1. < Prostate Cancer

Questions about radiation for prostate cancer: Can I drive myself?

Posted by paulcalif @paulcalif, Jan 31, 2024

Question to you who have been through radiation treatment for prostate cancer or have knowledge of the proceedure.
I'm considering some type of radiation treatment for my cancer. My main question is, will I be able to drive myself to and from?

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toolbelt | @toolbelt | Feb 11, 2024
In reply to @paulcalif "Thank you for the study info. I looked it up. Looks like ADT plus RT for..." + (show)
@paulcalif

Thank you for the study info. I looked it up. Looks like ADT plus RT for older intermediate risk patients may not be necessary as opposed to RT alone.

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The qualifier here is favorable vs unfavorable intermediate. I was 4+3 with a Decipher of .84 which made me unfavorable and tripped ADT for 6 months with Orgovyx.

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1 reply
paulcalif | @paulcalif | Feb 11, 2024
In reply to @mikewo "Look up the study "Radiotherapy with or without androgen deprivation therapy in intermediate risk prostate cancer"...." + (show)
@mikewo

Look up the study "Radiotherapy with or without androgen deprivation therapy in intermediate risk prostate cancer". It says that it makes no difference in patients over 70 as Jim is.

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Thank you for the study info. I looked it up. Looks like ADT plus RT for older intermediate risk patients may not be necessary as opposed to RT alone.

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2 replies
toolbelt | @toolbelt | Feb 11, 2024
In reply to @mdamato "@paulcalif, I’m about to start a very similar therapy. As was already said, reading about our..." + (show)
@mdamato

@paulcalif, I’m about to start a very similar therapy. As was already said, reading about our experiences gives me much encouragement to face the treatments ahead. One question, I’m also having a SpaceOAR installed to protect the rectum, but I haven’t heard about “Urethral steering.” What the heck is that? Also, for the original questioner, my RO told me I should be able to make the daily, 75 minute drives on my own. I live on an island north of Seattle and there are few options for obtaining IGRT.

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My SBRT was 5 fractions of 7.25 GU per fraction (36.25 total to entire prostate and proximal seminal vesicles) with a boost to the tumor to a total of 40GU. This focal boost SBRT treatment plan is fairly new having been implemented within the last 3-4 years.

When I had my MRI taken 7 days after my Barrigel rectal spacer placed my RO ordered very thin image "slices" taken. I think the image was sliced every 1mm. This enabled him to visualize my urethra as it passed through my prostate. He then fused my CT, MRI and PSMA PET and was able to visualize the tumor's position with respect to the urethra. Having that positioned they can either do urethral sparing ( lower radiation dose to the urethra) or urethral steering where they ensure no area of the urethra receives a "hot-spot" dosage that would exceed the whole gland dosage. When they treatment plan the radiation they put a bullseye on the tumor, and then have concentric isotonic rings representing the specific dose in each ring. With the prostate being the size of a walnut those "rings", are small. Any overlap would cause a higher dose in that area. Using the "steering" they make sure the urethra receives the whole gland dose of 36.25, but no more. Urethral sparing lowers the dosage to the urethra below the whole gland amount and may lead to less than optimal results if any cancer cells approximate or invade the urethra.

Steering within SBRT is fairly new, here is a paper from September 2023.
https://link.springer.com/article/10.1007/s00345-023-04579-6#Sec8
Please let me know if you have any additional questions.

Stay Strong Brother!

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jc76 | @jc76 | Feb 11, 2024
In reply to @marlow2 "Thank you for all the info. He had a regular PET Scan & I suppose that..." + (show)
@marlow2

Thank you for all the info. He had a regular PET Scan & I suppose that is not the same or is it?

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@marlow2 Yes they are the same. I was asked to do a PET scan at UFPTI. I had it done showed no spread of cancer. Then I kept reading on MCC about PSMA and I was confused is it different or same.

So I asked my oncologist/radiologist and he said it is the same. One thing I see everyone comments on is the extensive use of abbreviations when dealing with prostrate cancer, tests, and treatments. When I first came on MCC I was completely confused about all the abbreviations.

The monitor (Collen) did a great post citing most of the abbreviations and what they meant. If we did list the entere spelling of these the post would be twice as long. I am very guilty of doing long posts as my fingers show how fast my brain is thinking and don't even know they are that long until I see them on MCC.

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mdamato | @mdamato | Feb 11, 2024
In reply to @toolbelt "Absolutely. I was 4+3=7 in one core, 3+3 in one other, with a Decipher of .84...." + (show)
@toolbelt

Absolutely. I was 4+3=7 in one core, 3+3 in one other, with a Decipher of .84. Dr gave me 5 fraction of 7.25 grays with a boost to 40 gray at the primary lesion. Also used urethral steering to minimize radiation "hot spots" to the urethra to minimize GU side effects. Had a Barrigel spacer placed. I am on Orgovyx for 6 months. Last SBRT was Dec 28. I am essentially normal with a couple nightly moderate hot flashes. Currently on the second week of a SCUBA trip off Honduras......I am a lucky, appreciative guy. Any questions please let me know.
Stay Strong Brother

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@paulcalif, I’m about to start a very similar therapy. As was already said, reading about our experiences gives me much encouragement to face the treatments ahead. One question, I’m also having a SpaceOAR installed to protect the rectum, but I haven’t heard about “Urethral steering.” What the heck is that? Also, for the original questioner, my RO told me I should be able to make the daily, 75 minute drives on my own. I live on an island north of Seattle and there are few options for obtaining IGRT.

