External Beam Therapy

User

Posted 13 Jan 2016 at 16:26

On the EBRT theme, I had opted for HDR Brachytherapy with a top of 15 sessions of EBRT 2 weeks after the brachy. 6 months HT (bicalutamide) before and after.

Anyway, I had googled my oncologist at Clatterbridge some time ago and she was a leading light in a trial reducing EBRT to 20 sessions but with more sophisticated targeting. In short it deliver much higher doses to the actual tumor than to the rest of the prostate. I raised it at my appointment today and I was told that the trial had ended but that the consultant would consider me for the 20 session treatment outside of the trial. It wouldn't affect the speed of the process as the HT would be required in any event.

Tempted I must admit as it cuts out the brachy (and a night in hospital) and is by definition a bit less invasive although they do have to place markers in the prostate but this can be done as a day procedure.

I have another meeting with her in February. Apparently high level meetings will have taken place by then with the possibility of rolling it out more generally.

User

Posted 13 Jan 2016 at 22:13

Hi Pete48
Read Daily Mail 12/1/16, "High-Dose prostate therapy that halves trips to hospital" by OONA MASHTA
I have just read this in yesterdays Mail I wish I could have got on it, apart from the less time factor the side effects are possibly less ,an interesting read.
Cheers
Alan

KEEP POSITIVE and CARRY ON

User

Posted 14 Jan 2016 at 08:26

I also read the article in the Mail. I would have preferred the 20 sessions instead of the 37. I'm sure this will soon be the norm for EBRT. Must be quite a saving for the NHS not to mention the patients cost of travelling. Would cut my mileage from nearly 4000 miles to 2200 miles.

Still no complaints

Colin

User

Posted 14 Jan 2016 at 10:28

I'll let you know if I can have this. My meeting with the Oncologist is on the 10th of Feb. Apparently consideration is being given to rolling it out more generally in my area.

User

Posted 17 Jan 2016 at 13:48

John had the 20 sessions. There are some things to take into account -
- the trial was partly looking at how high a dose can be safely given
- where the tipping point is between effective treatment and increased risk of side effects.

So the common regime is 37 fractions of 2Gy = 74Gy. Men on the trial had 19 or 20 fractions at anything from 2.4Gy to 3.4Gy

John had 20 sessions at 3.3Gy = 66Gy .... Radiotherapy is cumulative so the 66Gy delivered in bigger slices has the same strength as the 74Gy. John sailed through the treatment, worked throughout, went to the gym every day and continued with his rugby - needed an afternoon nap on his desk sometimes though. When he was put on the trial, they were only selecting younger fit blokes for the higher doses, so it will be interesting to see what dose is suggested for Pete now the trial is completed

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 17 Jan 2016 at 15:01

Thanks for the update Lyn - hadn't fully appreciated that the initial trial was for younger guys although there was a 68 year old in the Clatterbridge part of the trial according to the Daily Mail.

I'll keep everybody updated after my meeting with the Onco on 10th February.

Meanwhile, I pick up my bicalutamide (150 mg) from the chemist tomorrow. The ride starts here!

User

Posted 17 Jan 2016 at 15:11

I don't think the trial was targeted at younger men but the highest doses were only given to men who were younger and/or particularly fit to begin with. I guess the thinking was that they would best cope with any increased risk of fatigue etc. but we are talking three or four years ago for John now so things have probably moved on a lot.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 18 Jan 2016 at 08:26

Well I am scheduled to start 20 session RT on Thursday. Not young (66) but all the consultants agree that apart from the PC I am in good health and I get my daily exercise of a 30min walk every day (something I will have to reschedule when the course starts). I was led to believe that here (Royal Berks, Reading) it is now the norm to give 20 session courses and it would be the exception to be moved to 37.

Edited by member 18 Jan 2016 at 10:58 | Reason: Not specified

User

Posted 18 Jan 2016 at 11:25

H Pete48

Good luck with everything ,I was on Bicultamide for 30 days prior to starting Zoladex, I'm sure you will be fine. http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-smile.gif

Regards

Alan

KEEP POSITIVE and CARRY ON

User

Posted 18 Jan 2016 at 12:05

Hi Pete
I've been on 150mg Bical for 4 months now. It actually hit me hard for 2 weeks but I'm ok now. My 33 RT due to start in April. I've been told with my figures that it's not likely to be curative, so I have just had a long chat with Onco secretary to ask if I can have 20 instead. Waiting to hear back. I'm not looking forward to it at all tbh especially if not curative , so the less sessions the better.
Very best wishes to you
Chris

User

Posted 18 Jan 2016 at 14:13

Regarding davews' post - it does seem to vary from area to area. It's not - yet - the norm in my NHS area which is odd because the consultant in overall charge of my case was a leading light in the initial trials of the 20 session approach. I think she is pushing for it hence my appointment with her next month.

Starting the bicalutamide today. I'm going to take them early evening as there is less chance of me forgetting! Doesn't seem to matter when you take them according to the bumf as long as you try to take them at roughly the same time each day.

User

Posted 18 Jan 2016 at 19:41

I was asked towards the end of 2007 when I was 71 whether I wished to take part in the CHHiP trial with randomized selection into the 37 fraction standard, 19 or 20 hypofractionated arms. So suitable 'old timers' were eligible even back then.

I asked if I was drawn into the 37 fraction arm if I could have the 20 higher dose fractions outside the study but was told no. I asked if I was drawn into the 19 fraction arm whether I could withdraw and have the standard 37 fractions instead and was told yes. As a further variation, I asked whether I could have an additional 2 fractions each of 2gy added to the 37 fractions. (This was on the basis that slightly better cure rates have been obtained with higher doses albeit with increased risk of more severe side effects). The Marsden would not agree to this - no doubt due to NICE guidance.

Hope treatment goes well.

Barry

User

Posted 18 Jan 2016 at 23:12

Hiya. My husband age 73 went for his ct planning scan today and followed all instructions for the past 5 days. Unfortunately they could not do the scan as he was told he had wind in the bowel. He has to go back this Friday. Any suggestions???? He is due to have 4 weeks daily ERT. He has also been given a different suppository.

Edited by member 18 Jan 2016 at 23:15 | Reason: Not specified

User

Posted 19 Jan 2016 at 00:13

Hi Marietta, I have replied on your own thread.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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