Advanced Prostate Cancer
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3 Weeks post Robotic Protectomy

Good morning and Happy New Year fellow fighters- I am 50 years old and 3 weeks out from surgery. My PSA is 0.28 and the plan is to hit me with Radiation and hormone therapy in 3 months. I had positive margins of the urethra up to the bladder neck. My doctor says it's an aggressive type of cancer, not the slower growing type. I have most control of my bladder function and am out and about for the most part. I only wear the Depends at night and use just 1 light shield during the day. I am back to work and am good for pretty much the whole day.

Does anyone have any comments on what I can expect physically during and after radiation and hormone therapy? (still waiting on genetic tests for exact treatment/drug plan)

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You will not necessarily have that much change. I didn't have much trouble before I had a spinal cord compression from a PCa tumor. If you have more trouble, you could have a uroevaluattion. Possibly you'll be given physical therapy including the use of biofeedback.

Radiation never kept me from going to work, but some guys don't find it that easy. I retired before hormone therapy. I never had intense fatigue until Xtandi (not as bad on 3 softgels as on 4).

Depending on how long you are on hormone therapy, you can expect it to kill your sexual desire & functioning. I found that I still had desire for my wife, & had the best possible system for artificial erections installed so that we could continue our sex life. Even without that, there's nothing to stop you from continued intimacy--from continuing your romance, continuing to stimulate your partner sexually, or from receiving pleasure from stimulation of your external nerves.

Good luck & Happy New Year.!

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Thank you Neal. I appreciate the feedback. I hope you are doing well in your fight.

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Welcome! Good to know that @ 50 you have the right 'fighting instinct' to begin with, that you have at once seen our fighters' barrack. Yes, we have many of them, very good fighters!

When I look at your treatment schedule, I am glad to say that you have been placed on the right track - a multimodal treatment strategy for your aggressive cancer. I assume yours is Gleason 9 or 10. You have not given your PSA before surgery and the cancer Staging ( TNM ) after surgery - Tumor ( within or spread ), Lymph Node involvement and Metastasis ( spread to other places.

I was diagnosed in March 2015 with high grade PCa Gleason 9, T ( within ) No Mo and positive surgical margins. Followed the multimodal treatment strategy RP ( surgery ) + IMRT( Radiation) + ADT ( hormone therapy ) for 2 years. I hardly experienced any side effects from these treatments. But this RP ( if nerve bundles are not saved ) and the ADT will make one virtually impotent. In my case completely impotent but I am nor worried since my age is 71. For you this can be a concern @ 50 and there are ways and means of maintaining sexual powers against these treatments. Hot flashes and the loss of muscle mass including breast enlargement are common to may undergoing hormone therapy. Get the state of the art IMRT - intensity modulated radiation to avoid radiation induced side effects. All in all you must have an excellent team : Urologist, Radiation Doctor and Oncologist specializing in PCa.

The result of the aggressive multimodal treatment regimen I have followed has been excellent. My PSA at the time of surgery was 9.7ng/ml but Adv. PCa of GS9. Two weeks after treatment PSA fell to undetectable and remaining ever since at 0.008ng/ml up to now. My 2 years ADT was completed in January 2017 and I am not taking any treatment for my PCa at present. I check my PSA every 3 months.

I hope you will benefit by looking at my experience and will keep to your treatment schedule and courageously tolerate any side effects of the cancer drugs with the important GOAL in mind - It is a fight against a dangerous beast for your own survival.

I wish you good luck and a very Happy New Year!

Sisira

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Thank you Sisira - my PSA was 15.8 prior to RP. Gleason9 T3b.

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TCP

Everyone has a different response to ADT and SRT . It’s really important to hire an RO who treats PCa frequently because the prostate bed is adjacent to the rectum and bladder which need to be protected from radiation as much as possible. You must not start RT until you’ve recovered full continence. From RT you can expect fatigue after a few weeks and perhaps constipation and or diarrhea but it all goes away after RT is completed. Rectal proctitis is not uncommon. Depending on the aggressiveness of your PCa, up to 18 months of ADT is appropriate . Most common side effects include fatigue, hot flushes, joint pain , bone loss and breast enlargement. To combat these , exercise is very important for fatigue and joint pain and I use estradiol patches for hot flushes. Vitamin D3 and calcium as well as prolia help combat bone loss. Peridic bone density scans and blood tests are necessary to check the impact of ADT on your body. Your RO should know all this .

Good luck

Bob

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Bob, Thank you for your insight. Thank you for taking the time to respond.

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