side effects of SRT

[Doggydad]

RP 6/2023. Now with a reoccurrence in 8/24. PSA went to 4.4 in 8 weeks. PSMA scan shows a small up take on a pelvic node. Put on Eligard shot Turned over to a RO for SRT Looking to find out is this a must and how bad are the long and short term side effects of SRT

[Justfor_]

IMO the risk reward ratio is not favourable and it should be kept as a last resort. Risks include radiation proctitis and/ or cystitis and in the distant future ( 10 years +) a second cancer. Claimed incidences are of the order of 10% (5-15%) but they are for life. Reward is 5 years of no PSA rise for the 50% of all patients, going down to 20-30% for the high risk ones like yourself. You may do your due diligence.

[Tall_Allen]

You are seriously questioning whether being cured is better than suffering from painful and crippling metastases?

[Doggydad in reply to Tall_Allen]

Hi. Thank you for the response. Im looking at 8 weeks of SRT. Just a bit nervous of side effects Supposed to be SRT to pelvic area and the node

[Doggydad in reply to Doggydad]

Hi Tall Allen I’m on the Eligard for four weeks now. Is that enough time to start SRT soon. Not sure Looking around some people say 2months prior to SRT. It’s was a 3 month shot. With another after SRT

[Doggydad in reply to Tall_Allen]

Hi Tall Allen. Did you originally have surgery. And did you have SRT too? If so what type of side effects from SRT. Seems like you have a ton of knowledge

[Tall_Allen in reply to Doggydad]

No, I originally had radiation (SBRT), which cured me.

[dans_journey]

Hi,

I had a RP in 2011 that failed (Gleason 3+4, negative margins, no LNI, SVI, ECE) and SRT with concurrent ADT (also Eligard) for 35 sessions (70Gy to the prostate bed only) in July and August 2022.

Going into SRT, my PSA was 0.36; it hit a nadir of 0.11 about 9 months after SRT ended; and it has continued to climb ever since until it hit 0.69 last week.

During the SRT, side effects included fatigue that kicked in about halfway through the 35 sessions and lasted for about 4 weeks after the sessions ended; increased urinary frequency and urgency; and I had minor skin irritation (itchiness) at the zapping site.

About five months after the SRT ended, I noticed a change in my bowel habits. I had been a one bowel movement a day kinda guy, but I found myself having 2-5 BMs a day for about a two month period. Fortunately, that calmed down and I'm back to 1-2 BMs a day now (27 months out).

Recently, though, I have noticed hints of blood in my stool, which I believe is one of the possible longer term side effects. Even that has decreased over time, and I see it in my stool about 5% - 10% of the time. I have appointments with my primary care physician and urologist in the next 2 weeks and will discuss it with them. I also emailed my radiation oncologist to get his insights, and am awaiting his response.

Fortunately, I don't have any mucus discharges or diarrhea at this point.

Tall Allen is a vast fountain of knowledge on this platform, and his insights have been valuable to me over the years. However, in this case, I believe he is being overly optimistic that SRT can be curative. Even my RO told me that the chances of this being curative were about 50-50.

From the study linked below:

"The estimated 10-yr cumulative incidence of BCR was 60%. Of the 274 men experiencing BCR, 149 (54%) had BCR within 18 mo of SRT."

pubmed.ncbi.nlm.nih.gov/311...

At 27 months out, I'm probably more in the "medium-term" side effects category. Others who may be 4 or 5 years out may offer better insights to us both.

One other thought. I really wanted to know where the cancer was located before starting SRT. I wasn't keen on the idea of blindly zapping based on statistical locations. I went for a PSMA PET scan when my PSA was 0.22, and it was inconclusive at that level.

Because the rate of increase in my PSA shot up after the PSMA PET scan, I agreed to move forward with zapping the prostate bed.

After the SRT appeared to fail, I had a second PSMA PET scan when my PSA was 0.37 and it, too, was inconclusive. With my PSA now at 0.69, we may try one more time. (PSMA PET scans have about a 90% chance of detecting lesions when your PSA is 1.0 or greater.)

Medical oncologist, Dr. Mark Scholz of the Prostate Cancer Research Institute, recently said there's "“a huge advantage of knowing where the cancer is and allowing the radiation therapist to target that spot” and:

"It’s quite tempting in many of the cases that I see to allow the PSA to go a little bit higher knowing that that 0.5 threshold [used by radiation therapists] was set at a time when we didn’t have scans and we didn’t know where the cancer was. There’s such an advantage of knowing where the cancer is and allowing the radiation therapist to target the disease that I tend to liberalize a little bit and allow the PSAs to rise above 0.5 if necessary."

dansjourney.com/2023/11/14/...

Clearly, you've already had the scan and the RO will know exactly where to zap, so perhaps in your case you may have a better chance of the SRT being curative.

I would be asking the RO if there is a need to zap the prostate bed at all if the scan showed cancer only in the lymph node. If that's the case, you may be able to avoid some of the side effects associated with zapping the prostate bed.

I believe it's definitely worth having the conversation of the RO and going from there.

All the best.

[NanoMRI in reply to dans_journey]

I learned from first hand experiences it is not possible to know if scans identify all the cancer.

Nearly seven years ago I consulted with Scholz on the findings of scans I had done in Europe, I reman grateful I passed on his recommendations - he was very wrong.

I act well before 0.5.

[dans_journey in reply to NanoMRI]

I agree about scans being unable to identify all the cancer. Just because a hotspot shows up on a scan doesn't mean that that there aren't microscopic cancer cells floating around elsewhere.

