44 sessions of EBRT

@jim18
Exactly 👍. It is not about number of sessions but total number of Gys.

Also, if SBRT is used , than it has different effect on tissue. Much higher energy is used during every session and than even lower number of Gys have the same effect as the higher number of Gys. I naively thought that getting 35 Gys in 5 SBRT is better since it is lower total amount of radiation but it is NOT the case ! It gives the same amount of damage as, lets say, 64 Gys administered over 7 week period. 😵‍💫

All in all, really fascinating field !

I had40 sessions of pelvic IMRT @ 2gy per session for a total of 80gy. Was told by my RO that in my case I was less likely to have long term side effects when administered over a longer time frame. Even though they routinely did SBRT at this center of excellence she didn't think I was a good candidate. Perhaps also that I had a prior focal treatment was a factor as well? Anyhow, It certainly helps if you can have regular bowel movement prior to your trip to the radiation center. I had no issue with this. A healthy diet with enough fiber helps, but not so much that you have a lot of gas. The radiation techs did have a sense of humor. I asked what if I have to pass gas during the procedure. She replied "let it rip" Lols! My struggles started after the first couple weeks. I was having trouble holding my urine after drinking the prescribed amount. The few minutes of treatment seemed like an eternity. I had to have them stop the machine a couple times to jump off and pee. Even after I finished my session and relieved myself, I couldn't make a half hour ride home without peeing again. The urgency was intense. A common side effect of the treatment according to the RO. I ended up taking an old towel and an empty wide mouth half gallon juice bottle just in case you need to pull off the road and relieve yourself. That saved me from wetting myself on a couple occasions. I know all this stuff you're reading can stress you out, but once you get in the routine it's no big deal. It did sorta seem like a job. You just need to be there on time and hydrated properly. They can see if your bladder full and rectum is empty. So they won't radiate you if that's not the case. All said and done after a few months of dealing with urgency and getting up a few times at night to pee things have returned to almost normal after a year. Hang in there!

@diverjer
Actually both IMRT and SBRT are specific, advanced techniques used to deliver EBRT. If you were told you’re having EBRT, you need to ask what type of EBRT.

@jeffmarc
Thanks, so Russell must be getting IMRT with 44 sessions as I think SBRT is fewer sessions with more grays per sessions.

@diverjer
SBRT To the prostate is usually five sessions So it sounds like you have figured it out.

@jeffmarc All SBRT is 5 sessions or less at least in USA. CMS and insurance will pay for 5 SBRT sessions; any more are reimbursed at IMRT rates which are less than 50% of SBRT. So financial vs. medical constraint.

I would suggest a prescription for Oxybutynin for bladder urgency before you start treatment. I had it bad and blew up on the table twice in one day. I had to demand treatment as RO didn't want to do anything outside of writing a plan. All my RAD Techs were burnouts except 2. Started experiencing bowel bleeding near the end of treatment and ended up with rather serious Radiation Proctitis that plagued me for 14 months after radiation. Not all of us experience RP but good to be aware or it. I didn't see if this was salvage or your primary treatment. If still have your prostate I would suggest SpaceOre as a barrier to protect your rectum. ADT knocked me down and found the whole experience rather tedious. The good news is I have been undetectable for over a year now. Good luck and be prepared to advocate for yourself if something doesn't seem right.

(I had 28 sessions of proton radiation during April-May 2021.)

My bladder being “full” was just 18oz of water to drink 30 minutes prior to each treatment. So, I emptied my bladder 45 minutes prior to treatment time, started the 40 minute drive to the radiation center, 10 minutes into the drive drank 18oz of water, arrived at the treatment center 30 minutes later, and had the treatments.

The bowels being “empty” didn’t mean it had to be clean like it is for a transrectal biopsy. What my radiation oncologist told me was what they really mean is nothing in the lower intestine, material or gas, that might move during the radiation treatment and cause the prostate to move. (So, no gassy foods that might cause issues.) So at the same time as emptying my bladder 45 minutes prior to treatment (mentioned above), I would also empty bowels.

The full bladder/empty bowel routine was easy to manage. In the weeks leading up to my radiation treatments, I practiced every day. By the time of my first treatment, I had the routine down to a ritual; it worked like clockwork every time and never caused a problem.

Figure out what works for you and stick to it.

I thought this would be interesting, but after reading I am not sure the study would convince me to ask for higher doses. If you read it be sure to also read the "accompanying editorial cautionary notes" link in the article. https://www.medscape.com/viewarticle/can-80-gy-radiation-boost-survival-patients-prostate-cancer-2026a1000w48
https://www.medscape.com/viewarticle/metabolic-issues-show-early-and-often-arpi-therapy-2026a1000rzg

@jeffmarc
I think I had that figured out then through my PA pal I find out about Hypofractionated Radiotherapy (HFRT) and how it comes with a higher risk for late gastrointestinal (GI) toxicity. Seems the lower dose over longer period of time is safer? But seems ADT helps, but has more side affects like cardiometabolic risk.