RP, Salvage Radiation with Ulcerative Colitis

[Fortysstyle]

After three years of having an undetectable PSA, I am now detectable at 0.1. Is there anyone in the group that has had a RP, salvage radiation, and also has ulcerative coilotis? I am in that place now, and the radiation oncologist does not want to perform salvage radiation because they can’t install the necessary protective gel barrier, SPACEoar, due to the prostate being removed. I am being advised that the damage to the rectum and colon would be significant and permanent. I am hoping to hear techniques not widely know, any ideas and alternative options. Otherwise, it is ADT and eventually castrate resistant. I am hoping to delay that. Many thanks.

[Tall_Allen]

In this small trial, primaryIMRT radiation did not have an impact on inflammatory bowel disease:

prostatecancer.news/2016/08...

But I agree that it is riskier with salvage radiation. You might try to find an RO that uses MRI-targeted radiation - either Viewray MRIdian or Elekta Unity. That will minimize radiation to your bowels.

[Fortysstyle in reply to Tall_Allen]

Thank you, TA. I will take a look. I am meeting with the RO in a couple weeks.

[Justfor_]

Will give you some numbers as vaguely mentioning "cure" is plain BS. Cure is considered as 5 years without any further treatment nor PSA progression. Your GS of 9, on average, translates to 20% succes rate. At your age it is more than certain that it will, earlier or later, come back. Do your due diligence on whether the early and late toxicities of irradiation are worth the gain. I did mine and decided to keep irradiation as the last resort. I am maintaining my PSA at the limits of detection (no silly undetectable <0.1 - detectable 0.005 to 0.026 for the latest 10 monthly counts) taking a miniscule dosage of Bicalutamide.

[Fortysstyle in reply to Justfor_]

You are fortunate that your PC G9 continues to be managed, taking only a small dose of Bicalutamide. What is the dosage? I like the idea and will talk to my oncologist about this. My experience is that they see a benefit to using radiation first to delay the start of ADT and the onset of castrate resistance. Thank you.

[Justfor_ in reply to Fortysstyle]

Current dosage is 75/14= 5.35 mg/day, approx. 1/10 of standard dose i.e. 50 mg/day. I may lower it a bit shortly as it drives my PSA lower than my liking. If you want to know more, check my thread: "An engineer's Bicalutamide maneuvers". Your oncologist will probably freak out on your mentioning. Good luck.