.

Thanks very much to everyone who read and commented on these posts. I surely appreciate it!

[NYC_talker]

Thank you for this. I'm glad it went so well and it does give hope to others of us who are/will be going through the same process. My overall anxiety is about planning around it and what to expect and you've given me a sense of it. Upon this last treatment are you still urinating quite often -- and how often is that? -- and what was the sense from the doc about how long it would be? And how are your energy levels, re: being able to exercise? Thanks again.

[Hope4Happiness in reply to NYC_talker]

Yes, a day after my final treatment, I am still urinating quite a bit and the burning is still there. Regarding the frequency, during my fourth and fifth treatment, my urination hit critical mass at about one time per hour, and I was getting up about three times per night.

I was told that the side effects would subside during the next two weeks.

The day after each treatment, I would feel fatigued. It never really subsided because I had a treatment every other day. During treatment, I tried to walk at least a mile a day. I tried to pick it up to a jog a few times, but I tired quickly.

Now that my final treatment is complete, I am hoping to get back to full exercising by the weekend.

[redonthehead]

Any bowels issues? After SBRT I had smaller poops but more frequent trips to the bathroom - perhaps 4-5 BM per day. Mostly gone after a couple weeks.

And you might want to be prepared for your first orgasm. It stung pretty good! that also subsided quickly.

[Hope4Happiness in reply to redonthehead]

My BMs increased a bit but no major changes.

Regarding orgasms, I did engage in sexual activity during treatment just to maintain blood flow and check any erectile/penetration problems, and yes, the stinging was indeed there.

[NYC_talker in reply to redonthehead]

Thank you. How long has it been since your treatment, and any other rectal issues since?

[redonthehead in reply to NYC_talker]

If you are asking me, I am 5 months out from SBRT. Just a few very minor issues still, really nothing, and it may be more related to a major change in diet due to a heart issue.

Frankly I'm a bit concerned that I didn't get enough GY as I was expecting more side effect issues. If I am to be truly cured by this, it sure speaks volumes about SBRT therapy for what I had - favorable intermediate risk PCa.

[climb4blue in reply to redonthehead]

Redonthehead, where were you treated and who was your RO?

What was the target prostate Gy / #fractions

What were the margins treated around the prostate?

[redonthehead in reply to climb4blue]

Tonlaar in Springfield MO on a Cyberknife. Not everyone lives in CA or NY.

5 x 7.25 GY is standard, but he agreed to an increase to 7.5 GY several weeks before planning. I need to ask if it he followed through on that

5mm margins, plus 10mm towards SVs. Don't know if that 10mm was on top of 5mm.

I had 4 gold fiducials and spaceoar placed by a UR under general.

[climb4blue in reply to redonthehead]

Although your RO should have followed thru with the dosage as you have asked, however, 36.25 Gy / 5 fractions seems curative based on many studies. At 36.25 Gy / 5 fractions, the Biologically Effective Dose was 211.5 Gy. Compare that to the Biologically Effective Dose of 186Gy for 80 Gy / 2Gy, which is the curative gold standard for prostate cancer using conventional fractions. Higher Biologically Effective Dose = More curative, cancer cell destructive.

Your margins were quite wide, so I am impressed you have minor side effects. As I understand it, margins and patient anatomy play a large role in side effects too.

[aceace12]

thank you for post.... good luck

[WilsonPickett]

H4H, Congratulations to you! I’m so happy for you. I will be happy for myself as well when is this finally done. Your documentation I had been very helpful to me and I really appreciate the roadmap. Now that I’ve started mine I’m finding out how many different treatments there are, even though our diagnoses are very similar. For example, in my case with the simulation I was not allowed to drink any water, my bladder had to be empty. Now that I’ve done those two things I have to wait till December 13 to start my treatments on the MRI Linec and in that case as well no water. Interesting right? Once again congratulations, and I still think we MSK Zelefsky alumni should have a party.😊

[Nous]

thanks for sharing all of this Hope4Happiness

[MackworthGuy]

Thanks for chronicling your treatments. I’m likely facing this next Spring but at a different location. It’s helpful to see it all described in order to balance the various snippets and questions normally posted.. Those are helpful too but just different. Know your willingness to share has helped at least me and likely others.