SBRT Side Effects

My brother had SBRT radiation to his prostate at 77. He had five sessions. The only problem he had was some proctitis Which he took Flomax to resolve. The problem lasted less than three months. They also put them on ADT and he had hot flashes from those. Went on for at over six months after It wore off because it took that long for his testosterone to return.

If they want you on ADT, tell them you want Orgovyx, testosterone returns much quicker with it. If you are going on ADT, there are side effects that you may notice. The shorter time you are on ADT the shorter time the side effects are a problem And the fewer problems you will have.

I had 5 sessions of SBRT 26 months ago at age 68. I too had, and continued a regular and fairly vigorous exercise program (typically 30 mins cardio, 15 minutes abs, 45 minutes on weight machines 5 days a week and walked 18 holes of golf the other 2 days. The days of treatment I did not go to the gym but would walk 3 miles after each session. During the treatment I had virtually no side effects. One month after treatment I went on a 2 week SCUBA trip to Honduras. I was also on Orgovyx for 6 months. Here is a summary of my experience. Executive summary is minor side effects after the fifth treatment that resolved in two weeks. Day Procedure Side Effect
1 First Treatment None
2
3
4
5
6
7 Second Treatment
8 reduced flow at night
9 Third Treatment Headache, medium fatigue evening
10
11
12
13 Fourth Treatment
14
15 Fifth Treatment Minimal fatigue
16 Pee 3 time at night, low flow, some urgency day time
17 Pee once at night
18 Minor hot flash at night, pee at 6am
19 GI urgency, some mucus (blood??), no Flomax at night, pee once. One doculax at night, some BM in am.
20 GI Urgency, some mucus, watery blood on toilet paper
21 GI Urgency/constipation. Burning on urination less.
22 This morning GI a little better, burning GU gone, pee 3 times last night.
23 Two "urgency" episodes that I did not need to act on last night. A little constipated this morning. Urination is fine.
24 Some constipation, watery blood on TP, mucus. Urination fine.
25 Urgency last night a couple times, once needed to get up and hit the can. Lots of gas…..This morning urgency ok, still a bit constipated (take that with a grain of salt as they used to set the Atomic Clock based on my "regularity". Urination fine.
26 Yesterday was best GI has felt since treatment ended. A little urgency and gas. Hopefully this will continue. Urination fine.
27 GI continues to improve, less urgency. Still some constipation.
28 Other than reduced diameter of stool and a little constipation GI is nearly normal. Urination continues at pre treatment levels (with Flomax)
29 Stools nearly back to normal, urgency gone, urination fine. No fatigue.
30 Pretty much back to normal

Stay Strong Brother, We Got This.

I finished 5 days of SBRT in late November. During the treatments I had no side effects. They started a couple of days later - diarrhea, frequent urination, fever that would spike to 100, loss of appetite. I started taking the probiotic Culturelle and eating more of the BRAT diet. After a week-10 days, the SEs started to diminish and in 2 weeks, I was fine. The fever worried me and I tested for flu and covid. The tests were negative.

You did not mention proton or photon. Not that it matters all that much. For me, 5 proton sbrt. I noticed slight twinge of pain after first treatment. After second treatment, there was no mistake that I had urinary discomfort. A call to the radiologist oncology nurse and they put me on Flowmax and AZO to relieve urinary pain. Third treatment intensified effects. Three days off treatment and I felt better. After fourth treatment urinary discomfort got worse. I asked about pausing treatments and they did not want to do so. By then I was on three Advils every eight hours, two Tylenols between the advil, Flowmax, and AZO. So I got blasted pretty good/bad.

After treatment the side effects peaked about a week-two weeks after last treatment. I gradually weened myself off of all drugs, but it took about two months to do so. I am now 3 months post treatment and on no drugs. Urinary capabilities continue to improve, not all the way back, but getting better.

Never had any bowel issues at all.

MAKE SURE that your team has inserted Space Oar or other spacing gel between rectum and prostate. Also with sbrt they usually place 3 or 4 carbon markers in prostate so that the machine can detect them and project the radiation on target. If your Center has not done these two things, request them or cancel treatment and find a Center that uses this technology. It is extremely important that this happens. With the high intensity of radiation over a short time, overspray will not be good.

For anyone wondering about the Space Oar and metal fudicial placement procedure you will probably be offered sedation and you won’t remember the procedure. You will get local anesthesia either way. I declined the Sedation and was awake the whole time. Did not feel much and got to talk to the Doc doing the work. I don’t like the Sedation drug as it wipes out my whole day. And makes the procedure longer with a recovery time. I was in and out in 45 minutes.

@dekestet
I had 3+4, 10.2 psa and 5 sessions of SBRT with the Mridian machine which has a built in MRI so the amount of exposed tissue was only using 2 mm margins around the prostate instead of 3-5 mm for other SBRT machines.

My symptoms were urination restriction after the 3rd treatment which Flomax took care of overnight. I did have spaceoar inserted a week or so before the treatment and no ADT. I did have urges to go more quickly for a few months thereafter and carried a pee bottle in my car for a while. Other than that, I really did not have any other issues.

@oldgreenpaint On point with the rectal spacer with Barrigel being another product. Also as to urinary side effects my RO was able to visualize my urethra on a CT, MRI and PSMA PET and used urethral contouring in the design of the radiation targeting to ensure my urethra did not receive any radiation hot spots.

@oldgreenpaint
You definitely seem to show that proton radiation is not 100% effective against hitting other organs and causing problems after treatment.

I know you didn’t expect that to happen, At least you were able to use a barrier to protect your rectum.

I had 5 treatments in January. The only side effect was fatigue for me. That lasted a month or so.

@jeffmarc Proton is not the panacea that many people think it is.

@oldgreenpaint Thanks for the quick reply and detailed info. I’m scheduled for space oar and 3 markers next week and plan to be fully awake. Can’t imagine it will be worse than the biopsy. Glad your effects are waning; your comments are appreciated and reassuring.