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How long between IMRT and brachytherapy boost?
My treatment plan called for an LDR brachytherapy "boost" followed by 5 weeks of IMRT. I realize this is the reverse of the usual order but that's how my RO planned it out so that's what we did.
I waited 7 weeks before starting the IMRT thinking the side effects from the brachy would have subsided by then but that was not the case. I still was suffering painful and frequent urination sometimes 2 or 3 times in an hour. Things were just starting to improve when I started the IMRT. After 4 days of IMRT I was in terrible shape and called the doctor to tell him I was suspending further therapy until
I could regain control and quality of my life. We agreed I'd take a week off and we'd talk again tomorrow.
The R-O is concerned that a longer break between the brachy and IMRT could hurt my chances for a cure. He would like to see me start again tomorrow. I'm thinking of starting again in January or even February if that's what it takes for me to regain quality of life before resuming treatment.
This raises the question: What IS an acceptable amount of time between the two therapies? Is there a rule of thumb for this?
I had the brachy back on Oct. 2. I'm a Gleason 4+3 with no metastases but a Decipher score of .96.
Thanks.
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I can't answer that question specifically. but the time limit between the debulking surgery for the metastasis on my spine and post-op SBRT radiation was a bit over a month — I suspect that's how long before there was a risk of any remaining cancer cells consolidating and the lesion growing back — but I'm just guessing. It could be an entirely different time window with your treatments.
They said I could wait up to a year on Firmagon and Erleada before getting the high dose of SBRT for the prostate itself, but I elected to do it sooner (after 6 months) because at the time COVID outbreaks were still sometimes causing hospitals to suspend outpatient services, and leaving it too long didn't seem wise
First off, my sympathies. The combination therapy is a bit of a barrage to the prostate. I believe that boost first then IMRT is fairly standard. However, I have also found reference that the sequence doesn't seem to matter. I had LDR brachytherapy with Palladium seeds on October 3 and started IMRT four weeks later. That was the preference of my RO. The last of my 25 treatments is tomorrow. I'm also on six months of Orgovyx.
I have had some days that were better than others. Some with more frequent urination, some with more bowel symptoms, hemorrhoids, many nights with little or no sleep as a result. Ibuprofen has helped with the prostate inflammation, phenazopyridine not so much. I take Tamsulosin twice daily but am not sure if it is necessary (I'll reduce the dose once radiation concludes).
When you were first diagnosed, where did they find the cancer? Had It spread outside the prostate at all? Your Gleason score isn’t too bad But the decipher score says do something soon or it could come back. Five weeks of IMRT would seem to imply they are worried about spread outside the prostate. Did they mention intraductal or cribriform was found in your biopsy results?
I didn’t have IMRT until 3 1/2 years after my prostatectomy, Because my PSA started rising, and that was most likely caused by something growing outside the prostate area.
Holding off treatment could reduce your overall survival. You could probably live many years, even without the treatment right away, But, how many years depends on getting treatment early.
Your Side effects sound really hard to deal with. I would suggest you ask for a palliative care physician to help you with reducing the side effects so that you can continue back on the IMRT.
Thanks for the response.
"First off, my sympathies. The combination therapy is a bit of a barrage to the prostate. I believe that boost first then IMRT is fairly standard. However, I have also found reference that the sequence doesn't seem to matter. I had LDR brachytherapy with Palladium seeds on October 3 and started IMRT four weeks later. That was the preference of my RO. The last of my 25 treatments is tomorrow. I'm also on six months of Orgovyx.
I have had some days that were better than others. Some with more frequent urination, some with more bowel symptoms, hemorrhoids, many nights with little or no sleep as a result. Ibuprofen has helped with the prostate inflammation, phenazopyridine not so much. I take Tamsulosin twice daily but am not sure if it is necessary (I'll reduce the dose once radiation concludes)."
Congratulations on finishing your radiation therapy!! Did you get to ring the bell?
Did your side effects "stack up" when you began the IMRT? That is, were you still suffering the side effects from the brachytherapy when you began the IMRT? Those sleepless nights were/are the worst!
"When you were first diagnosed, where did they find the cancer? Had It spread outside the prostate at all? Your Gleason score isn’t too bad But the decipher score says do something soon or it could come back. Five weeks of IMRT would seem to imply they are worried about spread outside the prostate. Did they mention intraductal or cribriform was found in your biopsy results?
I didn’t have IMRT until 3 1/2 years after my prostatectomy, Because my PSA started rising, and that was most likely caused by something growing outside the prostate area.
Holding off treatment could reduce your overall survival. You could probably live many years, even without the treatment right away, But, how many years depends on getting treatment early.
Your Side effects sound really hard to deal with. I would suggest you ask for a palliative care physician to help you with reducing the side effects so that you can continue back on the IMRT."
My cancer was discovered via yearly PSA tests. A PSMA/PET scan shows no cancer outside of the prostate. The path report has no mention of intraductal or cribifom cells.
Hi Mario, did I ring the bell? You bet, got lots of hugs from the radiology crew too. Just completing the process is a relief psychologically. I'm hoping that the bowel and urinary side effects will subside over the next several weeks.
Regarding the "stacking" I'd have to say yes, there likely was an additive effect due to overlap of the radiation therapies. First off, there's the direct inflammatory effect from the prostate getting "poked" during the implant. Then too, the seeds are giving off radiation. The half life of Palladium seeds is 17 days, so, by the time I started IMRT over 50% of the radiation dose had been emitted by the seeds. But as you can see, there's still an overlap of the two forms of radiation and hence, to answer your question, an additive effect.
I've never been a good sleeper, so the frequent nocturnal trips to the bathroom haven't helped. Surprisingly, over the past week, I've had a couple of nights where I was able to go 5 plus hours without waking and making the trip. So, I'd have to say that things have improved on that front. For me, 5 hours of sleep is a world event. Given my history, I don't anticipate the sleep thing improving significantly, just a consistent reduction of nightly urinary frequency.
Did you get to visit with your RO?
I had the boost nid-March and started 5 weeks of external beam radiation about 3 weeks later. Good luck!
Good to hear that you have finished the IMRT. For your particular case, that probably was important.
If you decipher score had been lower, I suspect they would’ve not done the IMRT right away. With your Relatively low Gleason score normally they would’ve only done the brachytherapy, And maybe put you on ADT for six months. But that decipher score implies recurrence so they want to try to prevent that from happening with IMRT. Your doctor was probably right, it gave you a chance of Long overall survival.
Wish you the best of luck in the future