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Is this a "debulking" of the primary tumor by RT, or just palliative

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Prostate Cancer
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Posted 4/27/2017 4:23 PM (GMT -5)
So as my PSA rises post chemo and Prostvac, hematuria detected in the UA triggers a cystoscopy, which reveals a tumor in the bladder neck, and I have been having increased frequency and urgency of late.

My MO agreed that palliative RT was an appropriate response, which I initially thought would be a case of "whack-a-mole" and targeting just the bladder neck. Of course it makes more sense to bake the whole prostate, which apparently insurance will cover if you have urinary symptoms.

Next Monday I start on 15 EBRT sessions with a dose of 37.5 Gy, all to the prostate directly.

Always questions regarding new therapy, and here they are for any of you with experience in these matters.

(1) 37.5 Gy is a little over half the dosage used to treat for a cure. Is this a de-bulking capable dosage, or is it just a band-aid for the urinary obstruction? I ask this because when I asked the RO how long I could expect relief of symptoms, he said "months to a year", but that other treatments through MO might extend that; I was a bit disappointed about that timeframe, making me question exactly what is happening in this setting.

(2) I am scheduled every AM at 8; told to have full bladder and empty bowels... I figure I will stock up on bottles of water and Fleets enemas- is the Fleets approach viable for these sessions.

(3) any others out there who have had RT for this reason, I am curious about response in PSA, etc if you are willing to share

thank you in advance
rf
Posted 4/27/2017 6:27 PM (GMT -5)
Full bladder and empty bowel. That's the tricky bit.

My appointments were at 12:45pm. I stopped drinking water entirely about 2 hours before the appointment. Then, about 1/2 hour before, I drank 13 oz of water. I played with that timing and amount to get it right. With an 8am appointment, you could probably do your morning business when you get up, and then drink a certain amount a certain time before your appointment.

The bowels took practice. I could sort-of stretch it if I felt the urge early, or go sit and "try" if it was late. By doing that for a couple of weeks, my system began to regulate so it happened very close to the same time each day, about an hour before. Being consistent was the key, consistent in everything: activity, type of diet, amount consumed, all of that. My wife found it amusing, but I got to be quite predictable.

The Fleets would probably be overkill, but if you can't get it any other way that might work. Avoid too much fiber, and anything carbonated. Bloating is not good.
Posted 4/27/2017 6:37 PM (GMT -5)
I'd drink my water bottle just before the drive in (about a 20 minute drive). The bowels ended up getting int "sync" after awhile, didn't use the Fleets. In fact after a few treatments I ended up with lose bowels and found I had no trouble emptying - often needed to urgently find a toilet.

Andrew
Posted 4/27/2017 7:12 PM (GMT -5)
It's moderately hypofractionated (2.5 Gy per fraction) which means, as you say, that it's biologically effective dose is 55% of the curative dose. Because you have cancer at the bladder neck, I'm sure he's worried about bladder neck contracture if you get a higher dose. Other options may include a TURP or a full prostatectomy.
Posted 4/28/2017 7:21 AM (GMT -5)
I would hold off on the Fleet's, only using them if an "emergency." I had SBRT, and they told me that using Fleet's for 5 days in a 2-week period was at the limit for recommended usage. If you use them more often than that, you risk dehydration, electrolyte imbalance and possibly other side effects.

You may want to consider gentler alternatives, like a stool softener or probiotic.
Posted 4/28/2017 11:32 AM (GMT -5)
thanks guys for the info and tips-

soldiering on...

rf
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