Site Navigation Menu

8. Patient checklist for external beam radiotherapy.
(Updated 4th October 2007 to reflect NICE 'consultative' recommendations.)

He who asks a question is a fool for five minutes;
he who does not ask a question remains a fool forever.
(Chinese proverb)

Prostate cancer consultation
Consultants are busy people and often under some pressure. Nevertheless, it is important as a patient to know the why's and wherefore's of your treatment and, if you are prepared, this need not necessarily take up very much time in a consultation. Below are listed some questions I would ask of a consultant. Most of them can be briefly answered but some may need elaboration.

1. What type of radiotherapy treatment am I going to receive? Conformal beam or IMRT?
(You should not now accept conventional ebrt. Go elsewhere if either of the above is not available)

2. What overall dose am I to receive and in what fractions?
(The UK National Institute for Clinical Excellence (NICE) now recommends 74Gy in 2Gy fractions as a minimum dose with 3D conformal beam radiotherapy - i.e. 37 days of treatment excluding weekends. They make no mention of a maximum dose but, if you are able to have IMRT, a dose of around 80 Gy is possible but you need to discuss this with your consultant.) )

3. Is anything done to allow for prostate movement during the course of treatment?
(The prostate gland can move around during the course of treatment. Generally, the movement is small but there are techniques for tracking the movement and adjusting the beam profiles. However, the probable answer in the UK is that nothing is done except to allow a margin around the prostate which it is hoped will ensure that the prostate gland is always within the high dose target region).

4. What is the targeted field?
(Ask to see your planning chart so that the consultant can explain just what is to receive high doses of radiation and how much of the rectum is to be within this high intensity field.)

5. What hormone treatment is to be given?
(The probability is that you will be recommended to have three months of hormone therapy before the external beam radiotherapy treatment (neo-adjuvant use) and that the hormones will be continued both during treatment (concurrent use>) and after treatment (adjuvant use). The main questions are what type of hormones are to be used and why - either LHRH agonists like Zoladex or anti-androgens like Casodex - and how long after the end of the radiation treatment will you continue to use them? - see follow-up actions and the comments about Casodex in web page 3.

5. How many prostate cancer patients have you treated in the last year and what do you think the outcome of my treatment will be?
(This is always worth asking to establish the general level of expertise of the clinic or hospital. The response to the second half of the question can also be revealing about the general awareness and competence of the consultant. Not all consultants and hospitals have a high level of experience and success in treating prostate cancer.)

Follow-up actions during and after radiotherapy.

1. If you show no signs of significant side-effects towards the end of your treatment, ask to re-examine the proposed overall dose. If you are receiving 74 Gy in 2 Gy fractions, it might be possible to increase this to 78 or even 80 Gy - (see web page 4). You should be conscious that you will be increasing the risk of developing late side effects - particularly rectal bleeding. However, you should be able to discuss the balance of risk with a good consultant using some of the results given in this web site. If you are diabetic, this fact should be included in the discussion - see web page 6.

2. After treatment, measure PSA every three months and be aware of the possibility of PSA bounce at around two years after treatment - see web page 7. The PSA behaviour after the radiation will be strongly affected by hormone use.

3. If the first couple of post-radiotherapy PSA measurements seem satisfactory, the possibility of shortening the period of adjuvant therapy should be discussed. The trial data shown in web page 3 suggests that the main benefits of adjuvant hormone therapy can be achieved in as short a period as two months. A more conservative period might be between six months and a year - see web page 3.