Radiotherapy or Not ?

[Chubby42]

Hi people, just had my first appointment with the urologist since having my prostate removed 6 weeks ago, my PSA reading has come back 0 for cancer but as the cancer was medium aggressive and that it was almost reading to break through the prostate wall the urologist has suggested a small dose of radiotherapy around the area near where that cancer has caused the lump on my prostate.

He said this may kill any cancerous cells if any that may still be around that area.

Has anyone else had this ? am I better off waiting to see if the cancer comes back first or should I go ahead and have the radiotherapy now and hope it kills off any cancerous cells remaining if any.

Also does having radiotherapy now effect my chances of using radiotherapy later on down the road.

Any help would be great 

Many thanks.

Gary

[Grahammd]

I would go ahead and have the radiotherapy waiting may make it more difficult to cure. The methods for radiotherapy nowadays are very accurate and shouldn't cause any side effects.

[Chubby42 in reply to Grahammd]

Hi Grahame, that's sort of what I'm thinking do it now and possible cure it, otherwise I could be chasing it later on down the road.

I also hope by having a shorter course in radiotherapy my reduce any side effects as well.

Cheers many thanks 

Gary

[BerkshireBear in reply to Grahammd]

I second Graham's comment.  Be very aware that great advances have been made in the radiotherapy machines, and continue to be made -- particularly in their ability to be finely focused, which limits collateral damage.  I suggest you seek treatment at a facility that has very new equipment with the finest focusing capability. 

[GARunner]

Obviously the choice is yours and I can only relate my own experience with a similar situation.  My post surgery pathology showed Gleason 7 (4+3) with 5% Gleason 5 with cancer on multiple parts of the margins, one seminal vesicle involved and perineural invasion.  No radiation was done because the Decipher DX genetic test showed I had low-average chance of metastisis.  My PSA was undetectable for 17 months and has now risen to 2 Consecutive PSAs of 0.2 which is considered biochemical recurrence. While one can never second guess their decisions, it would seem I should have looked more seriously at adjuvant radiation.  The 3 doctors that have consulted have pretty much said I should have had it followup radiation.  The decision not to was a joint decision between the surgeon and myself.  I now have to deal with the suggested possibility of 39 sessions of radiation over 8 weeks and possible hormone therapy.  I wish you the best of luck.

[Chubby42 in reply to GARunner]

Hi GARunner thanks for your reply this is part of the reason for asking to get others experience sorry to read you may have to have a full course of radiotherapy hope it all goes well for you mate, obviously there are no guarantees for me either but by having this  shorter course of radiotherapy now i am hoping i may not need a longer one down the road also i still need to talk to the Oncologist before making a final decision.

Cheers and thanks again 

[JoelT]

Gary,

It is helpful if you would share more information about your cancer.  Specifically, what was the result of the pathology from the actual surgery.  Also, did the pathologist say that the lump on the prostate gland was an actual prostate cancer tumor?  How close to the margin had the cancer been that had almost broken out?

Sometimes, radiation is given after surgery for men with high risk disease (positive margins, seminal vesicle invasion, positive capsular extension), even in the absence of a PSA rise. If you did not get radiation immediately, doing so later based on a rising PSA is often reasonable.

I am not recommending that you do or don't have radiation, but you should know that despite the better targeting we are now able to do, radiation is not necessarily without side effects.  Despite the better targeting and better computers sometimes there is damage to other nearby tissue (the most common side effect reported) which can cause bleeding and pain. 

There is also beginning to be evidence that radiation does increase your risk for a secondary cancer. 

All this is not to say that you should not have radiation.  In your case it very well might prevent any chance of having a prostate cancer recurrence, which might not be able to be eradicated.  It also might be an over treatment that could  leave you with unnecessary side effects.

The decision to move a head with radiation is just as hard as when you made your initial treatment decision.  Take your time, learn more about the risks and the possible rewards of radiation at this time.

Joel

[Chubby42]

Hi JoelT sorry i don't know the results of the pathology at this time maybe the oncologist will give me this information when i see them, the urology Dr said the lump on the side of my prostate was cancer and was pressing against the prostate wall and wasn't far off breaking through sorry i don't know anything else apart from that my cancer was not a slow or aggressive but inbetween so i was at a slighty higher or medium risk of it returning due to the lump almost breaking through even tho my blood work said my PSA was 0 they still think it could be beneficial for me to have a short course of radiotherapy to try and kill off any cells that may have cancer near where the lump was.

Thanks for your help but i don't know anything else apart from my pre op PSA & Gleeson scores.

Cheers

[ng27868168]

LISTEN TO YOUR DOCTOR!  He's the expert.  Cancer is not a cold.  Cancer is cancer, and cancer kills. 

[ng27868168]

Meant to add before submitting...., once the cancer is outside the prostate, it's a WHOLE DIFFERENT AND MORE SERIOUS BALLGAME.  You have been given a chance for a cure.  Don't waste it!  As a facilitator for our local PC group, I have heard more than one man say;  "if I would have known then, what I know now......."   

[Chubby42]

Hi ng27868168

Thanks mate yep I understand and having this forum to go to for us new people is such a great help and I don't won't to miss this opportunity either.

Many thanks

Gary

[ng27868168 in reply to Chubby42]

You are welcome Chubby42.  And please use your experience to help others who may be asking you for advice down the road.    This is a great site.  I wish it would have been around when I had questions.  Good Luck, buddy. 

[Chubby42 in reply to ng27868168]

Hey ng27868168

I will do for sure many thanks.

[Dr_WHO]

Thank you for starting this discussion.  The timing is perfect for me.

I am three weeks post surgery and will have my first post PSA will be next week.  The surgeon stated that he did not think he got all of it.  The path report said it was/is ductal (G 8, T3n1), and is considered both rare and aggressive.   I saw the radio oncologist a couple of days ago and he brought up the possibility that, due to its aggressive nature, I may want to have a mixture of radiation, hormonal and chemo no matter what the PSA level.  His point is that it is probably still in me no matter what they measure.  In any case,  my PSA was low when they first found the cancer.   I do not have confidence in this test.  

At first I was more of a wait and see.  Reading the above comments I may go ahead with treatment no matter what the PSA states.

[Chubby42 in reply to Dr_WHO]

Hi Dr Who I look at it the sooner I do something about it the better off I may be, in my case if having this short course of radiotherapy now kills off the cancer cells then I'm better off then chasing the cancer later on, I'm sure everyone is slightly different but it sounds like your Oncologist is pretty much telling you the same thing mate.

Let us know how you get on, I'm still waiting for my oncologist appointment.

Cheers

Gary

[Chubby42 in reply to Chubby42]

Hi guys thanks for your replies and advice still unsure about this clinical trial as its no longer a short course but 6weeks of normal radiotherapy the same as if the cancer had returned, my wife, family and friends are worried about the possibility of permanent side effects like bowl incontinence as there is still a chance my cancer may never return and i could be having this treatment when not needed.

I have also read having a good diet fruit & veg etc and cutting out sugar would also help to reduce the risks plus taking of vitamins to boost my immune system may also help, at 55 im not sure im prepared to accept permanent side effects even i could live 5yrs of normal life before the cancer returns maybe an acceptable compromise seeing as they can't guarantee having radiotherapy now would stop it from returning anyway.

Such a tough choice.