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Posted 10/30/2021 10:11 AM (GMT -5)
Hey all! Had my first Lupron shot yesterday so I guess I'm just waiting for the man-boobs to come in. ;)

Having a consult with my RO Friday to find out about my radiation treatment, and the main question I have is whether my treatment will be more 'targeted' in light of the PSMA PET scan results, or if they still radiate the same area whether they know exactly where the tumor/lymph node) is or not. The 'eyes to thighs' PSMA PET scan just found one lymph node in my pelvic area and nothing anywhere else.

I can't think of anything else to ask, mostly because I've read up on the treatments and SEs, and I've read the stories of others on this forum, but is there anything else I should ask him?

This forum has been such an awesome resource in my journey and I thank all of you.
Best,
Mic
Posted 10/30/2021 10:29 AM (GMT -5)
I would think they will radiate as wide an area as feasible. If one LN has detectable mets, there are other LNs that could have undetectable mets.
Posted 10/30/2021 10:48 AM (GMT -5)
Mic - the RO will probably want to do the prostate bed and lymph nodes with maybe an extra dose at the one lymph node. I would not think they would want to rely on the "new" PSMA scan to be the definitive word on possible spread. Even without the scan, consideration of ART or early SRT was on the table with your diagnosis. Will be interesting to see what your RO thinks.

I would also be interested to see what radiation scheme and duration they recommend. My RO said that SBRT or higher dose IMRT was not appropriate for ART at that time so many treatments are in order. Did not recommend any special considerations (no Space Oar, no implanted markers, just the CT scan and three dots with mold for butt and thighs) with low dose IMRT. Maybe thoughts have changed?
Posted 10/30/2021 11:10 AM (GMT -5)
When I got my last 106 Grey, finished last March, I got 50 Gy to the pelvic lymph nodes as 'salvage radiation' and 56 Gy to 3 hot lymph nodes. I told the RO to "hit those with a hammer". They were 1.2, 1.3 and 1.4 centimeters in diameter and gave me a PSA of 3.3 ng/dL. I will find out sometime next year if that worked as I come off the Eligard, starting Dec 2021 when I do not get that next injection.

The first 70 Gy was to the prostate bed 9 years ago. No recurrence there. smile SE's were minimal this time around, mostly just fatigue. He said they can target much better now.
Posted 10/30/2021 3:43 PM (GMT -5)
My lymph nodes were radiated and we didn't even have confirmation that my cancer had spread there.

Good luck with the radiation and the ADT. It's a bit of a slog, but you'll make it!
Posted 10/30/2021 9:27 PM (GMT -5)
https://prostatecancerinfolink.net/2021/05/19/new-guidelines-for-salvage-radiation-dimensions/

The entire pelvis according to the new guidelines mentioned above, with special attention to the one hot node.
Posted 10/31/2021 10:48 AM (GMT -5)
Ditto the others, wide swath. You usually radiate all the prostate and seminal vesicles plus about a 5-10 mm margin around. Often you radiate where the cancer often travels, the pelvic lymph nodes. Sometimes even wider based on the dx. There can be significant cancer brewing that no scan can see or biopsy can find. They know what they found. They do not know what they didn’t find. PCa is very multi focal. Radiate as much as possible.
Posted 10/31/2021 3:11 PM (GMT -5)
Thanks all. Great info as usual.
Posted 10/31/2021 3:54 PM (GMT -5)
A mate of mine got an adjuvant brachy seed in a hot LN. I have a question: if you radiate a target does that then rule out radiating another target anywhere near, due to the penumbra using up dose capacity? i.e you only get one go so you have to do everything?
Posted 11/1/2021 7:53 AM (GMT -5)
It all depends. Most will generally say you have one shot at a certain amount of radiation to one area. But that is oversimplified.. The original dose and target and passage of time will determine what can be done.

As an example, My wife had BCa in 1996 in the right breast. Had a lumpectomy, chemo and max radiation. Then in 2010 another unrelated BCa in the right breast. This time a mastectomy, chemotherapy and radiation. The RO is one of the best and with his technical team devised a plan that satisfied the surgeon and oncologist.

Passage of time is critical and the longer the more likely you can use radiation in the same area again. The original dose will also dictate what can be done at a later date to limit toxicity.
Posted 11/1/2021 11:35 AM (GMT -5)
When I had an Axumin scan early this year after a nearly 2 year break my MO was hoping they could identify targets for spot radiation before starting me on a new round of ADT. The scan picked up some hot iliac nodes and also some hot nodes near the prostate bed where I had SRT in 2010. My MO and the RO ruled out spot radiation for the time being because the risk of damage in the previously radiated prostate bed was too high. However they said new more sensitive external beam machine was being installed so there sill might be a chance to spot radiate on the next go-round. I may find out soon. If PSA is up, not down, when I go in for my appointment later this week, I'm not sure of the immediate next step. I'm thinking probably another scan and then maybe spot radiation if possible, otherwise likely add Zytiga or Xtandi to Lupron.
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