Whole Pelvis Radiotherapy and High Dose Rate Brachytherapy

User

Posted 02 May 2019 at 00:18

A treatment option offered by several oncology centres is combined Whole Pelvis RT (WPRT), and High Dose Rate Brachytherapy (HDR). This seems to be recommended for localised or locally advanced cases which are deemed "High Risk". I haven't seen any discussion of it here.

High Risk is defined as pre-treatment PSA > 20, or Gleason 8-10, or stage T3a or greater. (Some research papers also have an Extra High Risk category with pre-treatment PSA > 40.) The WPRT is aimed at mopping up any micro mets which haven't shown up in scans.

This is the proposed treatment path for me. The doses and fractions and order vary slightly at different centres. My centre does WPRT 46Gy over 23 fractions (4.5 weeks), followed by HDR 15Gy in one fraction.

Has anyone else here gone through WPRT, or even just the HDR by itself?
I'm interested to hear others' experiences - symptoms, side effects, etc.

I'm currently on HT. At my request, I'm aiming for a pre-RT PSA of 0.1, which several research papers suggest improves outcomes in High Risk cases, so my consultant has delayed it for 7 weeks to see if I can get that low (but wouldn't be happy to delay any longer even if 0.1 is not reached).

There is also a trial called PIVOTALBoost which has this option as one of the arms. My onco invited to join it if I really want to, but he is advising me to have this outside the trial, as I only get a 25% chance of this treatment on the trial, and he thinks I should do it anyway (and I wouldn't be able to choose to try dropping my PSA to 0.1 on the trial)

User

Posted 02 May 2019 at 01:20

It is still quite new but we do have a handful of members that have had RT/brachy - only one or two actively post though.

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

User

Posted 02 May 2019 at 07:08

Andy

A combination of repeated intrusions and SRT has resulted in severe damage to my bladder. When looking for help I came across pelvic radiation disease and found alot people suffering from adverse side effects of RT to the pelvic area , have you discussed the potential unwanted effects of the treatment. We all hopefully choose the treatment we think will be right for us.

Thanks Chris

User

Posted 02 May 2019 at 09:41

Thanks. I'll look up pelvic radiation disease, and discuss this again with my consultant. It was bowel issues he highlighted as a likely bigger issue than with more conventional prostate-only RT (PORT), because one of the important areas to include in WPRT are the lymph nodes all around the bowel. This can cause long term mucus farts, as he put it, and in the information he's given me, it also says rectal bleeding 2-4 years later, although not normally requiring any treatment. The dose is lower than the dose used for PORT.

Bladder damage is a well known possible side effect of the HDR brackytherapy, apparently.

But with a PSA of 57, and T3a, I am classed as "High Risk" (or "Extra High Risk") of recurrence after PORT, and this may be a price worth paying. That's clearly my consultant's thinking, but looking for views from others who've had it or read about it. Of course, I might pay the price and get recurrence - no guarantees either way.

User

Posted 04 May 2019 at 20:52

Hi Andy sorry to hear your on this journey, my OH had full pelvic radiotherapy 23 sessions as he had seminal vesicle invasion Gleason t3c said it would treat pelvic lymph nodes mop up any stray cells that could be there, he also had HD brachytherapy and HT 18months he's just had his last zoladex, if you read my profile tells you in a bit more detail..any questions feel free I'll try and answer as best I can, up to now my oh hasn't done too bad re side effects mostly aches and tiredness due to HT up to now fingers crossed none from the r.t or brachy..hope this helps stay strong....Jo.

User

Posted 05 May 2019 at 07:37

My first post so hope do it right ! I had high dose brachytherpy at Poole hosp last sept on n h s my Gleason score was 9 3t a psa bfore treatment o. 8 I had 3 weeks pelvic radiotherpy 2 weeks after psa went down to 0.08 due nex blood test in June also hormone injections every 6 months have hot sweats but no other problems / side effects didn't reilize at time how rare this option was told later that hosp only been doing 18 months at rate of 1 a fortnight !

User

Posted 05 May 2019 at 09:53

Roger,

Trials on this are covered in research papers dating back over 10 years, so there is survivability data available now. It seems that it's thought to be a good option for "High Risk" patients (PSA > 20, or G 8-10, or T3a or greater), the basic idea being to wipe out undetected micro mets in the pelvis which may make these cases high risk of recurrence otherwise.

