Connect
First Session of Radiation Called Off While on Radiation Table
Hello,
My husband has Gleason 9, cribriform prostate cancer, with PTEN-loss, which appears contained in the prostate based on scans. The cancer is diffused with no specific tumor, but cancer cells are throughout the prostate. He’s been on ADT (Orgovyx and Nubequ) for two months and yesterday’s labs show PSA of .05 and testosterone under 10. He plans to take ADT for 18 months to two years.
He started his radiation yesterday – or should have. Once he was on the radiation table, they told him his bladder was too full, so he let some out. Then they made him adjust body parts. Later, the doctor came in and said his anatomy had changed since the planning (which was on May 19, so not long ago) and they could not do radiation until they “tweaked” things. He left without getting treatment, and we drove 3.5 hours home. I asked him what the next steps were, and, of course, he had no idea because he didn’t ask questions (other than they mentioned he may have been gassy when they did the planning:). I was not present for any of this and wonder how two weeks after fiducial markers, a rectal spacer, and radiation planning were done, his anatomy changed enough that radiation was not possible.
The following notes were added by the radiation oncologist two days ago - the day before my husband’s first radiation treatment:
Procedure: simulated supine. Serial axial CT images are obtained of the abdomen and pelvis for treatment planning. Fiducial markers and rectal spacer are present. The bladder is sufficiently full and the rectum sufficiently empty. I have personally reviewed and approved the images for treatment planning.
I reviewed the simulation images. On each axial image, I contoured critical normal structures, including the rectum, bladder, penile bulb and femoral heads. I also contoured the prostate (CTV). A customized PTV1 was then developed to cover CTV1 with a margin of 3-5 mm to allow for daily setup variation and organ motion.
Normal tissue constraints and PTV coverage requirements have been specified on the constraint sheet.
Has anyone experienced this? Do they need to do all the planning again? Should we worry about incompetence? We are at Duke. Thanks for any insight!
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
Duke is a NCCN / NCI cancer center. Sounds like an extremely competent team. IMO it's a sign that the RO recognized a problem and refused to proceed so as not to harm uninvolved structures. You'll either, get a call to reschedule treatment if they were able to correct images while he was there or you'll get a call to schedule a new simulation if they couldn't.
-
Like -
Helpful -
Hug
7 Reactions@mjp0512 I agree that the postponement is not necessarily a sign of incompetence. The person in charge of the actual radiation treatment that day may have noticed something that made him or her feel it was unsafe to proceed. Since your husband didn't ask questions, if you don't hear from them first, call to ask for more explanation and to reschedule treatment. You might also want to call or message the radiation oncologist directly to ask the reason for the postponement.
-
Like -
Helpful -
Hug
5 ReactionsHi Scary1,
I was diagnosed with Gleason 9 with ECE and cribriform in 2021 and was treated at UW/Fred Hutch which is a NCI and NCCN designated institution. Several weeks into proton therapy and following a CT assessment, my subsequent treatment sessions were postponed to allow for the plan to be adjusted beyond what could be accomplished by the software which facilitates minute daily adjustments. In addition to movement of vital organs on an ongoing basis, neoadjuvant ADT (with or without an ARPI) can result in changes in the prostate or tumor within the prostate , including over the short period of time between simulation and treatment, that can result in vital organs receiving higher or the tumor lower than the desired dose of radiation. I viewed the delay to rework the plan as competance and concern for the longterm outcome of my therapy. The application of ongoing advances in technology and the results of the latest studies on adaptive radiation therapy should help you achieve the best possible outcome from your treatment.
I continue to do well with no residual side effects to date and a current PSA of .07. I wish for your journey with PCa to be both effective and uneventful!
Bill
-
Like -
Helpful -
Hug
9 ReactionsBe glad that they stopped and noticed there were major differences. It probably shouldn’t take too long to get him back on the table.
If he has the PTEN genetic Problem there is a new treatment.
Capitello produces FDA results
This year and last, Astra Zeneca spent a lot of money at GU ASCO advertising its PTEN mutation solution, capivasertib (Truqap). It's a drug the FDA has already approved to target PTEN mutations in breast cancer.
Yesterday the FDA's ODAC (Oncology Drugs Advisory committee) voted to advance capi for prostate cancer in conjunction with abiraterone + prednisone, based on the Capitello trial. This is initially for men with metastatic disease carrying a PTEN mutation. PTEN is one of the 3 Bad Boy Tumor Suppressor Growth mutations, along with TP53 and RB1.
Here's what its maker, Astra Zeneca had to say. Two AnCan Advisory Board GU med oncs strongly favor capi, Drs. Efastathiou and George. In fact Dr. George gave evidence at the ODAC hearing.
-
Like -
Helpful -
Hug
10 Reactions@dailyeffort
Hi Bill,
Thanks so much for writing. I read your post to my husband, and I think it gave him extra hope. Since he is also going to take ADT (Orgovyx and Nubeqa) for two years per the oncologist's recommendation, he wanted me to ask what your testosterone has done since you stopped the ADT. Has it returned to near-normal levels?
My husband is receiving the five blasts of SBRT, which is a bit controversial based on his aggressive cancer, but it's reassuring that your side effects are minimal!
-
Like -
Helpful -
Hug
1 Reaction@jeffmarc
Thanks, Jeff, for the new PTEN treatment info. This is another line of attack if needed. Right now, my husband is only two months into ADT and his aggressive cancer is still considered contained in the prostate, although we know how sneaky it can be.
Yesterday, the Duke medical oncologist said no other scans are done to check on the cancer unless the PSA level begins to rise. (This was when I asked how they monitor the cancer over the next two years on ADT.) Is this standard - no scans unless PSA levels rise? Just an assumption that all is well based on PSA?
@mjp0512
Thank you for the reassurance. My spidey sense tells me the same, but the radiation oncologist is fresh out of school, so I needed to check!
@scary1
This is pretty standard. With the PSA undetectable is very unlikely to find any cancer.
Some doctors do a CT scan every three or six months and compare it to the previous one, Because even though somebody is undetectable a metastasis can grow.
I had a scan 4 months after completing radiation and with undetectable PSA - on Orgovyx and Xtandi. The areas that were zapped showed significant decline on the scan as did the two potential bone metastases that were not zapped. RO said they should continue to decline. Plan is to not scan again unless PSA rises. Just 9 more months, total two years, of the Orgovyx and Xtandi. My original diagnoses was Gleason 8 low volume.
During the CT Sim procedure, did they tell him exactly how much water to drink (ounces) exactly how long (minutes) ahead of the radiation session? Did he strictly adhere to that guidance? (Also, during the day, did he monitor his hydration so that he wouldn’t be “too full” at the start of the radiation session? And did he monitor his diet so that there wouldn’t be any gas in his colon?)
The same with the gassiness - he has to get that exactly right every time.
When I had my radiation treatments (April-May 2021; just a 40-minute drive each way), the quick CT scan they did immediately prior to the radiation session allowed them to “tweak” the plan in case there were any minor changes. (Now, with today’s technology, they can actually make treatment changes in real-time.)
From the first day to the last day of my treatments (28 sessions), I lost 11 lbs. I had asked my radiation oncologist prior to starting treatments if weight loss would be a problem?; he said no, unless the loss was significant. (I assume that 11 lbs isn’t considered “significant.”)
As for what next? If it were me, I would get with the medical team to understand: (1) what the issue is, (2) what the expectations are, and (3) what exactly has to be done to get there from here (and then repeat that each and every time).
Good luck!
-
Like -
Helpful -
Hug
1 Reaction