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External Beam Therapy

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User
Posted 31 Jul 2015 at 15:51
Following on from my last post.

Well, finally seen the Oncologist, and had a very long discussion of the different treatments available, and I feel the best options for me are either to start Active Surveylance, or to start External Beam Therapy.

I know the pressures of AS and waiting for the cancer to change. So wonder wether to start External Beam Therapy.

Does anyone have any experience of EBT to share

Thanks Colin

User
Posted 31 Jul 2015 at 22:50

Hi Colin,

EBRT is the longest primary treatment because it is usually given in daily sessions (called fractions) of 19 to 37 depending on the dose administered. So it requires regular attendance over this period to be most effective. Just as when you have a single X-ray and feel nothing, you feel nothing when the linac dispenses controlled X-rays from different angles in a pattern that is specifically tailored for an individual. Most men tolerate this very well though a small number have an adverse reaction to the radiation and a very few stop having it at some point because they are severely affected. Some hospitals want the patient to have the treatment with a bladder with so much urine +- in it. Often a patient having RT will also be having Hormone Therapy where there is more potential for side effects. Some oncologists want the patient having RT to continue with HT for anything up to 3 years after RT so you could ask how long you would be on HT for if you went down this route.

As you have said elsewhere, once you have had RT, surgery after that is very difficult and indeed many surgeons won't attempt it, whereas RT can be given after surgery and often is.

Some men defer the potential side effects of active treatment by AS but this does require regular monitoring so action can be taken as soon as it is deemed advisable. You don't want to miss the best chance of beating developing cancer! This is a personal decision you should decide on having discussed it with your Consultant.

Barry
User
Posted 01 Aug 2015 at 13:59
Hi Colin

I started having hormone therapy in Jan 2013, followed by a TURP op in the June and started 37 sessions of Radiotherapy in the October. Fairly simple procedure, scan first to set where to 'aim' the x-Rays. 3 tiny dots tattooed for the target. Had to empty my bowels each day, and when at the hospital drink a bottle of water about 45 minutes or so before the treatment. The radiotherapy team were very good and would come out and tell us when to drink. Just had to lay still on a table while the machine did it's stuff - above me and to each side which took about 2 minutes total. Had a little soreness at the rear but easily treated with aqueous cream. Still on HT and seeing oncologist every 6 months.

Arthur

User
Posted 29 Oct 2015 at 19:54

Thanks Chris

When your in the waiting rooms you meet some very interesting people, and makes you realise that you're not the only one.

Good luck with yours in January

Colin

User
Posted 13 Jan 2016 at 22:13

Hi Pete48
Read Daily Mail 12/1/16, "High-Dose prostate therapy that halves trips to hospital" by OONA MASHTA
I have just read this in yesterdays Mail I wish I could have got on it, apart from the less time factor the side effects are possibly less ,an interesting read.
Cheers
Alan

KEEP POSITIVE and CARRY ON

User
Posted 17 Jan 2016 at 13:48

John had the 20 sessions. There are some things to take into account -
- the trial was partly looking at how high a dose can be safely given
- where the tipping point is between effective treatment and increased risk of side effects.

So the common regime is 37 fractions of 2Gy = 74Gy. Men on the trial had 19 or 20 fractions at anything from 2.4Gy to 3.4Gy

John had 20 sessions at 3.3Gy = 66Gy .... Radiotherapy is cumulative so the 66Gy delivered in bigger slices has the same strength as the 74Gy. John sailed through the treatment, worked throughout, went to the gym every day and continued with his rugby - needed an afternoon nap on his desk sometimes though. When he was put on the trial, they were only selecting younger fit blokes for the higher doses, so it will be interesting to see what dose is suggested for Pete now the trial is completed

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 18 Jan 2016 at 08:26

Well I am scheduled to start 20 session RT on Thursday. Not young (66) but all the consultants agree that apart from the PC I am in good health and I get my daily exercise of a 30min walk every day (something I will have to reschedule when the course starts). I was led to believe that here (Royal Berks, Reading) it is now the norm to give 20 session courses and it would be the exception to be moved to 37.

Edited by member 18 Jan 2016 at 10:58  | Reason: Not specified

User
Posted 18 Jan 2016 at 11:25

H Pete48

Good luck with everything ,I was on Bicultamide for 30 days prior to starting Zoladex, I'm sure you will be fine. http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-smile.gif

Regards

Alan

 

KEEP POSITIVE and CARRY ON  

User
Posted 18 Jan 2016 at 12:05

Hi Pete
I've been on 150mg Bical for 4 months now. It actually hit me hard for 2 weeks but I'm ok now. My 33 RT due to start in April. I've been told with my figures that it's not likely to be curative, so I have just had a long chat with Onco secretary to ask if I can have 20 instead. Waiting to hear back. I'm not looking forward to it at all tbh especially if not curative , so the less sessions the better.
Very best wishes to you
Chris

If life gives you lemons , then make lemonade

User
Posted 18 Jan 2016 at 19:41

I was asked towards the end of 2007 when I was 71 whether I wished to take part in the CHHiP trial with randomized selection into the 37 fraction standard, 19 or 20 hypofractionated arms. So suitable 'old timers' were eligible even back then.

