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Repeat radio therapy to the Prostate?

User
Posted 14 Feb 2020 at 08:16

If, following Hormone & Radio therapy for localised Cancer - your PSA goes up later on (Perhaps a new tumour has appeared?), say a couple of years later - is repeat Radio therapy used? & what is the success rate?

Thanks.

 

User
Posted 16 Feb 2020 at 16:10

I haven't even started my 37 fractions of EBRT yet but the onco has already told me that, should the cancer return at a later date, further RT will not be an option.  Worries me because of my family history (my dad died of PCa) so I think, even if they "cure" the current cancer, surely my genetic predisposition must mean there's a good chance of a new tumour popping up later.  Crazy really, worrying about something that hasn't even happened, and might not happen.  Must concentrate on worrying about the tumour I have now!

User
Posted 19 Feb 2020 at 09:55
Bean, the chance of your cancer being genetic is minimal. Your dad wasn’t a young man when he died, you weren’t particularly young at diagnosis and less than 10% of prostate cancers are believed to be genetic. Your chance of success with RT is as good as anyone else’s.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 19 Feb 2020 at 11:44
The worry never leaves, you just learn ways to keep it in a box!
User
Posted 22 Feb 2020 at 10:05

Keep it up, Pete - I hope it is successful for you.

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User
Posted 14 Feb 2020 at 09:11
They won’t offer RT to the prostate again as you will, in all likelihood, had the maximum dose

Bri

User
Posted 14 Feb 2020 at 12:52

I agree with Bri. You will not be able to receive radiotherapy to the prostate again. 

Possibly another type of focal treatment? 

Ido4

User
Posted 14 Feb 2020 at 16:39

It's rare that cancer returns in the target area of the radiotherapy, although not impossible.

You really need a PET scan to find where it is, and if it's far enough away and not too widespread, you might be able to have Cyberknife or one of the other highly targeted RT treatments, without exceeding max dose to any body tissues.

Sometimes, brachytherapy can be offered as a secondary RT treatment, again, depending heavily on the circumstances and previous treatment doses.

Edited by member 14 Feb 2020 at 16:41  | Reason: Not specified

User
Posted 14 Feb 2020 at 18:43
Thanks for your replies, it seems no is the probable answer.

Hopefully, I will not be in that situation.

User
Posted 14 Feb 2020 at 21:54

Next week I am starting repeat radiotherapy for recurrent prostate cancer. It's very similar in intent to Cyber Knife but is known as SABR - Stereotactical Ablative Radiotherapy. When my oncologist suggested this I mentioned maximum dose to the prostate but she said that the lymph node involvement was in an area just above the prostate and, therefore, could be done. 

As Andy says it is rare that the cancer returns in the target area of the prostate. In my case the nodes are above the prostate (or what's left of it) and the original radiotherapy had evidently destroyed the cancer at which it was aimed. There is no trace of cancer in my prostate.

It kind of indicates that the cancer had already escaped and set up shop in these nodes at the time of my original treatment although I don't know this for sure. They must be very small and very slow growing. They showed up as tiny green dots on the PET scan and were undetectable on MRI and CT scans.

Edited by member 14 Feb 2020 at 21:56  | Reason: Not specified

User
Posted 14 Feb 2020 at 22:37
When it comes to EBRT, it's not just a matter of total dose but the paths taken to the tumour(s) as the radiation causes collateral damage all along it upto and into the tumour but also after the tumour. I know the linac used on me directed the dose from 5 angles to spread out the radiation and this is probably typical of many linacs. However, some hospitals now use a linac that does a continuous sweep directed at the Prostate. This is called 'Rapid Arc' and my understanding is that in doing this damage is less concentrated on a few paths to and after the target. When I asked about the possibility of Cyberknife to treat a small tumour that had regrown in my Prostate after IMRT, I was asked by the Royal Marsden if I knew the paths previously used, so this must be a consideration.
Barry
User
Posted 15 Feb 2020 at 01:10

RapidArc is Varian's brand name for VMAT (Volumetric modulated arc radiotherapy).

This is EBRT treatment using a continuous sweep, combined with intensity modulation and dynamic beam shaping.

I think most main centres have been doing VMAT for a while, but obviously earlier treatment are less likely to be.

User
Posted 15 Feb 2020 at 07:36

Hi

Tony had RT back in 2006 and has just finished 5 weeks of RT in middle of Jan for lympth node involvement near his kidneys, will be seeing his consultant at the end of the month for results.

 

barbara

User
Posted 16 Feb 2020 at 16:10

I haven't even started my 37 fractions of EBRT yet but the onco has already told me that, should the cancer return at a later date, further RT will not be an option.  Worries me because of my family history (my dad died of PCa) so I think, even if they "cure" the current cancer, surely my genetic predisposition must mean there's a good chance of a new tumour popping up later.  Crazy really, worrying about something that hasn't even happened, and might not happen.  Must concentrate on worrying about the tumour I have now!

User
Posted 19 Feb 2020 at 08:08

Originally Posted by: Online Community Member

I haven't even started my 37 fractions of EBRT yet but the onco has already told me that, should the cancer return at a later date, further RT will not be an option.  Worries me because of my family history (my dad died of PCa) so I think, even if they "cure" the current cancer, surely my genetic predisposition must mean there's a good chance of a new tumour popping up later.  Crazy really, worrying about something that hasn't even happened, and might not happen.  Must concentrate on worrying about the tumour I have now!

