a dilemma...

[ixolib]

RALP 6/28/2021

3+4=7 (70-80% Gleason 3 & 20-30% Gleason 4), T3A, N0, SV0, Neg Margins, Positive for capsular extension

I was recurrent with PSA at .2 six weeks post RP and .5 by mid November. As of last week I was at .6

Axumin Scan showed no regional or distant metastasis as of last week.

I should have begun SRT and ADT by now but since surgery I have been dealing with severe and painful chronic constipation because of my sigmoid colon. In an effort to resolve the issue over the last two months before SRT (the concern is that radiotherapy will compound the problem) I've undergone pelvic CT, MRI, and a colonoscopy all of which revealed a circumferential thickening of the sigmoid which may or may not be the result of surgical adhesions and what is called a tortuous sigmoid.

I then had a referral to a colorectal surgeon where I thought we would discuss lysis to free the colon of adhesions but he is of the opinion that my colon is simply diseased and his recommendation is a sigmoidectomy prior to radiotherapy. This will result in delaying SRT even longer obviously and no one has an opinion for me on when the resectioned colon could then be safely exposed to the same radiotherapy that concerns me currently.

After the consult with the surgeon the GI doc gave me a script for Linzess to try and help with the symptoms and it has improved my condition in that it has completely eliminated all of the pain (it was severe stabbing pain every time my colon distended from gas) and I am able to evacuate within a couple of hours after taking every morning. It is like doing a miralax prep each morning but without the time consuming drinking and waiting.If I didn't need SRT I would never consider the surgery because my QOL now with the Linzess is a favorable one.

So at this point I am considering moving ahead with SRT without surgical intervention. But I wonder if I am making a mistake. I started Casodex last week ahead of my first Eligard injection next week in anticipation of PSA flare all in an effort to keep me in a sort of flight pattern over this dilemma I have to resolve.

Of note prior to surgery I was as regular with bowel functions each day as one can get. Never had an issue with it but I have had diverticulitis in the past most recently in 2018 which was painful as well. My preference is to move ahead with SRT and get it out of the way. The velocity of my PSA rise is worrisome and I am not convinced the ADT will "keep the cancer at bay" until post surgical healing will allow me to begin radiotherapy.

I would most appreciate if those who have completed SRT could share if they had negative experienced with bowel function as a result of it.

Many Thanks

[Tall_Allen]

ADT will certainly keep your cancer from growing while you settle those other matters. Why do you believe your cancer will not respond the way it does for everyone else? At your PSA and with your PSADT, you will certainly need short-term ADT anyway.

[ixolib in reply to Tall_Allen]

I do believe it will respond to ADT and don't understand your question Tall_Allen.

[ixolib in reply to Tall_Allen]

Sorry Tall I see I reported what my MO said about keeping it at bay and my doubts or concerns really about that. The reason is until SRT has been done I am reluctant to have surgery in the area of the rectum/prostatic bed because I've read how adjacent surgical procedures can disrupt natural barriers that contain the tumor cells and they can become breached enabling cancer cells to escape their original confinement and spread to other parts of the body and that surgery induces immune suppression while initiating an inflammatory cascade that provides cancer cells the ability to propagate. Also the surgery requires a Urologist to place stents in both ureters for some reason.

I've read how debilitating it can be if the rectum is negatively impacted by SRT but I don't know how common it is.

[Tall_Allen in reply to ixolib]

So you want to begin ADT+SRT before you take care of your rectal issues? Does your RO agree to that?

[ixolib in reply to Tall_Allen]

My RO states that their patients rarely report negative outcomes in the colorectal area during or after SRT. So he is willing to proceed but the risk of compounding the problem does exists however and that is the dilemma I face. I did a search on here looking for SRT with negative outcomes for bowel function but I’m not seeing much. Thanks

[Justfor_]

Have you read my Bicalutamide maneuvers post?

[Channelhomec]

Did have some minor bowel issues seemed like hemorrhoids after 6 months went away. Had colonoscopy every thing ok psa started rising slightly 2years after srt 0.06 now