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Leo Robot spares some nerves

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User
Posted 25 Sep 2021 at 09:49

Hi Chris,

Thanks very much for your good wishes, and your extremely detailed log.

"A second Hem-o-lok clip" - Jeez H. C. on a bike

"33 salvage RT sessions". How many Gy each, since a mere 20 fractions seems to be the order of the day down here in deepest, darkest Kernow?

Jim

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 25 Sep 2021 at 12:41

Hi SoulSurfer, many of the studies on SRT show that it is more likely to be successful if started as early as possible and before PSA rises much above 0.2 if possible.


In my case PSA rose within a few weeks from 0.3 to 0.7 so I was put on HT in addition to SRT. 

Ido4

User
Posted 25 Sep 2021 at 13:26

Originally Posted by: Online Community Member


Hi Chris,

Thanks very much for your good wishes, and your extremely detailed log.

"A second Hem-o-lok clip" - Jeez H. C. on a bike

"33 salvage RT sessions". How many Gy each, since a mere 20 fractions seems to be the order of the day down here in deepest, darkest Kernow?

Jim



 


Jim 


2 Gy per session 66gy total  according to my hospital letter. Don't we all get a similar total amount, sure the scholars will know ?


Hope all goes well for you.


Thanks


 

User
Posted 25 Sep 2021 at 13:52

Yes we do all get roughly the same amount of Gy. Though one does here the phrase biologically equivalent dose, which some how comes in to the equation. The standard used to be 37 * 2gy = 74 gy, now they tend to give fewer fractions i.e. 20, 15, or even 6. But with a bigger dose, so 6 * 6gy=36gy, presumably biologically this is roughly equivalent to 74gy in smaller doses.


I had 15gy HDR, but that is biologically equivalent to about 40gy, plus 15 * 2.75gy. So in total my biological equivalent dose was between 70 and 80 gy. 

Dave

User
Posted 25 Sep 2021 at 14:31

Hi Ido (If I may call you that?),

Thanks for the info, and your detailed log too!

"20 sessions of radiotherapy with 55 Grays total dose." - Same (proposed) here.

"PSA rose within a few weeks from 0.3 to 0.7"

In my case PSA has fallen from 0.3 to 0.25 over 4 months.

As you will see above, my GP refused to check my cholesterol and/or liver function readings on my last visit. My previous onco wanted to wait until I'm fully recovered from last Autumn's unanticipated triple CABG and subsequent iatrogenic liver problems before taking any further action.

Cheers,

Jim 

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 25 Sep 2021 at 17:06

Thanks again Chris,

"Don't we all get a similar total amount"

It seems not. Unless 55/20 is somehow "biologically equivalent" to 66/33 as per Dave's suggestion?

Jim


 

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 25 Sep 2021 at 19:19
It isn't linear - 20 fractions at 3Gy or 3.2Gy delivers about the same amount of radiation damage as 37 fractions of 2Gy.
If you are being recommended for 2.75Gy that is either because it is salvage treatment or they think you don't need the higher amount. Perhaps they are aiming at quite a small area or it is going to be a bit close to your bowel or something.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 25 Sep 2021 at 20:11

Thanks Lyn,

In my case it is certainly SRT. As yet I have no idea precisely which area they are thinking of irradiating, and I harbour this sneaking suspicion that they don't either!

Jim


 

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 25 Sep 2021 at 20:59
Sorry - didn't word it very well - I know you are having SRT, what I meant was that your hospital might have a regime of 20 x 3.2Gy for radical RT and 20 x 2.75Gy for SRT, or something like that. John was put on the trial for 19 or 20 fractions at 3 / 3.2 / 3.4Gy when he had his SRT - they wanted to test out the theory that men could cope with a higher amount of radiation than had previously been thought, without the side effects becoming too intolerable. What they found was that fewer fractions at a higher dose is just as effective as the old 37 x 2Gy but with fewer side effects.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 Sep 2021 at 18:53

Thanks again Lyn,

"Fewer side effects", and certainly not "intolerable" ones, is certainly highly desirable from my perspective!

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 26 Sep 2021 at 20:30

Standard hypofractioned dose for radical radiotherapy is now 20 x 3Gy.


I don't think anyone suggests it generates fewer side effects, but rather that it doesn't generate more, while being significantly cheaper, and more convenient for the patient. (And we probably don't have enough theraputic radiographers not to be doing hypofractionated treatments.)


SABR/SBRT/Cyberknife takes the hypofractionation (reduction in number of fractions) further, typically down to 5 x 7.5Gy.


There's been talk of two fraction treatments. When we used to do HDR brachy as a monotherapy, that was 2 x 15Gy, but I don't know what the dose is for two external beam fractions.


As Lyn mentioned, the doses for salvage treatments are sometimes different, but I don't know what they typically are.

User
Posted 26 Sep 2021 at 22:23
The CHHIP trial indicated that fewer fractions at higher dose had fewer side effects for most men.