If you don't mind sharing, I'd be curious to know what Scholz's recommendations were in your case (I read your summary in your bio). I appreciate his efforts in educating men on PCa, but I don't always agree with his approach to some things. (I've never consulted with him, so have no first-hand knowledge.)

Thanks,

[NanoMRI in reply to dans_journey]

Appreciate the dialog. Looking at the Scholtz quote you cited - there's “a huge advantage of knowing where the cancer is and allowing the radiation therapist to target that spot”. I learned first hand tumors can be missed by PSMA PET CT - not just 'microscopic cells' you cited. When this happens the radiation therapist will not hit all the 'spots'.

Nearly seven years ago I was referred to Scholtz by imaging center in the Netherlands where I had both PSMA PET CT and Ferrotran nanoparticle MRI, done at uPSA 0.13. Although the PSMA PET CT was clear the nanoMRI correctly identified multiple cancerious pelvic lymph node mets including para-aortic.

When I consulted with Scholtz he was well aware of the capabilities of the Ferrotran nanoparticle MRI - but have you ever heard him mention it in any of his many many videos? I have not - why not?

In his written consultation report (to me) Scholtz had several (wrong) recommendations. His most stunning recommendation was that I should return from France to Austin, Texas to have another PSA test from "the same lab"; this after the successful imaging. He categorically rejected my interest in salvage extended pelvic lymph node surgery in favor of non-curable cocktails that come with serious SEs.

As I share, I choose salvage extended pelvic lymph node surgery with the frozen section pathology method. Seven years later my uPSA is holding very low stable 0.02X - 0.03X range, NED based on multiple imaging methods and it seems liquid blood biopsy testing. This is without ADT. Are there likely 'microscopic cells' or cancer cells by other names floating about, yes; I never presumed I was cured. Since my Dx ten years ago my intent has been to, if it comes to it, to defer ADT and thereby likelihood of CR for as long as possible. Scholtz remains anti-surgery and leans very heavily to his ADT biases. Had I gone with ADT as he recommend might I be CR today?

[dans_journey in reply to NanoMRI]

Hi Murray,

Thanks for taking the time to reply with such detail. I appreciate it. You've introduced me to a few new things that I'll need to check out and discuss with my team at my next appointment on 14 November.

I wasn't aware of the Ferrotran nanoparticle MRI and its capabilities. Doing a quick search, it seems quite impressive in what it can detect.

Like you, I've never heard Scholz mention it in any of his videos, and I get slightly annoyed when he hypes up PSMA PET scans as much as he does. Yes, they're an improvement over some of the earlier technologies, but the two that I have had have yet to show anything conclusive at PSAs of 0.22 and 0.37. I'm beginning to wonder if I'm in that lucky 10% of patients for whom PSMA scans aren't useful.

Like you, I'm in no rush to get on ADT for the same reasons—the side effects and getting to castration resistance earlier than need be. Even in my early conversations after the SRT failed, the medical oncologist said she would start ADT when my PSA hit 2.0; the urologist wants to wait until metastases.

Before that, I want to push for additional imaging to see if we can figure out what's going on and where, and then make decisions based off of that information.

Thanks again for your insights, and hopefully your PSA will continue to stay low for years to come.

[Doggydad]

Thanks for your reply. Yes he is wanting to zap the bed too. Thinking microcells ..He is thinking regional to pelvic area. Question to you is are you able to have a normal daily routine through they therapy tIme ,Work schedule yard work etc? I’m 61

[dans_journey in reply to Doggydad]

Hi,

I was 64 when I did the SRT and Eligard. I received the Eligard injection 2 months before we started the SRT, and I noticed that that had me firing on 6 or 7 out of 8 cylinders when it came to fatigue. It was a nuisance, but I was still functional.

When the added fatigue from the SRT kicked in about halfway through it, it became more challenging to get through the day. Fortunately, I was retired at the time, so if I felt like I needed a nap, I was able to take it. My SRT sessions were scheduled at 9:15 a.m., and mid-afternoons could be tough for me. If I was still working (office job), it would have been tough to keep focus. Yes, I probably could have powered through it, but I had the option to let my body get the rest it wanted.

Also, it wasn't like I was curled up in a ball for 7 weeks. I'd take my 1-2 hour nap and then be quite functional the rest of the day. I suspect we all react differently.

Honestly, one of the worst parts of the whole experience was getting the timing down when it came to drinking enough water to ensure your bladder was full before the zapping. Two or three times, the techs made me get off the table because my bladder wasn't full enough (they used imaging to guide the zapping). Also making sure your bowels were empty before zapping was important, too.

I hope that helps.

[Doggydad in reply to dans_journey]

Appreciate the response. Yes that helps for sure

[NanoMRI]

An all too often outcome that is too often overlooked is that the cancer is already outside the treatment field so the treatment is unsuccessful. This happened to me.

Short term side effects that pass with no chance of recurrence are tolerable and I would say well worth them if 'cured' and certainly tolerable even if not cured. Mine were limited to one single bad day.

From the RT I developed ureter strictures that trapped a 1mm kidney stone requiring surgery. I have altered my diet in hope of avoiding further stones and surgery.

Another overlooked outcome is that the exposure to the radiation limits future treatments. I now face metastatic melanoma and have to consider additional RT very carefully.

An alternative treatment method that is rarely discussed here in US, which I had nearly seven years ago, is salvage extended pelvic lymph node surgery using the frozen section pathology method.

[Doggydad]

Wow! Seems like everyone has different side effects and gets thru them differently. I’m hoping that you are all doing well. This is a true journey for everyone Thank you