Trials are still running (I mentioned PIVOTALboost) and different centres use slightly different doses and fractions.

Jo J.t,

Thanks for your post. I had searched but hadn't find any other people, and your posts also link to another patient with same procedure. I started wading through the relevant conversations, but at a quick glance, neither of you seem to have any nasty side effects, and I hope it stays that way.

User

Posted 05 May 2019 at 11:15

Hi Andy my oh hasn't had any side effects up to now from radiotherapy or brachy so all good up to now, he worked through all of his sessions, he's had his last zoladex now ,next PSA test in sepember and we.l go from there, this forum has been a massive help the people are fantastic, Jo.xx

User

Posted 25 Jun 2019 at 23:43

Had my CT planning session today.

It seems that what oncologists, urologists, and scientific papers refer to as Whole Pelvis Radiotherapy (curative treatment that includes prostate and pelvic lymph nodes) is different from what Radiologists refer to as Whole Pelvis Radiotherapy (which is a palliative treatment for pelvic bone mets). I wonder how often these get mixed up?

The Radiography reception nurse (that will be completely the wrong name) was very impressed when she asked if I had any kidney problems, and I produced a spreadsheet printout of all my blood test results since 2011. "Never had anyone bring that before," she said. My creatinine level is slightly above normal, but some way short of the 120mmol/L max for the contrast dye to be used, so that was OK.

I'd been to the loo on the way in, emptying out No 1's and No. 2's. My body seemed to anticipate this event and had been running overtime on the No. 2's the night before, so there was nothing there. That was until I'd drunk my litre of water and the CT scan started, at which point I could feel my guts rumbling, and duly failed the empty bowel test. Took the enema and went back into the waiting room to empty out the No 1's and No. 2's again. The 15 mins they said the enema would take got to 45 mins without any signs of anything, so I thought I'd better try. Still nothing much, but downed the second litre of water. I could feel my blood pressure was through the roof with all that fluid - my bladder is only fractionally over half a litre, and the excess fluid was making my heart pound whilst laying the CT scanner. Anyway, my bowels passed muster second time around, so I had the second part of the CT scan this time with the contrast dye, was drawn on by felt tipped pens, and then tattooed. I pondered going to the tattoo parlor afterwards to get them turned into proper gun target tattoos, but then thought better of it - one of them is only 2cm from the dangly bits. Talking of which, they initially stuck some tape or similar (I couldn't see with my head laying flat) in the positions, and the one next to the dangly bit he unsuccessfully tried to rip off my pubes in one jerk, which wasn't the most pleasant experience.

I hung around in the hospital for a hour or so or I was going to get caught short on the M25, with all that water still working its way through.

Anyway, the main lesson of the day is don't try and fart after you've had an enema, not even hours later. Fortunately I had just arrived home and the underpants could go straight into the washing machine. I could so easily have been sliding around in the drivers seat on the M25 though.

User

Posted 26 Jun 2019 at 07:01

I had “wide area” RT, Andy, because my relatively high PSA at diagnosis (31) didn’t really fit with the G3+4 cancer that the biopsy found. HT/RT was recommended over surgery so any undetectable spread outside the prostate could be zapped. I had my RT in 30 fractions and it really wasn’t too bad at all. No side-effects for the first half of the treatment, but towards the end I started passing a bit of clear mucus and had issues both with urine flow and frequency. In the last couple of weeks I was needing to make two loo stops on my 45 minute journey back from hospital, and needing to pee every hour through the night, which was pretty exhausting. I was given Tamsulosin for the flow issue which sorted that out. You quickly get into a pattern for the required empty bowel / full bladder combination for the RT and I didn’t have any problems with that, although in the final days of treatment I sometimes had a close call in holding it in until the end of treatment!

Side-effects peaked around 10 days after the end of treatment and then rapidly subsided. I’m now 3 months post-RT (3 months today, in fact) and have no symptoms other than an occasional mild dose of proctitis (a burning sensation in the rectum) which lasts a few days and then subsides again. At my follow-up 6 weeks after treatment my PSA was down to 4.6 and my oncologist pronounced himself pleased with the way that things were progressing. My next follow-up is in November.

Best of luck with the RT,

Chris

Notification

Join the online community now.