20 fractions at 3Gy is standard in some areas but not all yet, more's the pity - we still see men on here being told they will be getting 37 sessions.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Sep 2021 at 22:41

Andy - Many thanks for the info, and the comprehensive profile. It sounds as though you're a professional in the PCa arena?

My PSA was 131 when tested for the first time. Try as they might no scan since has revealed any problem anywhere except my prostate before it was (almost!) all removed.

Lyn - Thanks again. An acronym I haven't come across before, so I'll go away and look it up. When I asked the onco from Treliske where I should look when doing my due diligence he suggested:

1) The Prostate Cancer UK web site! He didn't sound keen to take a look at my personal story though.

2) The RADICALS trial findings

Jim


Edited by member 28 Sep 2021 at 11:05  | Reason: Not specified

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 27 Sep 2021 at 23:21

RADICALS makes interesting reading but was focused on the benefits / risks of adjuvant RT over salvage RT - John's onco is one of the authors here
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31553-1/fulltext#:~:text=RADICALS%20is%20an%20international%2C%20phase%203%2C%20multicentre%2C%20open-label%2C,centres%20in%20Canada%2C%20Denmark%2C%20Ireland%2C%20and%20the%20UK. 


CHHiP looked specifically at standard RT (74 fractions) v hyperfractionated RT (19 or 20 fractions) - John's onco was also involved in this trial which is how J got his 20 sessions although at a higher dose that CHHiP was using at the time.


https://www.icr.ac.uk/our-research/centres-and-collaborations/centres-at-the-icr/clinical-trials-and-statistics-unit/clinical-trials/chhip 

Edited by moderator 06 Jul 2023 at 13:17  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 28 Sep 2021 at 18:03

Thanks again for that info Lyn,

I asked my previous consultant for a printout of my most recent F18 PSMA PET CT scan results and a suite of DVDs. By the sound of it she had other things on her mind at the time, but the printout finally arrived in my letter box today. The highlights read as follows:

"Physiological uptake is seen within the salivary gland...

No convincing focal lesion or uptake is seen within the prostatic bed. There is a tiny focus of moderate uptake in the left pelvic side. This does not readily correlate to any anatomical structure and is nonspecific.. No further area of increased uptake is seen. No abdominal or pelvic nodes are measurable...

IMPRESSION - No definitive evidence is seen for localisation for relapsed disease. Nonspecific uptake in the left pelvic sidewall. An interval study may be of benefit in further assessing."

Can anyone with more experience in these matters than yours truly translate that into plain English for me?

Jim


Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 28 Sep 2021 at 19:21
Just says that there are no areas looking suspicious for spread - prostate bed and lymph nodes look clear, there is an area that is lit up in your pelvis but it isn’t bone or lymph and isn’t attached to anything like your bowel so unlikely to be mets. Their suggestion is that if the scan is repeated at some point in the future, that may provide more answers.

Salivary gland comment is odd - perhaps you had a bit of infection / inflammation at the time?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Oct 2021 at 17:35

I had another PSA test yesterday. Up to 0.35 this time.

I'm expecting another call tomorrow from a (probably junior) member of my oncology team. No doubt zapping my prostate bed will be highly recommended.

It seems as though the time has come for some further action to be taken. I wish I felt more confident that they'll be zapping the alleged microscopic cancer rather than some other bit of me that is currently undamaged and still useful!

Jim

Edited by member 13 Oct 2021 at 23:41  | Reason: Not specified

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 13 Oct 2021 at 21:41

Originally Posted by: Online Community Member
Salivary gland comment is odd - perhaps you had a bit of infection / inflammation at the time?


PSMA is often present in salivary glands. It's unfortunate it was called *PROSTATE SPECIFIC* because it's not. This is a significant factor with Lutetium 177 treatment, which hence also impacts salivary glands.

User
Posted 14 Oct 2021 at 08:45

Thanks very much for that helpful information Andy,

That explains that, so now one more mystery remains to be solved. What might the "tiny focus of moderate uptake in the left pelvic side" actually be?

Perhaps PSA isn't prostate specific either? Perhaps whatever it is that's taking up the PSMA tracer also produces PSA? If so is it malignant or not?

Jim
 

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
User
Posted 14 Oct 2021 at 10:43

An "interesting" sequence of conversations with the junior doctor this morning.

I didn't realise, but it seems that the "hotspot" in my left pelvic side will get zapped as a matter of course. I was envisaging the prostate bed and remaining lymph nodes, but apparently pretty much the whole pelvic region gets treated.

I signed up for a "planning CT scan" in a week or two followed by 20 fractions over a 4 week period starting perhaps 3 weeks after the scan.

A few minutes later the phone rang again. I paraphrase only slightly:

JD - "I've just had a word with your new consultant [He who must not be named?], and he would like to start you on hormone therapy for a couple of months before starting SRT"

Jim - "What evidence is there that hormone therapy would benefit somebody in my position"

JD - "There isn't any"

Currently we're back on Plan A as agreed 10 minutes previously, whilst I do yet more due diligence.

Jim

Reality is merely an illusion, albeit a very persistent one - Albert Einstein
 
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