That is a heck of a lot of fractions - I had 20 at Addenbrooks in Cambridge. with a PSA of 27 & 3-4 Gleason.

User
Posted 19 Feb 2020 at 09:52
37 fractions at 2Gy is the norm

20 fractions (usually at 2.9 or 3Gy but sometimes at 3.2Gy) was a trial but is becoming more common now.

It doesn’t have anything to do with PSA or staging, simply onco preference I think.

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

User
Posted 19 Feb 2020 at 09:55
Bean, the chance of your cancer being genetic is minimal. Your dad wasn’t a young man when he died, you weren’t particularly young at diagnosis and less than 10% of prostate cancers are believed to be genetic. Your chance of success with RT is as good as anyone else’s.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 19 Feb 2020 at 11:44
The worry never leaves, you just learn ways to keep it in a box!
User
Posted 19 Feb 2020 at 13:01

Lyn is spot on about the 20 sessions of RT as opposed to 37. When I embarked on my RT I was expecting to have 37 fractions but I was aware that my particular oncologist was one of the leading lights behind the 20 fractions policy. She told me at the time that the trial had ended but she would seek authority to let me have the 20 fractions. The total dose is about the same.

Mine was called "dose painting" so a higher dose is directed at the tumours and less to surrounding areas.

User
Posted 19 Feb 2020 at 13:41
John was part of the trial - it was to find out a) how high the dose could go before the side effects became unacceptable and b) what the impact was on effectiveness. They found that 19 or 20 fractions at 2.9, 3.0 or 3.2Gys worked at least as well as 37f at 2Gy and with slightly fewer side effects - if they went above 3.2Gy the side effects rose significantly. The early conclusions were that if the man was fit & healthy then the shorter course at a higher dose was best option.

NICE recommendation is that men should have 20f at 3.0Gy unless they are not able to have hyperfractionated RT in which case they should have 37f at 2Gy

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

User
Posted 19 Feb 2020 at 17:04

60GY# 20 is the treatment I had! That is what it said on the onco's letter.

I assume that means 3GY a time. I'm pleased it was not any more, as 20 45 min trips, was more than enough ;)

 

Edited by member 19 Feb 2020 at 17:06  | Reason: Not specified

User
Posted 20 Feb 2020 at 10:16

I agree about the 20 sessions versus the 37 sessions in terms of travel time Bob. My journey was a 70 miles round trip so if I had had 37 sessions it would have been nearly 2,600 miles! 1,400 was enough.

User
Posted 21 Feb 2020 at 07:27

Originally Posted by: Online Community Member

I agree about the 20 sessions versus the 37 sessions in terms of travel time Bob. My journey was a 70 miles round trip so if I had had 37 sessions it would have been nearly 2,600 miles! 1,400 was enough.

Thanks Pete, I assumed that the 20 session idea, is now standard - perhaps wrongly,

mine was Sept - Oct 2019. A 20 X 80 mile round trip approx to Addenbrooks. 14 using hospital transport, some on ezec vans, that did not have springs!, the rest in Taxis & volunteer transport. Tip for anyone doing the same, avoid Mondays & Fridays! I drove myself then.

Sorry you need some further RT, how many sessions will that be? (For your 70 mile trip!) But all the best of luck.

Thankfully, my PSA results are good, (Latest 0.04) & I had my final (3 month) Hormone injection on Tuesday this week. Barring the unforeseen of course. 

User
Posted 21 Feb 2020 at 16:54

Hi Bob - 9 sessions this time. It's a specialized form of RT called Stereotactical Ablative Radiotherapy (SABR for short) and is delivered over 9 sessions. It's aimed specifically at the affected lymph nodes. The stereo bit comes from the fact that very narrow beams are fired at the node from different angles meeting in the middle. 

Done first week now so 6 more to do. Asked them today if each node gets a blast each day but no - week one they attack one node, then move to another and finish with node number 3.

Not sure what happens if you have more or less than 3!

User
Posted 21 Feb 2020 at 17:21

You probably wouldn't be offered SABR or Cyberknife if more than 3 locations.

User
Posted 21 Feb 2020 at 18:42

Thanks Lyn.  I should clarify that if I'd chosen prostate only EBRT I would have had 20 fractions.  It's only 37 because there's a question mark over spread to lymph nodes and so I've chosen to have the wider area covered.  Though the thought of the shorter course was tempting it was the knowledge that should it crop up in my lymph nodes later, further EBRT would not be an option that led me to go for the 37. 

Edited by member 21 Feb 2020 at 18:45  | Reason: Not specified

User
Posted 22 Feb 2020 at 10:05

Keep it up, Pete - I hope it is successful for you.

User
Posted 22 Feb 2020 at 15:37

Originally Posted by: Online Community Member

You probably wouldn't be offered SABR or Cyberknife if more than 3 locations.

Interesting. The oncologist did say that I "qualified" for the treatment but I didn't ask her what the actual criteria were.

 

 

 
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