I asked if I was drawn into the 37 fraction arm if I could have the 20 higher dose fractions outside the study but was told no. I asked if I was drawn into the 19 fraction arm whether I could withdraw and have the standard 37 fractions instead and was told yes. As a further variation, I asked whether I could have an additional 2 fractions each of 2gy added to the 37 fractions. (This was on the basis that slightly better cure rates have been obtained with higher doses albeit with increased risk of more severe side effects). The Marsden would not agree to this - no doubt due to NICE guidance.

Hope treatment goes well.

Barry
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User
Posted 31 Jul 2015 at 22:50

Hi Colin,

EBRT is the longest primary treatment because it is usually given in daily sessions (called fractions) of 19 to 37 depending on the dose administered. So it requires regular attendance over this period to be most effective. Just as when you have a single X-ray and feel nothing, you feel nothing when the linac dispenses controlled X-rays from different angles in a pattern that is specifically tailored for an individual. Most men tolerate this very well though a small number have an adverse reaction to the radiation and a very few stop having it at some point because they are severely affected. Some hospitals want the patient to have the treatment with a bladder with so much urine +- in it. Often a patient having RT will also be having Hormone Therapy where there is more potential for side effects. Some oncologists want the patient having RT to continue with HT for anything up to 3 years after RT so you could ask how long you would be on HT for if you went down this route.

As you have said elsewhere, once you have had RT, surgery after that is very difficult and indeed many surgeons won't attempt it, whereas RT can be given after surgery and often is.

Some men defer the potential side effects of active treatment by AS but this does require regular monitoring so action can be taken as soon as it is deemed advisable. You don't want to miss the best chance of beating developing cancer! This is a personal decision you should decide on having discussed it with your Consultant.

Barry
User
Posted 01 Aug 2015 at 13:59
Hi Colin

I started having hormone therapy in Jan 2013, followed by a TURP op in the June and started 37 sessions of Radiotherapy in the October. Fairly simple procedure, scan first to set where to 'aim' the x-Rays. 3 tiny dots tattooed for the target. Had to empty my bowels each day, and when at the hospital drink a bottle of water about 45 minutes or so before the treatment. The radiotherapy team were very good and would come out and tell us when to drink. Just had to lay still on a table while the machine did it's stuff - above me and to each side which took about 2 minutes total. Had a little soreness at the rear but easily treated with aqueous cream. Still on HT and seeing oncologist every 6 months.

Arthur

User
Posted 01 Aug 2015 at 14:10

Thanks Barry and Arthur for your info on EBRT. I was also offered Brachytherapy but decided against it in favour of RT.

Who knows what is the right way.

Having another PSA check on Monday, if it's risen I think it's will be decision made.

Thanks Colin

User
Posted 01 Aug 2015 at 18:36

Colin,

Brachytherapy is just another way of dispensing RT. There are two kinds of Brachytherapy, high dose where radioactive rods are inserted for a time during an operation and low dose where radioactive seeds are implanted during an operation but remain in position dispensing low radiation for a couple of years or so. Both of these forms of radiation can where the oncologist considers appropriate, be augmented by External Beam. Not every hospital can offer Brachtherapy and for some it might not be very suitable. Nevertheless it's always worth getting the opinion of your consultant on this. HIFU is yet another possibility but not yet widely available. In need it can be repeated whereas usually if you have a full dose of RT it can't be repeated other than on a small scale in certain situations.

Edited by member 01 Aug 2015 at 18:42  | Reason: Not specified

Barry
User
Posted 01 Aug 2015 at 19:03

Barry

Ive only been offered EBRT and Brachytherapy. If I have to choose between the two I have to say that EBRT is the cure that would suit me. I don't mind the daily session, all be it difficult with the daily 100 mile round trip. I'm led to believe a hospital car picks up 2 or 3 for the daily commute. The other is not having a catheter to consider. Hopefully at the end of the treatment I should be cancer free. ??

Thanks Colin

User
Posted 01 Aug 2015 at 21:46
Colin

I went in a car every day with a few others and it worked quite well, we had the same driver most of the time and he picked me up at 7am which was good as we got in the queue early. The discharge lounge would phone him when we were all ready to go back home. We generally had a laugh travelling together. When some completed their treatment others joined us.

Arthur

User
Posted 29 Sep 2015 at 14:20

Well it's been a while since I've been here.

