Prostate cancer 5 sessions radiotherapy- enough?

Hi !

I suppose the fractions he is about to have SBRT which is actually delivering very high dosages per fraction; for example 5 GY to 7 GY per fraction which is extremely efficiant of killing cancer.

A similar treatment is for example HDR Brachy of for that LDR Brachy.

i would consider perhaps adding 6 months of hormone therapy

Hi thanks for responding- we have not been told it is anything different re normal radiotherapy- how do i ascertain this ? Hubby doesnt ask!  They reckon the sessions research  negate hormone therapy at his age! 

Hi !

Standard extern beam radiation therapy / EBRT is almost always from 20 fractions and upwards (35 up to 40 for example) depending on modality. If you have lower amounts of fractions you normally receive higher dosages per fraction.

In terms of efficacy, 20 fractions of 3 GY each is noninferior compared to for example 35 fractions of 2 GY

But, just talking of 5 fractions then you’re most likely is talking SBRT where each fraction delivers much higher dosages, normally in the range 5 to 7 GY per fraction.

In terms of sufficient. Yes, it’s sufficient because measuring and comparing different modalities you can’t look at the dosage in GY only. Higher dosages for each fraction even if fewer fractions can be more efficient than more fractions with lower dosages per fraction and this can only be shown calculating something called BED and EQD2 if you really feel the need to drill down in ’bit and byte’ knowledge

So SBRT (and for example HDR Brachy) is very efficient and in much less time and with comparable toxic side effects (there are very low risks of having any major side effects by the way with radiation) as with more standard EBRT treatment modalities

Hello Pastyum and welcome from another wife who has a young 81 year old husband. He has had standard EBRT to the whole pelvic area plus SBRT to distant mets. The main difference was that the radiographers made sure that he was immobilised for the SBRT in order to minimise any collateral damage to the surrounding areas. His main side effects were fatigue which did build up the more sessions he had. The radiotherapy does cause 'bruising' so there could be a temporary increase in urinary symptoms. After a few weeks everything returned to normal and he has had no long term issues as a result of the radiotherapy. It is important to keep an eye on urine flow as treatment can occasionally lead to the ureter or urethra narrowing resulting in a build up of fluid in the bladder or kidneys which can be dangerous.

We were told that it was important to exercise during treatment and he had to get into a routine of drinking plenty and have regular bowel movements. Some hospitals want an empty bowel and provide micro enemas. Also the requirement for an empty or full bladder varies by hospital but you will be given instructions before hand. I have attached a link on what to expect. The radiographers are brilliant at looking after the patients and will help your husband get through the procedure.

https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/radiotherapy-for-prostate-cancer

Ulfhbg has given a good explanation of the differences between SBRT and EBRT which are considered to be equally effective in dealing with the cancer. Radiotherapy continues to work for 18+months as the debris is cleared out of the body and this should be reflected by a decline in the PSA until it reaches a nadir, lowest point, so your husband will have regular PSA tests every 3 to 6 months initially to check that this is happening. 

Please ask any questions, no matter how small or trivial you might think them and we will try to help.

Thank you for replying! Yes he has been given the enemas and told how it all works needing a full bladder etc He is on Tamsulosin to improve flow prior to treatment as they did mention flow may change with treatment. His PSA level is rarely mentioned as I dont think his has changed much over a few years despite being found to have prostate cancer. Biggest worry is side effects post treatment- we both want a holiday its been a year since he was diagnosed with NHL and rarely had a week without an appointment somewhere but scared to book until we know how it has affected him! Time will tell! Thank you for replyinv much appreciated! 

Thank you for your response! Hubby not interested in the technical whereas I am and you have explained it in terms I understand! Thank you 

Hey Ulfhbg & Alwayshope 

you always amaze me with such detail . Didn’t know the RT worked for 18 months . Oncologist just said 12 weeks . Mmmm.

im trying to decipher what OH had in relation to RT  the paperwork says

3600cGY in 6#  6MV so could one one you lovely people tell me what he was given . 

Liz xx

Hi Liz. Your OH has been given 36 Gy in total with 6Gy per session. The radiotherapy gives a good blast at the cancer and stops the cells from multiplying. It kills or damages them over several weeks or months but the debris remains. This debris can take a long time to get out of the body and relies on the bodies own lymphatic system to do this which is why the PSA can continue to drop for 18+ months. The bounce is thought to be associated with the body's immune system having a push to do this but the mechanism still hasn't been fully evaluated.

I should think you must be counting down the days until you can get some sun and have a well deserved break. Have fun.

Hi Liz, your OH, had hypofractionated RT.

3600cGY = 36 GYs, total amount of radiation given.

6# = 6 fractions, number of treatments.

6MV = 6 mega volts, this is the comonist level for delivering RT

A first class treatment.

Eddie xx 

Thank you Alwayshope . & eddiel 

yes we are indeed needing some sunshine and not the subbed type as Brian would put it . 

We are just hoping that his liver function has settled so he doesn’t need to reduce or remove the Abiraterone. Although the information you posted about Vietnam’s dosage sound ok .  It’s funny as his sugar level had risen , then  cholesterols and now liver. I just wonder if it’s been the RT causing some havoc on his system. 

will post a few pictures once we’re settled

huge hugs to you all and honestly can’t thank you all enough 

Liz & OH xxx.