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1 reply
mikewo | @mikewo | Feb 10, 2024
In reply to @marlow2 "Jim is scheduled for the pacer surgery on 3-14-24. Then on 3-15-24, he will have the..." + (show)
@marlow2

Jim is scheduled for the pacer surgery on 3-14-24. Then on 3-15-24, he will have the CT and MRI scans. As of yesterday, he has decided not to do the 18 months of hormone therapy that was suggested by the doctor in radiology. He thinks that Eligard and all the other hormone injections cause too many side effects. Has anyone had the Proton Beam therapy without Hormone injections & how did they do?

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Look up the study "Radiotherapy with or without androgen deprivation therapy in intermediate risk prostate cancer". It says that it makes no difference in patients over 70 as Jim is.

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1 reply
mikewo | @mikewo | Feb 10, 2024
In reply to @marlow2 "Dr. Frendle is also Jim's surgeon for the Spacer. He also did his biopsy." + (show)
@marlow2

Dr. Frendle is also Jim's surgeon for the Spacer. He also did his biopsy.

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He also did my biopsy. He did piss me off a little because even after I did a 30 core transperineally biopsy with a local and didn't flinch once he still insisted on knocking me out for the Space Oar and marker insertion. I am someone who does my colonoscopy with no sedation at all. I like watching and seeing what is going on.

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marlow2 | @marlow2 | Feb 10, 2024
In reply to @bandit11 "Had proton therapy two years ago without hormone therapy after diagnosis of (4+3). Had Decipher test..." + (show)
@bandit11

Had proton therapy two years ago without hormone therapy after diagnosis of (4+3). Had Decipher test and PSMA pet scan before declining such. Last PSA level was 1.1; looks good so far😄.

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I sure hope you continue to do as well as you are doing. Thanks for the information.

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marlow2 | @marlow2 | Feb 10, 2024
In reply to @jc76 "@marlow2 One question. Did Jim have the Decipher test done? If so he should have that..." + (show)
@jc76

@marlow2
One question. Did Jim have the Decipher test done? If so he should have that done before making any decisions on treatment and hormone drugs.

I was classified as intermediate based on my biopsies and May oncologist/radiolgist stated radiation and hormone treatments but (thank God) mentioned doing a Decipher test. I had that test and came back low risk not intermediate which does not have a recommendation for hormone treatments just curative radiation (words of my radiologist/oncologist).

So I had 30 rounds of proton radiation at UFPTI as May Jacksonville does not have proton radiation to treat prostrate cancer only photon. UFPTI radiologist/oncologist did not recommend hormone treatment either.

I have heard very sad stories of those takign hormone treatments and some that tolerate them quite well. But for me I did not want them and was glad that the Decipher test showed was not needed.

If you have not been told the hormone treatments are to starve the cancer cells of totosterone and keep from growing. Asked your oncologist/radiologist about the Decipher test. FYI, I had very little side affects from 30 rounds of proton radiation at UFPTI.

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Thank you for all the info. He had a regular PET Scan & I suppose that is not the same or is it?

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1 reply
bandit11 | @bandit11 | Feb 10, 2024
In reply to @marlow2 "Thank you so much for your encouraging words. Jim seems to be OK with the spacer..." + (show)
@marlow2

Thank you so much for your encouraging words. Jim seems to be OK with the spacer surgery. What he does not want to do is to have Hormone Therapy. They suggested Eligard however he checked all the hormones that they use and it scares him that they can cause a stroke or a heart attack. Has anyone had the proton beam therapy without hormone therapy?

From: Mayo Clinic Connect
Sent: Friday, February 9, 2024 5:22 AM
To: marlow2@cox.net
Subject: @bens1 posted a new reply to your comment "We saw the radiologist at Mayo this morning. My husband is set up for a urological..."

## reply above this line ##

Mayo Clinic Connect

Reply by @bens1 to a comment you posted on discussion "Questions about radiation treatment for prostate cancer"

Excerpt of your comment
We saw the radiologist at Mayo this morning. My husband is set up for a urological...

Their reply
I had spaceoar inserted a week or so before my radiation. That was in December 2022. If I had to do it again today, I might try BioProtect instead but the spacer makes a difference in protecting healthy tissue. I was knocked out and had a spaceoar technician in the procedure room along with an anesthesiologist and my RO. I did not feel anything afterwards not even the full feeling some have afterwards.

Jump to this post

Had proton therapy two years ago without hormone therapy after diagnosis of (4+3). Had Decipher test and PSMA pet scan before declining such. Last PSA level was 1.1; looks good so far😄.

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