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Radiotherapy choices. WPRT or PORT

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User
Posted 19 Oct 2022 at 17:34

Hi, my husband was diagnosed with prostate cancer on the 17th of August this year, he was prescribed bicalutamide, had his first Prostap 3 hormone injection on the 8th of September, and is currently taking tamsulosin to help with his pee flow. He was told that he may have brachytherapy at the end of November, (dependant on the pee flow improving), followed by radiotherapy. His consultant said that he would need to choose between prostate only, or whole pelvis radiotherapy, but he is struggling to decide, and decision time seems to be rushing up on him. He is 58 years old, his PSA is 8.7, his Gleason score is 9, and his stage is T3a. Is there anyone who could give us some advice on making this decision? Many thanks in advance.

User
Posted 14 Nov 2022 at 22:27

The reason for 20 or 37 fractions is not quite what you might think.

The traditional treatment was 37 x 2Gy = 74Gy. (Gy is the radiation treatment dose.) This is used on prostate and pelvic lymph nodes.

It was discovered that prostate tissue can handle higher doses, and this is even beneficial, requiring a lower total dose for same treatment effect. This is called hypofractionation (fewer fractions) and is delivered as
20 x 3Gy = 60Gy.

However, other tissues such as lymph nodes don't handle 3Gy doses very well, so if they're including the lymph nodes, they go back to using 37 x 2Gy.

Edited by member 14 Nov 2022 at 22:29  | Reason: Not specified

User
Posted 23 Oct 2022 at 20:42

Yes, I had RT treatment for lymph mets outside the prostate but "whole pelvis" doesn't quite describe what was actually targetted treatment of specific nodes covering cancerous nodes and "elective" nodes with an extra 4mm radius of surrounding tissue. The level of RT at the same strength as was used for the prostate.

Jules

User
Posted 15 Nov 2022 at 07:54

Originally Posted by: Online Community Member

However i didn’t realise that RT is a one time only so assume if it had spread undetected it would mean HT for the rest of my life? Yuck! 
I think my decision has now been made thanks to the help from this forum.

RT is "one time only" to the same place.

If you don't treat lymph nodes first time you can go back and treat them later. The problem is this is not as effective.

User
Posted 19 Oct 2022 at 17:34

Hi, my husband was diagnosed with prostate cancer on the 17th of August this year, he was prescribed bicalutamide, had his first Prostap 3 hormone injection on the 8th of September, and is currently taking tamsulosin to help with his pee flow. He was told that he may have brachytherapy at the end of November, (dependant on the pee flow improving), followed by radiotherapy. His consultant said that he would need to choose between prostate only, or whole pelvis radiotherapy, but he is struggling to decide, and decision time seems to be rushing up on him. He is 58 years old, his PSA is 8.7, his Gleason score is 9, and his stage is T3a. Is there anyone who could give us some advice on making this decision? Many thanks in advance.

User
Posted 19 Oct 2022 at 18:46
I had whole pelvis radiotherapy (in early 2019) because in my case there was felt to be a high likelihood that cancer cells had spread undetectably into the lymph nodes around the prostate, and they wanted to get everything. I found the radiotherapy side-effects to be very tolerable. If whole pelvis RT offers a better chance of a long-term cure it would seem like a good idea to take that option, because radiotherapy is a "one time deal" - it can't be repeated.

Best wishes,

Chris

User
Posted 19 Oct 2022 at 19:01

I agree with cc I had whole pelvis radiotherapy and also found it really tolerable hopefully to make a better chance off a cure 👍

User
Posted 22 Oct 2022 at 19:22

Thank you Cheshire Chris and gaz61. Both your replies have helped him to make his decision.

User
Posted 22 Oct 2022 at 20:41

No problem Elle my journey started with psa off 24.9 and Gleason 9   18 months on after 37 fractions off radiotherapy and decapeptyl every 3 months  psa stable at 0.01 hopefully stays low after my last injection in December good luck with your choice off treatment gaz 👍

User
Posted 22 Oct 2022 at 21:53

Same here - I chose whole pelvis radiotherapy. 3+ years later, no known side effects from the whole pelvis part. It's done at a lower dose rate than if they know there's cancer in pelvic lymph nodes.

Incidentally, "whole pelvis" means something completely different to uro-oncologists than it does to radiographers. Radiographers call it prostate and seminal vesicles and [pelvic lymph] nodes. For radiographers, "whole pelvis" is a palliative treatment for pelvic bone mets, which is not what the uro-oncologist means!

User
Posted 23 Oct 2022 at 09:54
John had whole pelvis RT as salvage treatment and has never had any significant side effects from it. The main additional side effect is lymphodema but that is very uncommon
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Oct 2022 at 10:14

Originally Posted by: Online Community Member
The main additional side effect is lymphodema but that is very uncommon

That was my concern. My oncologist said he'd never had a case at the lower prophylactic dose that's given when there's a risk but no known cancer there (I think it was 45Gy over 23 fractions in my case). I don't think it's that common even at the full dose.

User
Posted 14 Nov 2022 at 21:54

I’m having the same issue, trying to decide whether to go for 20 fractions to treat the Prostate and Seminal Vesicles…or go for 37 fractions to treat the ‘whole’ pelvis including lymph nodes. At my first meeting with the oncologist I got the impression he was trying to dissuade me from the 37 because of a significant risk of more severe and longer lasting side effects. However i didn’t realise that RT is a one time only so assume if it had spread undetected it would mean HT for the rest of my life? Yuck! 
I think my decision has now been made thanks to the help from this forum.

