Adjuvant Radiation After Prostatectomy Question

[Fox2018]

Looking for input from those of you who needed radiation after your radical prostatectomy. What type? How many times did you have to go? How often? Anything else you can add will be appreciated.

Mike

[Tall_Allen]

it's usually 38-44 treatments, but there have been experimental protocols of 26 treatments:

pcnrv.blogspot.com/2016/08/...

Here are questions to ask your radiation oncologist:

pcnrv.blogspot.com/2017/12/...

[Fox2018]

Hi Nalakrats,

Too soon - just had the surgery 2 days ago. I will provide details when I get post removal details.

Thanks,

Mike

[DFL208]

I had adjuvant radiation in May-July, about 12 weeks after my RP. I went 5 days a week for around 8 weeks for a total of 42 sessions. The process is very simple. They made a mold of my body contour before my first session and a couple of dot sized tattoos so they can line you up the same position every time. The session was lying down on the mold, getting the machine lined up, and the radiation machine was on no more than 2 minutes or so. I went in the morning right after rush hour and had the rest of the day to do work from my job. I felt fine the whole time. The main challenge is that I had to have a full bladder for every session. It was hard to have the bladder as full as they wanted it and not be very uncomfortable. The standard routine was to rush to the bathroom after the session. The only side effect I had is that I had very good continence after surgery and the radiation set me back a bit on that. I would note that I ate very healthily during this time and made sure my bowels were regular and emptied before the radiation sessions. I know everyone is different, but my experience was very positive.

[Ramp7 in reply to DFL208]

I waited about a year after RP, when my PSA was 0.10. Very similar experience as DFL208.

[harryb48 in reply to DFL208]

I had radiation treatments about six months after RP, I believe it was termed "salvage radiation" A total of 39 treatments and as you stated the hardest part was showing up with a full bladder. I had a 35 minute drive to the radiation site and found that consuming a 12 ounce bottle of water during the drive was sufficient to fill my bladder, had to go like crazy after the treatment though! No adverse side effects except for a little fatigue at the end of the weeks sessions. I recently had a colonoscopy and the doctor was amazed that there wasn't any damage to the rectal area following the radiation. Six years post RP, now on Eligard and Zytiga, been a hell of a ride!

[j-o-h-n in reply to DFL208]

I kept my mold..... My blow up doll is fond of it... so I can't throw it away.... Geez Women, women, women

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/24/2019 6:00 PM EST

[Fox2018]

Thank you so much for the detailed response - exactly what was looking for. Not sure whether or not I will need it, but I like to understand all options before being faced with having to make a decision.

Mike

[Blackpatch]

Hopefully you won’t need it, but it’s no big drama if you do. In my view, the key issues to determine are the field of coverage and whether or not accompanying short term ADT is required.

A lot depends on your post-op pathology and PSA behaviour, but there is an increasing body of evidence suggesting short term ADT is worthwhile insurance in many situations.

Stuart

[abmicro]

I am NOT a fan of salvage radiation treatment. It is blind radiation that mostly gives you rectal damage. Bleeding can hit you after treatment and 10 to 15 years later more bleeding. I got rectal damage and bleeding even with a light treatment to the prostate area, not full salvage. I bled 15 years later due to permanent rectal damage from radiation in 2005.

If you have an aggressive Gleason, it will probably come back later in a bone somewhere even after Salvage treatment. If your Gleason is 6 or 7, perhaps Salvage is justified because you have a 2nd chance to try and cure it.

Salvage eliminates you from many clinical trials because it radiates too much bone, and you dont even know if it hits the cancer or not.

Some opt to just do ADT drug therapy and wait for it to show up on a scans years later, then spot treat it where ever it shows up. Systemic radiopharmaceutical treatments are also available if it pops up later on a lot of bones.

Early Chemo is an option to salvage radiation.

[marlins1]

Mike I had a similar experience as dfl208. It was well worth the trouble. Really not that bad. I had a BCR 3yrs(.34) after RP and neg scans pre radiation. 39 RT to full field and boost to prostate bed. 6mo of lupron as adjuvent. Whole process was quick and I continued working the whole time. Only had some bowel irritation a few times which resolved one week after completion of treatment. It would seem this is your last best chance for a cure assuming you have localized disease. So go for it..........

