Whole pelvic radiation after testicular cancer?

[Adendino]

My husband is 63, dx Oct/2022 with PSA of ~11 and all twelve cores positive with GL 8 and mostly 9’s (4+5). He had SVI, PNI, and probable ECE, but PSMA PET showed no spread. He’s being treated at UCHealth/Denver CO at their urologic cancer center. His treatment consisted of 39 radiation sessions + 2 yrs of Lupron + Abiraterone/Prednisone. He’s extremely active, works out almost every day and we still mountain bike and hike all over our beautiful Colorado. He mostly feels really great with little side effects from the radiation, and he’s managing the ADT side effects with such grace and positivity, despite the changes in his body. We eat fairly clean and he practices mindfulness daily. His PSA is currently .04 and we’re almost a full yr into this journey.

The radiation team suggested AGAINST whole pelvic radiation as part of his treatment plan because he had testicular cancer 25 yrs ago and we (or the hospital) don’t have records which show which lymph nodes were targeted after his partial orchiectomy way back then. His recent radiation treatment only hit the prostate, the seminal vesicles and some margin around the prostate but no lymph nodes. I keep reading how whole pelvic radiation is key. My question is… if a lymph node was previously radiated prophylactically for testicular cancer, can it still become cancerous from prostate cancer???? Or, can we assume it’s been nuked and is dead and can’t get cancer? I understand why they don’t want to overdose his lymph nodes with potentially double radiation, but I fear we missed an opportunity to hit it hard initially with whole pelvic radiation.

Thanks to all of you for sharing your stories, your insight, and your strength. You truly are amazing and inspiring to those of us who love and cherish you.

[Tall_Allen]

I would think it can't become can't become cancerous, and areas treated 25 years ago are probably fully recovered anyway. But I understand their caution.

[JWPMP]

My husband had identical experience 32 years ago. Now being treated at UCSF and they also wouldn't do extensive radiation due to the RT previously and lack of detailed records. Am astonished that it could be too much toxicity after all these years. Dr Mohamad (who has recently relocated to MD Anderson Houston) ran several scenarios and also consulted Mack Roach. They wouldnt do the pelvic nodes or pelvic bed. I've had the same fear/disappointment you express. They did do HDR Brachytherapy to his prostate and seminal vesicles only. He has been almost two years undetectable. Don't know if that helps.

[j-o-h-n]

My advice is don't ever take mine.........

As far as me being truly amazing and inspiring to those who love and cherish me, my advice is that I agree.

Keep on asking your question(s) there are more answers out here.........Bless you and keep biking.....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/22/2023 10:45 PM DST