Any trials showing long term side effects of 20 day IMRT vs 38 day?

I had about 38 sessions and had no side effects at all. Six years later, I started to have an incontinence, but I had had a prostatectomy 3.5 years before the radiation so who knows what caused the incontinence. I had none after the surgery.

The 20 day treatment with higher radiation is more risky but it usually results in only short term urinary and bowel issues like diarrhea. They usually go away pretty quickly. I know one guy that had His short-term radiation switched to only four days a week, so he had the weekend to recover, and that worked well for him.

The thing is no two people are the same and some get much worse, long-term side effects.

@jeffmarc
Thank you Jeff - I'm glad you had six years trouble-free. Yes, everyone is so different - and everyone is different.

Maybe the Prostox test would be useful.

@klein505
Yes, Prostox test is useful for urinary side effects but does not apply to all side effects that are possible with RT. I do not have any links at hand, but it is kind of standard school of thought that less RT with more sessions gives less side effects. There is really no reason to go with short and aggressive program other than convenience OR if the patient has physical limitations and needs to be done with treatments faster.

The difference however is in single digits %, as far as I remember but if one has a concern and would like to be on a safer side, than it is better to stick with longer RT. HOWEVER, the most important part is to have RT done with skilled team and RO is just a part of a team. Every plan goes through 3 sets of hands. RO, machine operators and team of physicists before it is finalized. And, one can argue that even type of machine has an effect on a precision.

Hope this was of some help .

Hi Surf,

You are right - the technicians are as important as the RO! How do you find such a team - the RO, the machine operators, the physicists - is the only way to go to an NCI designated "center of excellence" ??

There are not a lot of reviews on Trustpilot for this!!!

As per which machine, I wanted one with real-time imaging; but all the MRI-linac machines seem to be used for 5 session SBRT _ not applicable for us, post RP.

I found this trial, but it is only 161 patients. The HYPORT trial, long long term follow-up, 8-13 years.
https://www.sciencedirect.com/science/article/abs/pii/S0360301625003621

@klein505
Ahhhh, dear K.
I wish I know the answer, and to be honest I found a lot of faults so far in the cancer center that we are "attending " 😩. For that reason I was somewhat relieved that there are actually 3 tiers of control here and also that during our "second opinion" at a different major center the "big star RO" told us that our RO is VERY good and that he knows him and has high opinion of him. Well, we shell see, I guess ... *sigh

Yes, MRI machine is more precise but again it all depends of an operator and the planning. I tried to make Mr. Surf call Stanford (which has that machine and as far as I know it is used for salvage RT too) but he called only once, did not go through, was annoyed with desk person at general scheduling (not even RT department) and did not call again *eyeroll. He is in general somehow very attached to this hospital by invisible "cord" lol, and I just have to choose my battles at this point 😑 ... It is a high time for RT, his RO got a good review by "big name" and 5 stars from hundreds of patients (on Yelp and on their website). I thought well, they probably leave only 5 stars for people to see, but I was wrong. I looked into even bigger name there and he had less 5 stars than our young RO. Go figure ...

I know that I did not say anything wise here 😞, I just shared our experience of how we ended up with our RO. Yes, I read reviews and made sure that we get second opinion and we asked of how plan is actually done etc. , we talked with 2 ROs at this same hospital and the "chosen one" was chosen due to really great "bed side manners", patience and of course amazing education and training with unique field of research AND because he ordered every possible test we asked for - no questions asked while the other one there dismissed some as unnecessary. All else is written in the stars , I guess ...
How one chooses - great question indeed *sigh ... Once you check credentials, reviews and find couple of really good ones it is honestly very subjective choice at the end. Same as with any other PC treatment . 🙃

@klein505
Actually, I had my prostatectomy 16 years ago. 3.5 years later My PSA started rising, so I had the salvage radiation. Add three more reoccurrences since then because I have BRCA2.

Orgovyx and Nubeqa I’ve kept me undetectable for the last 32 months.

Six years after the incontinent started, I had an AUS put in and I am completely continent now.

There are solutions for the side effects.

The primary reason for hypofractionation (20 to 28 fractions vs. 35+ fractions) is to lower costs for the insurance company, and free up resources in national health plans (Medicaid in US, NHS in UK etc.) with more efficient treatment. Unless you have classic Medicare without a supplement it usually does not change the out-of-pocket cost for the patient so main patient benefit is connivence due to reduced sessions. Studies have shown fewer sessions at higher Gys to be "non-inferior" so not better. The 20 sessions will cost insurer/Medicare at least 35% less than the 38 sessions. Many patients are forced into fewer sessions by their insurance (including Medicare Advantage) refusing to cover a higher number of sessions (although most cover at least 30).

We all can react differently to radiation. I did 25 sessions and had horrible side effects that eventually required being scoped and cauterized for heavy rectal period like bleeding. Virtually complete loss of bowel control. Also had Bowel Radiation Enteritis that required 3 months of daily medicated enemas. Ya won't know until you go through it. As you can see some of us had serious issues and some didn't. I've read that I fell into the 15-25% category. The good news is there are treatments for it.

@klein505 I had the 25 session IMRT at Sloan Kettering on Long Island.
The trial (which took place about a year or so beforehand), showed an increase in both bladder and intestinal SE’s short term, but EQUAL SE’s at 6 months.
I had ZERO bladder issues and some diarrhea for about 10 days at the very end of the treatment.
Now 20 treatments is going to add more radiation to each treatment session so there almost has to be an increase in SE’s for many (but not all) men.
The targeting software and the machines themselves are always getting better and they can actually ‘shape’ the beam to spare delicate tissue, so I would imagine that this becomes very do-able.
But the one crucial thing I’ve seen, heard and read is that we are all different; what kills one person makes another stronger and every level between those two extremes are possible.
Best of luck on your outcome,
Phil