My PSA was 7.4 and diagnosed T2c both sides. It's been a long time decision making and finally opted for EBRT. I've had the markers placed and the tattoos done, and my first appointment of 37 starts tomorrow finishing on the 19th November. Suddenly the thought of prostate cancer being eliminated is great, but seems to be a long a long way off yet. I'm travelling 106 miles to and from Oxford every day.

Anyway my bags are packed and I'm ready to go.

I would like to thank this forum for the support and advice along the way, and wish everyone all the best.

Colin

User
Posted 29 Sep 2015 at 15:46

Hi Colin
I'm so pleased you've made your mind up and are confident . I hope sincerely it is a cure for you that involves minimal side-effects . I'm due to start EBRT in the New Year after an unsuccessful Radical Prostatectomy . I don't envy you the journey though . Just one journey from Southampton to Oxford was enough for me. At least I will only have a 20 minute journey each way every day , which hopefully I can do alone .
All the very best for tomorrow
Chris

If life gives you lemons , then make lemonade

User
Posted 29 Sep 2015 at 16:31

Good Luck Colin,
Hope all goes well for you and that side effects are kept to a minimum.

All the best
Sandra

We can't control the winds - but we can adjust our sails
User
Posted 29 Sep 2015 at 16:45

Thanks Chris & Sanda,

fingers crossed for mild side effects.

Hope all goes well in the new year for you Chris. I'll be following your posts.

Cheers Colin

User
Posted 29 Sep 2015 at 17:01

Hi Colin
This is my journey following EBRT.Diagnosed Feb 14 2014 following biopsy on Feb 4th.
Results Gleeson (4+3 = 7). 11 of 12 samples positive. 80% of prostate involved. Stage T2/c Original PSA 4.98. Underwent 37 RT sessions May- July. PSA Sept 0.25. PSA Dec 0.34. PSA March 2015 0.89. PSA June 0.31. PSA Sept 0.39. I think these results are ok. My last HT was in June 2014. Only minimal side effects to date.
Good luck hope all goes well with your treatment

User
Posted 29 Sep 2015 at 17:48

Hi bellaire,

Pleased all is well with you, hoping mine goes the same. I'm looking forward to the new year now already.

Cheers Colin

User
Posted 29 Sep 2015 at 19:02

Hi Colin,

One thing worth considering, if you suffer bowel problems as the treatment progesses, is a low fibre diet.

I found that initially I was OK so far as side effects were concerned, but after the first two weeks of EBRT I started to get bowel issues.

These continued and peaked about 2 weeks after treatment was complete.

The advice of my hospital was a to cut out all fresh fruit, dried fruit, green veg, beans, fried food etc and survive on a fairly bland diet of boiled white rice/pasta/potatoes, white bread (nothing brown or wholemeal), chicken and fish.

They even had a diet sheet which was rather counterintuitive, forget 'healthy eating' the only things they recommended having 5 of each day was Jaffa Cakes!

Of course after about a month things settle down and you can resume healthy eating, I celebrated with a red bean and spinnach curry, which is guaranteed to get things moving!

:)

Dave

User
Posted 29 Sep 2015 at 19:24

Thanks Dave

Looking for all advice on diet thanks. Ill pass this onto Barbara my other half.

Thanks again Colin

User
Posted 29 Sep 2015 at 19:45

Hi Colin,

The very best of luck for your radiotherapy, mine seems to have worked well, so far.

When I had mine last October I did write a daily account of how it went.  Might be worth you checking it out if you're interested.

 "My Radical Radiotherapy Starts Today!"        

Steve

Edited by member 29 Sep 2015 at 19:51  | Reason: Not specified

User
Posted 29 Sep 2015 at 19:51

Hi Steve

Pleased the RT worked for you.

I have actually read your journey. I've spent a lot of time reading and not posting. I really must try in the future.

Cheers Colin

User
Posted 30 Sep 2015 at 02:18
Hi Colin,

I'm pleased you had chance to read my account of my RT experience. I hope it helped.

I was really glad to start the treatment because at last something seemed to be happening after several months of waiting. The daily routine will become part of your life for the next couple of months. It will be soon over and you can look forward to the new year knowing that the cancer cells have been well and truly zapped.

I wish you well today and in the coming weeks. Let us know how it goes.

Steve

User
Posted 30 Sep 2015 at 11:29

Thanks Steve,

Well that's the first one done, only 36 more to do.

Colin

User
Posted 30 Sep 2015 at 18:50
Hi Colin

My hubby has had 18 / 25 sessions of RT, luckily the hospital and his work are both in Central London so he only has a journey if he's having a day off from work.

Steve's right, 25 sessions (5 weeks) seemed a very long time 3 weeks ago but now we're looking forward to the final session Friday week!

Good luck with your RT.

Maureen

"You're braver than you believe, stronger than you seem and smarter than you think." A A Milne
 
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