Radiation Oncology meeting: What questions should we ask?

I assume with 28 sessions, your husband will get the moderate-hypofractionation treatment. My husband had 25 sessions and completed it in mid May. At the first appointment, I asked several questions including these following;
1. Are the sessions traditional radiation therapy or moderate-hypofractionation radiation therapy (higher dose but less time)?
2. What locations will be treated? And what are the dosage (GY) use at each location?
3. What machine will be used? and why they use this specific machine with my husband? I needed to know then so that I could look up the pros and the cons. In my husband case, they used Elekta with Monaco treatment planning system. The three centers we went for consultation have combination of Elekta Synergy, Elekta Versa HD, Elekta Unity (MRI-guided), Varian Trubeam, and Siemen Ethos (similar to the LINAC but not using MRI).
4. Do they have "in-house" physicists?
5. Will my husband need to be on strict diets? Ask for recommendations. Some RO do but some don't.
6. Will my husband need to do the protocol "empty bowel, full bladder"? If he does, will he be allowed to use enema on the treatment day.
7. I asked them to explain clearly how the planning day will be like and specifically asked them for the protocol before we coming in.
8. In case of emergency or sudden side-effect symptoms, who should we contact?
9. Will bloodwork be done half-way through and at the end of the treatments?
10. What are the possible side effects that you should be aware of?
11. What is the plan for post-radiation?

Depending on how large is the treatment area, the MRI guided radiation therapy machine (Elekta Linac) may not be good options. In my husband's case, he was not a candidate for both Elekta Unity (MRI-guided) and Siemen Ethos (similar to Linac but not MRI) because his treatment area was vast and needed shorter time to avoid his movement. Both Elekta Unity and Siemen Ethos required longer time for his treatments (20-35 minutes of laying still per session) whereas the VMAT system only took (less than 10 minutes of laying still per session). Two centers decided to offer the treatments with either Elekta Versa or Elekta Synergy (both with Monaco treatment planning system) that could use VMAT system to do the job mainly because my husband needed Simultaneous Integrated Boost (SIB) to one PSMA-positive lymph node. Another one center offered SBRT which was not approved by our insurance due to my husband's biological history. My husband got 25 sessions of the moderate-hypofractionation to his prostate bed and whole pelvic lymph nodes, plus the SIB to prostate bed and the one PSMA-positive lymph node.

@prettypass2000 thank you for responding to my query. This info is most helpful. We do know ahead of time that he will have the minimum of 28 sessions. His doctor said the 5 day, higher dose radiation would not be optimal for my hubby.

There are reasons that centers of excellence such as Cornell Weill, MD Anderson, John Hopkins, and others are choosing an Mri based Radiation machine. The margins of exposure of healthy tissue is less, and therefore the side effects are less. It is worth asking your doctor whether you can have that type of machine and whether it is available. The two machines are the Mridian and the Elekta Unity. What they can see, they can treat. You might also want to consider a quick, second opinion via telehealth with a center of excellence.

Doctors are dedicated and do their best, but hospital institutions are competitive and make their choices accordingly and sometimes the in house machines are not the best choice for that particular patient. Outcomes may be the same, but side effects can vary significantly for a number of reasons, including the type of machine.

@jeffmarc I've experienced no burning on urination. The flow was worse for a few days after the treatment, now (at almost 3 weeks) it is usually a bit better. My nocturia seems to be heading towards twice a night as opposed to every hour immediately after the 20 sessions. Food is almost tasting as it used to taste at this point. I forced myself to eat during the worst period and weighed myself every day. I did try eating more often with smaller amounts. I kept going into food stores dreaming that I'd find something I'd like to eat. I bought a lot of different things that didn't work out. I lost 5 pounds very fast, but I've gained 3 lbs back and stabilized now.

I'm not sure all my problems are due to the radiation treatment. At various times in my life I've run myself down during somewhat manic periods, without really noticing, until suddenly I've crashed for weeks.

I think part of this crash after the external beam 20 session treatments is due to the accumulated many months of the stress of the diagnosis, deciding on a treatment, getting the HDR, moving to Seattle for a month to get the external beam, going through ADT, etc.

I felt almost normal right up to treatment 17 when I returned home for a 3 day weekend. I slept the whole weekend it seemed. I pulled myself together and didn't feel that bad until right after the treatments were done. Then - crash.

@climateguy I am so sorry you are going through this. PCa is hideous.
Did you have a rectal spacer placed?
Hubby is scheduled for it on Sept. 17th.
Hopefully, it will help alleviate a lot of the issues associated with radiation.

@climateguy
It’s real good to hear your symptoms are starting to go away.

Maybe it was partly stress that you were finally released from after having treatment.

Those urinary issues are a real pain, Seems like everybody gets something these days, At least getting up twice at night isn’t too oppressive. You could get one of those bottles designed for peeing into that would eliminate needing to get up. When I had my knee replaced, I used one because it was just too painful to get up for the first week or two. I kept two of those bottles next to the bed in case I had to go too much. I would even use them during the day, Getting a knee replaced can be really difficult for the first couple of weeks