Surgery or Radiotherapy? Decision made!

I have my consultation on Monday next, so I have plotted the graphs of my important markers (for the blood count readings, see my comments earlier in this thread).  I’m hoping for the white blood cells recover (immune system, including T cells, killer cells etc). I have learned that they never recover fully, due to radiation of bone marrow in the large pelvic bones, but there is no evidence that infections cannot be dealt with at these lower static levels (which still increase at the onset of infection, as, thankfully, there are plenty of other bones producing white cells at the normal rate).   AW

Hi AW

This aspect of RT continues to interest me as I was unaware of this before.  I am also due to commence my ultrafractionated 7 fractions tomorrow, so have skin in the game - so to speak.

I will not be receiving RT to the surrounding lymph nodes and pelvis - only to my 36cc prostate with small margins - I assume.

I am therefore hopeful that the RT effect to the bone marrow of the pelvis and hip bones will be reduced.  WDYT?

Hi ToFo

I am interested in your initial and current side effects after your 5 dose SBRT, because I will be commencing similar Ultrahypofractionated RT tomorrow.

You would have received 36.35 Gy over 5 fractions, which amounts to approximately 5.18 Gy per fraction.  I will be receiving 42.7 Gy over 7 fractions, ie 6.1 Gy per fraction.  Approximately .3 Gy per fraction higher.

You had the RT within a period of  less than 2 weeks.  I will have the RT over 2.5 weeks.

In the research it mentions that ultrahypofractionated RT can cause a little more rectal problems immediately after and in the first year following RT, then the side effects are much the same as standard fraction RT after a year.

I am therefore interested to know about your side effects, ie rectal, urinary and GI etc.

Dedalus.

Hi Dedalus,

My husband starting RT 6 sessions at the end of April. Our oncologist explained that this is only to the main tumor, not to nodes or bones, just the prostate. I assume is similar case to yours where there is a spread to the nodes and pelvic bones? I did not see any details on your profile.

Best wishes for tomorrow

Dafna from Brighton

Hi D,

Yes, there will be less effect on your blood cell producing marrow , as you will have fewer “bones in the game” so to speak.   I elected to have wider pelvis radiotherapy due to some aggressive traits of my cancer and I wanted to throw the kitchen sink at them in case a few micro mets had made it out of the prostate and into the pelvic area (first port of call is usually pelvic lymph & bones).

Good luck tomorrow and the following days : I’m sure you’ll be fine: let us know how you get on.

AW

Hi AW,

It is interesting you saying you opted for wider pelvic RT rather than the tumor only. We have no choice at the matter. When I asked the consultant why not RT to the all area the answer was it is only intended for the main tumor and not the mets. My conclusion is, for the last few months, that each trust and each consultant act differently. I was trying to argue and negotiate a wider RT to no avail. I just want to trust that they give the best treatment, but admittedly  I have doubts when I am reading about other with same spread and stronger treatment. Here you go, I let it out.

Best wishes

Dafna

Hi AW

Thanks for your reply and well wishes.

You have come to the same logical conclusion as I have, which is reassuring.

I have read of your treatment and progress.  Following my research, your choice of treatment  was the one I considered the most effective, and the one I  therefore wanted, but could not get, due to previous HOLEP.  

Good luck, going forward.

D

Hi J&D , I found graphs supporting brachytherapy boost trials (see my bio) and most participants were on elective pelvic RT.  Once I had seen the graphs of performance, I was convinced.   However, my consultant wanted prostate only RT.  I managed to persuade her to take my point of view.  My aggressive traits of AIP and cribriform supported my position.   AW

Hi J&D - no evidence of mets to lymph or bones for me.  Just “early T3a N0 M0. “

Aggressive inter cell structure (but not IDC-P) was found.  Needed hitting hard before it developed into inter ductal cancer.

AW

Hi AW,

Yes, maybe this is why the difference in treatment, as Jacob is T3A N1 M1. 

Thank you for that.

Best wishes

Dafna