Hello All. I am a recently diagnosed 73 year old man. My Gleason score was 3+5=8. The biopsy was done locally in Santa Cruz, California and confirmed by a second reading at Stanford University. I've had an MRI, Pelvis CT Scan and Bone Scan. Both the MRI and the Pelvis Scan indicated no spread outside the gland and the cancer is on one side only. My urologist has recommended radiation therapy for me and I have an appointment with a radiation oncologist on August 9. One of the listed side effects of radiation therapy is fatigue. I would appreciate any opinions as to the severity of the fatigue-is it something that a determined individual can work through to continue exercise and normal activity or is it quite debilitating?
Any information will be appreciated and thank you in advance.
I just finished 43 fractions of EBRT 4 months ago. Yes, you will have fatigue, It will not curtail your normal activities, However strenuous exercise will be something that you will not be able to do. I am speaking for myself, I am sure it affects some men differently. Exertion of any kind caused me to pant heavily. You will also have some issues with burning urinating, at least I did. There are meds that will help you along with this.
After surgery I had 38 rounds of radiation that ended last October. Fatigue hit towards the end of the treatment. I have some slight problems with on and off again rectal bleeding.
The biggest problem I had was maintaining full bladder during radiation. Your bladder is like a balloon. They need it full so that, like a full balloon, it is out of the way during radiation. As I do not have the best bladder control (result of surgery), keeping my bladder full during treatment was a challenge.
Dr.: Thanks for the reply. The more I learn, the better although I would have been happy to have been able to remain blissfully ignorant and not in need of PC information.
After TURP surgery for enlarged prostate years ago I found that full bladder requirement to be a real challenge, given the quantity of water they were suggesting. Silly or not, that was one factor that pushed me to get HIFU instead of the radiation they recommended. No regrets so far, other than the high out-of-pocket cost.
With cancer confined to the prostate, did your urologist discuss surgery? I am used to oncologists favoring radiation, but not urologists, unless there are other health issues.
I had surgery 13 years ago, but it was not effective, so I then had salvage radiation. I don't remember fatigue, but I certainly remember the radiation proctitis that kicked in after the first week. But maybe that happens more with salvage radiation.
Cancer cell resistance to radiation is similar to drug resistance. It starts with the first treatment. There are natural products that may inhibit radioresistance, so that you get the greatest killing effect from the treatment.
"Resveratrol enhances radiation sensitivity in prostate cancer" [1].
Source: [1a].
"Genistein potentiates inhibition of tumor growth by radiation" [2].
"Curcumin sensitizes prostate cancer cells to radiation" [3].
Source: [3a].
Many men with PCa use Metformin. It has been shown to "sensitize prostate cancer cells to radiation" [4].
{Mention a Gleason Score = 8 & most here will think 4+4, but it can also be 3+5 or 5+3. The presence of Gleason Number 5, even in the minority position, makes it of concern. i.e. 3+5 is as serious as 4+4.}
Thank you for all the information. My Urologist was very forthcoming about all the options. In the end, it is down to Da Vinci, Cryosurgery and the radiation therapy. I had a somewhat bad experience with general anesthesia after my second cochlear implant surgery and I think that may have influenced his recommendation. Before making a final, final decision, I'll see what the Rad-Onc has to say on the 9th. If it turns out that surgery is the best option, I'm leaning towards Cryo as it is much less invasive, has about the same number of side effects although different ones and I would be under general anesthesia less time than Da Vinci.
This is the opening sentence of a recent paper [1]:
"The management of locally advanced prostate cancer (PCa) remains controversial."
It's controversial mainly because urologists & oncologists have bias. Fortunately, we have studies that compared survival for surgery versus radiation:
[1] "EBRT {external-beam radiation therapy} was associated with {141%} ... overall and {235%} PCa-specific ... mortality." versus radical prostatectomy.
[2] "A total of 13,803 men who underwent RP {radical prostatectomy}, EBRT {external-beam radiation therapy}, or brachytherapy at two US high-volume hospitals between 1995 and 2008."
"EBRT {external-beam radiation therapy} patients with similar nomogram-predicted 5Y-PFP {5-yr progression-free probability} appear to have a significantly increased risk of PCSM {prostate cancer-specific mortality} compared with those treated by RP.
[3] "The 5-year estimates of cancer-specific survival rate for men treated with RP {radical prostatectomy} and RT {radiotherapy} were 96.5 % ... and 88.3 % ... respectively."
There are older studies, but the message is the same - better survival with surgery over radiation.
Whatever you decide, make sure that the person doing the procedure has done a lot of them.
wdwest 65...., 23 years ago at age 52 I had radical PC surgery BEFORE there even was DaVinci. The PC was thought to be contained within the capsule but a year later my PSA started to rise again and I had 35 radiation treatments I suffered NO ill-effects other than slight itching of some hemoroids. I did not notice any fatigue but was much younger. I best advice I can give you as a facilitator for our local PC Support Group is...., DO SOMETHING! PC is not like a cold and it will not go away by itself. And, once it is out of the prostate gland it becomes a whole new, much more dangerous illness!. I have seen more than a few men who thought watching and waiting to see what happens, typically called "Watchful Waiting" or so-called "Active Survalance", usually ends up with both you and the Doc saying.., "if we would have known then what we know now, we should have been more aggressive". Age at diagnosis is important, IMO,but 73 is a lot younger than 80.
My most sincere thanks to all who have responded to my original post.
At 75, PSA 8, GL score 7, I opted for ADT + Brachy + 25 lo-dose radiation as described by the NCCN guidelines. I never had many problems with the ADT or the Brachy, however did have mild radiation problems ( bowel urgency, diareah, etc) which cleared up 3 weeks after the external radiation stopped. I NEVER had any fatigue and have always been active.
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