wide or narrow radiation?

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Greetings Friends,

Just when I thought all the necessary decisions had been made- this falls on me:

Oncologist started me on hormone therapy and sent me for IMRT of the whole pelvic area, while the radiologist wants to blast only the prostate alone.
Oncologist says: better survival rate
Radiologist says: faulty study, no statistical basis, but certain collateral damage and associated side effects

I don't have faith in either of them.
open to advice...

Background: 56 years old, diagnosed 12/07, PSA 23, gleason 4+5=9 in most of all 6 cores, first Zoladex implant 1 1/2 months ago.

Menachem

Replicant · Moderator Joined: 01 Nov 2006 Posts: 197

Hopefully the radiologist is a radiation oncologist. My inclination would be to listen to the specialist in the field. The other onco is a medical oncologist, right?

If you don't trust either one, go to another specialist in that field. But if you need radiation, you should be consulting with radiation oncologists.

With IMRT, a plan would be developed. It's not this OR that, with nice sharp lines. With a 3D CT scan, different areas get different dosages. (For an idea of how this is planned, see this picture: http://medicineworld.org/images/blogs/9-2006/imrt-prostate-plan-71.jpg

So in my case, the area where the prostate used to be got the max, and sort of like a topographical map, areas further out got less. My radiation oncologist told me he would "touch" the surface of my bladder and rectum with the radiation. Because it's salvage, they have to cast a wider net because they don't know exactly where the offending cells are hiding. The plan is based on your medical history and scans.

All of this is planned with a medical physicist, by the way.

Does that help?
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Replicant,

Thank you for the well presented explanation.

I guess my biggest problem is the disagreement between the radiation and the medical oncologists, both of them department heads at a major hospital.
Both bring supporting studies.
I could ask for an additional opinion, but not sure what that would add... try for 2 against 1? Does the majority rule??

Just trying to get well...

Menachem

brainman · Last edited by brainman on Wed Feb 20, 2008 2:49 pm; edited 1 time in total

badtrip, I am so sorry about your cancer. While I do not have experience with Prostate cancer, I do have a general opinion. IF (and this really is a big issue) IF your radiologist is a radiation oncologist, I would go with what the radiation oncologist is saying.

Unfortunately, it seems like the two of them are not consulting with each other and reaching a joint decision. You might want to bring up the difference in their advice with them and see if that changes their opinions or if they change their opinions.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Replicant · Moderator Joined: 01 Nov 2006 Posts: 197

I hope I didn't sound too blithe about the situation before. It is an unpleasant situation to find oneself in.

Personally, I would lean more towards the advice of the radiation oncologist, like Jim says. And I would probably go find another radiation oncologist for a second opinion then go from there. But that's just me.

It sounds like you have a good hospital, but is there an even better one you could travel to for a consultation?

Living in Arizona, if I found myself in such a situation, I'd probably pay my own way for one consultation at Mayo Clinic in Scottsdale, or go to UCLA or MD Anderson. Just to see if a world-renknowned center of excellence agreed with my first radiation oncologist. Not sure if a similar option is available to you.

Whatever you do, I wish you well.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Thank you both for your advice.
Will probably go with the radiologist's narrower approach, since the benefits of the wider approach are disputed, while the damage is certain...
Will also be hearing a few more opinions before closing the issue...

Health!

Menachem

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