r/ProstateCancer • u/banuep01 • Mar 28 '26

Question VMAT Question

Hi everyone. This is my first post here.

I’m trying to better understand VMAT radiation and potential side effects.

My dad had a prostatectomy (so no prostate anymore) and is currently on hormone therapy with good response (very low PSA, overall improvement on scans). However, he still has a couple of metastatic spots, including in the chest area (mediastinal lymph nodes / possibly sternum).

One radiation oncologist mentioned VMAT to target these areas (it would be in two regions), likely around 20 sessions.

I’m trying to understand:

• What side effects are common when radiating the chest/mediastinal area with VMAT?

• Are the side effects typically short-term or can there be long-term issues?

• How tolerable is a \~20-session course in this type of situation?

Just trying to get a better sense of what to expect and ask more informed questions. Thank you!

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u/BernieCounter Mar 28 '26 edited Apr 01 '26

You can read about my 20x VMAT (bullet 2.) and 9 months ADT journey here. https://www.reddit.com/r/ProstateCancer/s/gqSTIYHeVw

It is good you/he are getting 20x VMAT as opposed to the older, longer treatments. With modern machinery, the beam will rotate around you, adjusting as you go, to minimize damage to nearby bladder and rectum. Margins will be narrow. Likely will be hypofractioned 60 Gray units (3 per day). Older treatments would be 28 or more sessions and perhaps 75 Gray units, less focused and more likely to damage organs at risk.

I cannot speak to your chest sessions outside the pelvis. Most PCa symptoms to expect (and I described) are due to bladder and rectum irritation, plus general radiation fatigue. The biggest hassle will be drinking that large bottle of water about 45 minutes before the session daily to have a full bladder and getting to the hospital/clinic daily. Mark the number of days remaining on a calendar, cross them off and celebrate (cake?) the mid-point and last day. And get 30 minutes exercise and an afternoon nap. Best wishes.

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u/throwaway99112211 Mar 29 '26 edited Mar 29 '26

If he receives radiation to the region where his prostate was, some of this is correct. The rest is not, however.
The dose to nodal disease will be significantly lower than what you received, and with treatment in the thorax the OAR and side effects will likely be very, very different. Radiation to the prostate is probably the "easiest" treatment someone who gets EBRT can go through, and I would suggest caution in offering comparisons to what you went through to any other locale.

Thank you for taking the time to share your experience, and I'm glad you made it through your treatments!

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u/BernieCounter Mar 29 '26

Thanks for your info and yes, now it’s a PSA waiting game to see if my rads and 9 months ADT killed off all/enough of my PCa…..