My next appointment with the oncologist is on 23rd November….I really want this over and done with ASAP but my treatment will probably not start until the New Year as they don’t like to split the sessions over Christmas.

Elle,  as I am likely to be on a similar path to your husband’s, let’s keep in touch and maybe we can be of support to each other.

User
Posted 14 Nov 2022 at 22:51

I suspect their planning software could do this, but you'd still need 37 doses, so it wouldn't help with anything.

User
Posted 15 Nov 2022 at 13:08

Adding further treatment is not just about previous doses to that target, but also previous doses to the paths the radiotherapy will take though the body, and that can be difficult if it's near somewhere else which has already been treated.

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User
Posted 19 Oct 2022 at 18:46
I had whole pelvis radiotherapy (in early 2019) because in my case there was felt to be a high likelihood that cancer cells had spread undetectably into the lymph nodes around the prostate, and they wanted to get everything. I found the radiotherapy side-effects to be very tolerable. If whole pelvis RT offers a better chance of a long-term cure it would seem like a good idea to take that option, because radiotherapy is a "one time deal" - it can't be repeated.

Best wishes,

Chris

User
Posted 19 Oct 2022 at 19:01

I agree with cc I had whole pelvis radiotherapy and also found it really tolerable hopefully to make a better chance off a cure 👍

User
Posted 22 Oct 2022 at 19:22

Thank you Cheshire Chris and gaz61. Both your replies have helped him to make his decision.

User
Posted 22 Oct 2022 at 20:41

No problem Elle my journey started with psa off 24.9 and Gleason 9   18 months on after 37 fractions off radiotherapy and decapeptyl every 3 months  psa stable at 0.01 hopefully stays low after my last injection in December good luck with your choice off treatment gaz 👍

User
Posted 22 Oct 2022 at 21:53

Same here - I chose whole pelvis radiotherapy. 3+ years later, no known side effects from the whole pelvis part. It's done at a lower dose rate than if they know there's cancer in pelvic lymph nodes.

Incidentally, "whole pelvis" means something completely different to uro-oncologists than it does to radiographers. Radiographers call it prostate and seminal vesicles and [pelvic lymph] nodes. For radiographers, "whole pelvis" is a palliative treatment for pelvic bone mets, which is not what the uro-oncologist means!

User
Posted 23 Oct 2022 at 09:54
John had whole pelvis RT as salvage treatment and has never had any significant side effects from it. The main additional side effect is lymphodema but that is very uncommon
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Oct 2022 at 10:14

Originally Posted by: Online Community Member
The main additional side effect is lymphodema but that is very uncommon

That was my concern. My oncologist said he'd never had a case at the lower prophylactic dose that's given when there's a risk but no known cancer there (I think it was 45Gy over 23 fractions in my case). I don't think it's that common even at the full dose.

User
Posted 23 Oct 2022 at 20:42

Yes, I had RT treatment for lymph mets outside the prostate but "whole pelvis" doesn't quite describe what was actually targetted treatment of specific nodes covering cancerous nodes and "elective" nodes with an extra 4mm radius of surrounding tissue. The level of RT at the same strength as was used for the prostate.

Jules

User
Posted 14 Nov 2022 at 21:54

I’m having the same issue, trying to decide whether to go for 20 fractions to treat the Prostate and Seminal Vesicles…or go for 37 fractions to treat the ‘whole’ pelvis including lymph nodes. At my first meeting with the oncologist I got the impression he was trying to dissuade me from the 37 because of a significant risk of more severe and longer lasting side effects. However i didn’t realise that RT is a one time only so assume if it had spread undetected it would mean HT for the rest of my life? Yuck! 
I think my decision has now been made thanks to the help from this forum.

My next appointment with the oncologist is on 23rd November….I really want this over and done with ASAP but my treatment will probably not start until the New Year as they don’t like to split the sessions over Christmas.

Elle,  as I am likely to be on a similar path to your husband’s, let’s keep in touch and maybe we can be of support to each other.

User
Posted 14 Nov 2022 at 22:27

The reason for 20 or 37 fractions is not quite what you might think.

The traditional treatment was 37 x 2Gy = 74Gy. (Gy is the radiation treatment dose.) This is used on prostate and pelvic lymph nodes.

It was discovered that prostate tissue can handle higher doses, and this is even beneficial, requiring a lower total dose for same treatment effect. This is called hypofractionation (fewer fractions) and is delivered as
20 x 3Gy = 60Gy.

However, other tissues such as lymph nodes don't handle 3Gy doses very well, so if they're including the lymph nodes, they go back to using 37 x 2Gy.

Edited by member 14 Nov 2022 at 22:29  | Reason: Not specified

User
Posted 14 Nov 2022 at 22:48
Sorry if this is a stupid question but not knowing how these things work, can they treat the prostate with 3Gy but the lymph nodes with 2Gy?
User
Posted 14 Nov 2022 at 22:51

I suspect their planning software could do this, but you'd still need 37 doses, so it wouldn't help with anything.

User
Posted 15 Nov 2022 at 07:54

Originally Posted by: Online Community Member

However i didn’t realise that RT is a one time only so assume if it had spread undetected it would mean HT for the rest of my life? Yuck! 
I think my decision has now been made thanks to the help from this forum.

RT is "one time only" to the same place.

If you don't treat lymph nodes first time you can go back and treat them later. The problem is this is not as effective.

User
Posted 15 Nov 2022 at 13:08

Adding further treatment is not just about previous doses to that target, but also previous doses to the paths the radiotherapy will take though the body, and that can be difficult if it's near somewhere else which has already been treated.

 
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