Radiation Sessions - 28 or 39

I'm also on blood thinners. I had 20 doses (total 60 gy) of SBRT with no rectal bleeding or discomfort, but everyone's experience is different.

I did have blood in my urine a year later because of some damage to my bladder (just "level one" cystitis, according to my treatment team)

@jcbagley
The information given to me by my R/Os at both Mayo and UFHPTI is that radiation will usually still get to and around colon as most R/Os will do margins. The Space/Oar is there to help move colon away from prostate radiation.

I was told the radiation will damage the very small blood vessels. After radiation will start healing by growing new blood vessels. They are very fragile though and things like constipation and straining can cause them to bleed. This is usually temporary as they grow stronger. Again, I am not a medical professional just passing on what was told to me by medical professionals. Some will have more problems and others none. I had minor bleeding that did go away.

You mentioned the high dose and low dose. According to my R/Os (two different medical institutions) both have almost identical success outcomes. What my Mayo PCP told me was that their research is showing now more side effects level of those getting the high dose limited number of treatments versus the low dose expanded number of treatments. I had 30 rounds of proton radiation.

It has to be a persona decision. And that includes your mental outlook. Some want to get the treatments over and getting them causes stress and anxiety, so they want to get a high dose and get over it. Some like me got low dose and 30-40 treatments preferring less chance of side effects if possible.

If I had a chance to do it over, I think I might have selected the high dose limited number of treatments. Why, not because I had any significant problems at all. It was simply hard driving 5 days a week to UFHPTI (45-minute drive) for 30 rounds. It took from May to July to finish because of the holidays.

Mayo Jacksonville did not offer proton radiation, just photons. I chose to have the proton again after research and consultations with 2 different medical facilities and then finally with my Mayo PCP where we decided as a team that proton low dose and thus the high number of treatments was the best for me at time.

I hope that helped. I did not have hormone treatments so cannot comment on that. I would solicit feedback from those who did get it to provide you others feedback on that.

Surprised you have a SpaceOar- thought they only used it in SBRT when they know that the tumor is only inside the gland.
I had salvage radiation and no spacer was used since cancer cells could be in front of the rectum and you don’t want to block the beam. But I don’t know your exact situation so don’t go by me.
I just had 25 sessions - no real side effects (not on thinners, just daily aspirin). Studies have shown some earlier side effects in the shorter duration (25) treatment arm, but effects were the SAME after 6 months in both groups.
All I can say is that
25 sessions was like a godsend to me…14 more sessions would have really sucked! After the first 5 sessions or so you start to get irritable because you realize you have to keep doing this for another month. So another 6 weeks would have really gotten me down….just my feelings on the subject.

I had 5 hypo-fractional treatments finishing in February of 2023 with an MRI guided mridian machine and I also had spaceoar. I had Urination decrease but got relief with Flomax, overnight. Toxicity and side effects are affected by the choice of MRI guided machines vs non-mri guided machines. Here is a link to Urology Times and the Mirage randomized trial toxicity/side effects results from that study: https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

2010 Loma Linda Hospital for 2.5 months with proton radiation. Gleason 3 plus 3; PSA: 6.47
The diagnosis was slow-growing cancer. I had two biopsies that were identical in results in terms of location and Gleason score. Never had any issues, in fact, I stayed at March AFB and played racquetball normally each afternoon. My sessions were early in the morning around 730am. Usually, there were five or six men awaiting their radiation on three "machines". Our conversations were limited, but I would say about 60% or more were doctors. That fact alone reinforced my solo decision to undertake proton radiation therapy. Because of the cost of housing for nearly three months, many select other options. But, given the right criteria and prostate cancer condition(s), proton radiation is the best option. RH/Florida

My RO originally had me scheduled for 28 sessions of VMAT, but changed it to 39 sessions after I had my mapping session. I did have SpaceOAR. I finished up about 18 months ago and have never had any bleeding and PSA consistently dropping over that time frame.

On the other hand, I have a good friend who did 28 sessions without SpaceOAR a few months ago. He recently had emergency surgery because of a bleeding rectum.

Following RP, I had Salvage Treatment w/ 37 IMRT radiation sessions; 1.8 gy per session; 66.6 gy total. I think that compares to the total radiation received by others as primary treatment.
While I had bowel issues the last half of my radiation, all disappeared 2 - 3 weeks after treatment ended. A subsequent screening Colonoscopy revealed, as a secondary finding, no radiation damage to the colon.
I think that your answer is contained within your question.
Treatment for PCa is serious, and I would choose the treatment protocol that maximized benefit while reducing risk.
Best wishes.

I'm not on blood thinners but do have a bleeding disorder where I bleed REALLY easily. I had SpaceOAR and five sessions of SBRT and have not had any rectal or bladder bleeding issues at all. Even after my prostate biopsy, I only had blood in my urine for about a day. IANAD so can't say if my experience is typical.

@westernflyer
I have read that Loma Linda was along with UFHPTI one of the first centers to offer proton radiation. Read great things about them too.

I too believe I made right decision on proton versus photon.

UFHPTI has 5 gantries with each having each own changing room and bathroom. It was just so professional there with great care and courtesy. When I would finish with my team assigned to me (had same team each time and same gantry) I would say after they confirmed my time for next visit, "Okay same bat time, same bat channel, same bat team." WE all got a laugh from it.

When I finished the team came out and watch me ring the huge bell in waiting room applauding me.

Hi, I had 43 radiation treatments this past summer and continue on ADT since Mid March last year. I also take daily blood thinner. I was offered option of getting off the Xarelto for the duration of treatments (I did that), vs the insertion of what I think you referenced in order to avoid stopping thinner.
I developed a clot in my calf and went right back on the Xarelto for last couple weeks of radiation with no bleeding issues but again, did develop the clot. Just my situation so hope it helps in some way. Good luck with your radiation.