Radiation after Radical Prostatectomy with Lymph Node Removal in Non Metastatic and Metastatic Men. Need some answers.

[Shorehousejam]

For anyone following this post, just asking for clarity on the differences and to share your individual experiences.

I had a radical prostatectomy with lymph node removal only 8, negative for pca.

But, found with positive EPE margins, bladder wall, and microscopic bladder neck.

A RO mentioned radiation to prostate bed and left lymph nodes

Will it help me? As I am Oligo metastatic.

What is the purpose to get rid and kill cancer?

To prevent it from coming back but only in these areas?

[Shorehousejam]

 Tall_Allen You are probably getting tired of these questions, however, many men between YouTube videos, Kwon at Mayo, Trials and Physicians offering either one or both…there is a lot of major confusion, especially in chat rooms and messages…hopefully these people have joined and are at least reading these post.

[Tall_Allen in reply to Shorehousejam]

Kwon (who is not a medical oncologist) has no basis for his opinions, which are incredibly uninformed or ignore the actual data. If he presented to oncologists what he puts on youtube videos directed at patients, he would be laughed out of the room. In contrast to his videos, here's what actually happened at Mayo:

Mayo retrospectively looked at 115 patients who had an oligometastatic recurrence to the bones (1-5 metastases):

•115 patients were treated with SBRT. They had a median of 1 bone metastasis.

•47 patients were treated with ADT-only. They had a median of 2 bone metastases.

This was not a randomized study, so it is entirely likely that there was "selection bias" -- those who received ADT-only may be because it was felt they would not be able to benefit from SBRT or that it might be unsafe. Patients who received ADT-only had a higher number of bone metastases and a higher PSA. All of those receiving MDT for bone metastases were also receiving ADT.

• The 5-year prostate cancer mortality was no different between the two groups

• The 5-year radiographic recurrence-free survival was no different between the two groups

Among those with 5 years of follow-up, the time remaining free of the next significant systemic therapy (e.g., chemo, Zytiga, etc.) was longer for those getting zapped. However, it should be noted that the decision to give an additional significant therapy is a physician decision based on many factors, including patient status, number of metastases, and PSA. Because number of metastases and PSA are changed by MDT, and those receiving MDT started with one less metastasis, the physician may feel pressured to start a new therapy sooner in patients receiving ADT-only.

Pending confirmation from long-term randomized clinical trials of MDT to oligometastases in bones, there is no evidence of oncological benefit.

nature.com/articles/s41391-...

(note that Kwon is a co-author)

Now that Mayo is finally getting a good prostate oncologist (Oliver Sartor), I hope they will stop confusing patients.

[Shorehousejam in reply to Tall_Allen]

So, there is no benefit say for myself to radiate the prostate bed, bladder neck and a lymph node area? It wouldn’t help “ get rid of pca in that area? Or trying to get rid of the cancer that I see in my body?

[Tall_Allen in reply to Shorehousejam]

I already told you what is known.

[Shaunjon in reply to Shorehousejam]

I had pelvic radiation for lymph nodes in my groin in 2009. Since then I've went through a hydrocell eventually bursting testicle sack was mini basketball size. Almost bled out, testicle removed. About a year's and a half ago I thought I started experiencing sciatic nerve pain. I worked until I couldnt walk. MRI showed collapsed femoral head left hip. Right femur doing the same thing. it is my opinion/experience that radiation has caused serious bone marrow damage in both hips, avascular necrosis of femurs.i have been diagnosed with avascular necrosis. My red blood cell count, white blood cell an count and platelet count are all low. At 47 years old, without the ability to get up out of bed and just walk, make it to the bathroom in time are very challenging and preventable. Radiation has damaged my kidneys as well. Thank you.

[Justfor_ in reply to Shaunjon]

Very sorry to learn what you are going through, yet, by doing this you offer a valuable service to others. This forum has a strong bias towards irradiation treatments. If someone questions regarding late toxicities, there are numerous posts drawing an idyllic picture of a walk in the park. And they are all genuine, but with one constraint: Responders have not passed the 10-15 years mark post irradiation. Under this light, your post shifts the balance towards it's true epicentre. Thank you very much for this.

[Seasid]

I would like to understand.

What is your treatment now and what is your PSA now and what is your PSA doubling time?

How many visible mets you have now? Are they stable or new once are popping out?

[Shorehousejam in reply to Seasid]

I am stage 4 hormone sensitive oligo metastatic

[Seasid in reply to Shorehousejam]

I assume than that you don't have any visible met on any scan. Did you have psma PET/ct?

Would it be save to sbrt your visible mets?

I am polimetastatic but hopefully still hspc with no visible mets (I hope) on any scan.

What is your PSA and what is your treatment now?

I am on firmagon and last PSA was 0.23 and dropping.

What is your PSA movement? Up or down?

[Seasid in reply to Shorehousejam]

At which PSA did you have your psma PET scan, when was it and did you have any visible mets on that scan?

[Shorehousejam in reply to Seasid]

I’m on Firmagon @ 28 days, Zytiga and Prednisone daily, Metformin 500mg daily,

PSA <0.06

Radical Prostatectomy with 8 lymph nodes removed negative for psa.

3 Lytic lesions resolved

I have not had radiation

[Seasid in reply to Shorehousejam]

In my situation (not yours) I would feel comfortable radiating only my visible cancer either visible Mets or prostate.

I believe that you don't have any visible Mets therefore you don't need to sbrt anything.

Again it is only the way how I feel. If I would get visible Mets or any cancer detected by any scan I would consider radiate it if it is safe to do so. That visible Mets on the scans (if they are not false positive) are probably crpc therefore worth considering to radiate it. You could instead decide to get chemotherapy depending on your situation. That is why we all need good oncologists to help us.

[Shorehousejam in reply to Seasid]

Well my medical Oncologist is of the thought to wait until the psa rises

But studies are showing that radiation after radical Prostatectomy extends survival

I would like to have another pet and have the prostate bed, possibly bladder wall and neck and a piece of fat near a pelvic chain lymph node radiated

My concern as well as my wife would or could radiation set off the pca and cause the psa to rise

Tough decision

[Seasid in reply to Shorehousejam]

If you want you could maybe arrange for a second opinion with the Dana Farber Cancer Institute Radiation Oncologist. You could do it even online by visiting the internet site of that cancer institute. You don't have to do it in person if you don't want to travel.

[Shorehousejam in reply to Seasid]

Great idea, any recommendations?

[Seasid in reply to Shorehousejam]

Contact tango65 if you want more details I am in Australia.

[Shorehousejam in reply to Seasid]

Thank you