Options when adjunct radiation can’t be given?

[Crwatapc]

I am in a pickle. My first 2 PSAs after prostate removal are 0.39 and 3 months and 0.4 at 4 months. My urologist is referring me for radiation oncology.

Even if my PSMA only lights up in the prostate bed, I don’t think radiating the pelvis would be wise:

1. I had 3200 grey treatment 43 years ago to the pelvis area for testicular cancer. Getting radiation would involve another 6500 grey to that area. That would be a double hit to structures like my bladder, colo/rectal area, urethra etc. Potential complications could severely impact quality of life - incontinence, fistula, radiation proctitis etc.

2. Additionally, now close to 5 months post op I am experiencing intermittent gross hematuria ( no risk other that prior radiation). I need a work up - extremely high risk for 2nd gu cancer (bladder most likely). kidney or ureter is possible also. Synchron gu cancers are not unheard of. I never had visible blood in the urine until prostate biopsey and surgery - it cleared after 2 weeks after catheter was removed. Now 18 weeks later it is intermittent back. There is a 2nd cause lurking that was yet to be determined.

Wondering what my best options might be at this point? It is quite possible I may need surgery pending the cause of the hematuria. Gross hematuria in my risk category is due to malignancy in a very large percentage of the casss.

[Tall_Allen]

Tissues irradiated 43 years ago may have healed.

However, radiation may make permanent changes in your prostate tissues, rendering them "sticky" for your prostatectomy, which caused the gross hematuria. You are right that radiation on top of unhealed cuts may make it worse. Your only alternative is permanent hormone therapy.

[Crwatapc in reply to Tall_Allen]

The previously radiated tissues have permanent disruption in the DNA of the cells in the therapeutic field. The incidence of 2nd cancers in TC survivors approaches close to 40 per cent after 35 years after treatment - the most common being bladder, prostate, stomach, pancreas, kidney, and colon.

I think my best path might be either orchiectomy or a medication other than lupron. Right now the immediate bigger threat is the cause of the hematuria.

[j-o-h-n in reply to Crwatapc]

Greetings Crwatapc,

Would you please let us know, your age and your treatment location(s). It's a good idea to update your bio with this information and anything you think is important for future referencing. All info is voluntary but helps you and helps us too. Thank you and keep posting!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[Crwatapc]

I am 64, treatment location is NY