To radiate or not to radiate?

[Sandiego2]

My metastatic prostate diagnosis was established three years ago by biopsy (Gleason 9) and PMSA that showed "innumerable osseous lesions" throughout my skeleton. I was started on ADT and initially responded well. However, my PSA has now risen to 0.7. So my oncologist ordered a repeat PET/PMSA that (happily) now shows active areas only in the prostate itself and in one rib. He considers this "olioprogression" and referred me to a radiation oncologist--who recommends a course of radiation to my prostate and to the rib. However, I am quite afraid about proceeding with this--because my urinary function remains rather poor (hesitation, poor emptying, frequency). But I have been managing with Flomax--and not requiring catheterization. The radiation oncologist tells me that as the course of radiation proceeds, there typically is swelling of the prostate and possibly urethral irritation. I'm guessing I might require catheterization, and this does not seem a happy prospect. Since this radiation would certainly not be curative, would it really be "all that" beneficial. What would it really accomplish? Should I really proceed with it? I'm in a quandary . . . any thoughts?

[Tall_Allen]

Trials have proven there is no benefit to prostate radiation in men originally diagnosed with more than 3 bone metastases.

prostatecancer.news/2018/09...

[Sandiego2 in reply to Tall_Allen]

Thanks so much for your helpful comment/info. I believe I will politely decline radiation ... at least for now.

[HaMoon in reply to Tall_Allen]

wouldn't radiation to the prostate help shrink the cancer there and help with urination?

[Tall_Allen in reply to HaMoon]

His urinary function is already poor, so radiation will make it worse before it gets better. A TURP may be beneficial for restoring good urinary function though.

[Sandiego2 in reply to Tall_Allen]

Yes, exactly, TallAllen. And that's what I fear. I'd probably need to have a catheter inserted to complete the radiation--and get little, or maybe no, benefit from the radiation . . . And yes, a time may come when I will need to get a TURP.

[MJCA]

I understand your quandary. The question you have to ask yourself is: Do I want to live if my urinary function is compromised? I will share. Three years ago I had a hip replacement. The anesthesiologist gave me a nerve block in my spine. Unfortunately, the idiot anesthesiologist severed the nerve connection between my brain and bladder. I had NO choice but to do intermittent catheterization.

Your case, of course, is different. Given that there are lesions on the prostate and a rib, radiation would be your best course of action. I shared my story to let you know that intermittent catheterization is a little difficult at first and doing it in a public restroom may you feel a bit uncomfortable. After a while, you adjust. Best of luck and let us know what you decide.

[maley2711 in reply to MJCA]

SO, you disagree with the study results linked by TA above?

[MJCA in reply to maley2711]

I probably answered without seeing Allen’s answer. I would always defer to his recommendation.

[Lettuce231]

Dilemma, I hope this helps a little. I was diagnosed over 10 years ago, the cancer was found to be in the lymph nodes. My oncologist said he would use radiation if ADT failed. I got a second opinion, he recommended radiation. But warned me of the risks you are facing.

I've been on ADT only, not having radiation has worked for me, I don't know what difference it might have made, a friend of mine had radiation, plus ADT, but the beast returned.

I wish you well and hope that you find the right solution for you.

[jimg51]

Get the radiation. If you don’t trust your doctor, find one you can trust, but do what he/she says. You should do research and question so you can discuss your treatment intelligently, but do what your doctor recommends.

[RCOG2000]

All radiation is not the same. mthe machine that is used and the physician and physicist planning the treatment all vary drammatically. I had a remission lasting 18 years with combination brachytherapy and external beam back in 2000. At that time this treatment was not SOC and widely criticized by surgeons etc. Studies that show radiation has no effect are limited by the machinces used and staff as referenced above studies that ae over five years old likeyl used older equipment. When i had reoccurenc in 2018 i had tw courses of radiation to metastatic areas in lymph nodes. Followed by one year of andorgenn blockade with low dose enzalutemide and lupron. resulted in compelte reaponse on PMSA scan. Psa still undetectable at eight months post blockade. Urinary symptoms have ben minimal at all statges of radiothereapy in my case.

[Teacherdude72]

Radiation for the rip certainly.As to the prostate there as other methods for treatment to ask about

Chryi, heat and recently ultrasound.

[Derf4223]

Are you off ADT now?

[Sandiego2 in reply to Derf4223]

No, I'm still on ADT and will likely need it for life.

[Derf4223]

To radiate or not? It all depends on your will to do what it takes, We are all trying to survive long enough until more effective options are available. Some for whatever reason want short term fun as opposed to risking S/E's and quality-of-life risks. Speaking for myself, I am passionate about controlling what I can, being there for my wife and family, and letting my God take care of the rest. Lots of exercise and a decent diet are my #1 non-negotiables.