[tallguy2]

I had approximately 44 sessions after my RP. Every weekday. Not too bad in terms of side effects. Perhaps some fatigue and one issue when I had spicy food either the night before or the day of a treatment.

[Harley1948 in reply to tallguy2]

I had ART (37 session) due to a positive margin and an EPE with a negative margin. I started ART 3 mos after RP. My psa was and has been <.02. It was an easy process. Gleason: 3+4.

[Fox2018]

Thanks to all who have responded to my request - love you guys!

Mike

[GeorgesCalvez]

If it seems likely that all of the residual cancer cells after a prostatectomy are restricted to the prostate bed then salvage radiation is worth going for in my opinion.

I had 66 Gy in 33 fractions over seven weeks. I used to drink a substantial amount of water a couple of hours before going and then go to the toilet. Making sure that my rectum was empty became easier with time as the rectal irritation kicked in. I would then drink more about an hour so so before going.

When I used to arrive at the hospital I was really full, so much so that sitting was uncomfortable, as soon as they were ready for me I was on the table.

When they had finished I would make a beeline for the loo to unload and several times after that when I got home.

I had no rectal bleeding, my urine stained the Tena pants I wore a little pink at the end.

I had no skin burns either, it just felt a bit itchy at times and I left it well alone.

[Blueslover]

Surgery 2008, one dirty margin, some Gleason 9. PSA undetectable post-surgery and for 4 years afterwards. Then PSA gradually rising.

Salvage reduction to prostate bed. Radiation itself a breeze but after effects not pretty. Gradual loss of ability to have an erection necessitating an implant. Moderate fecal incontinence. Now radiation cystitis 5 years later with uncertain outcome.

Now on ADT for 2 years and handling it well so far. Looking back would have preferred this to the long term effects of radiation.

Hugh

[van123]

Six months after my surgery, I had 26 treatments to kill any cancer remaining in my bed. Going on my 5th year of being cancer free.

[Brianj131 in reply to van123]

I am 51 and 12 weeks post op. I have my next appointment in 6 weeks. I was a Gleeson 7 (4+3) with seminal vessel invasion. Clear margins and no lymph node involvement. I’m afraid my doctor will recommend adjuvant radiation with hormone therapy. Did you have hormone therapy with your radiation treatment? I have no continence problems and hope to gain potency soon (nothing as of yet) so I don’t want to take a step backwards. Sounds like your treatment went well. Just trying to prepare myself for whatever is next.

[kensawyerwayland]

Gleason 9. Surgery in 2011. I was 60. Negligible PSA after for almost 2 years, when it started to creep up. Had 36 sessions of radiation, PSA again negligible until 2017. Cancer metastasized to base of skull. Went on hormone therapy and PSA came right down to next to nothing, where it stayed for almost a year. When PSA crept up again, Radiation again, only 10 sessions and only about 10 minutes each (original radiation was much longer, but I was spared the full bladder expectation others report). PSA dropped again. Now, a year later, PSA has just begun to creep up again, a little; I get it checked every three months with my hormone shot.

[j-o-h-n]

Hello Fox2018, Too soon for rad....

Here is my post from awhile ago:

I've had 39 treatments (8 weeks, 5 days a week minus 1 day). I did NOT have any side effects during the actual "FRYING". However years later it was discovered that my left urinary tract had become scarred/constricted and required many "in and out stents" for my kidney and urine. BTW the in and out of the stents were "a walk in the park". No Pain or discomfort. Rad was done at Memorial Sloan Kettering cancer center in NYC.

Ask radiologist about a rectum paddle for protection...

btw NO MORE STENTS FOR ME....

Just be wary of the damage that Rad can do (even if it's silent).

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/24/2019 5:56 PM EST

[Hidden]

Watch this and reconsider adjuvant vs early salvage RT:

youtube.com/watch?v=GS5Pawg...(Not working as expected?)

Also, read these:

ro-journal.biomedcentral.co...

dailynews.ascopubs.org/do/1...

redjournal.org/article/S036...

[VictoryPC]

I personally know 3 guys doing it this month . Treatments 20 to 40 times. Please advise if you have success. Stay Strong.