Chemotherapy versus Radiation

[Pherndz]

A friend as me today if Chemotherapy is the next step after radiation then why don’t the just use radiation first? This asked because I have been referred for pelvic radiation due to aggressive prostate cancer after RP, and a rapid climb in PSA. Which, as the doctor states could conceivably be metastatic disease. The latter is scary. I have a consult for Monday morning with radiation oncologist.

[Tall_Allen]

They do salvage radiation first. If that doesn't cure it, there are a variety of systemic therapies.

[Pherndz in reply to Tall_Allen]

Thank you, so it’s a process we’re talking about. If a then b. If b does not work then c, an so forth!

[tucker_man]

If it were me, I'd question why they want to do localized radiation if they suspect metastatic cancer. I would think the next step is a PET scan to see if the cancer has spread to other parts of your body and go straight to systemic treatments rather than waiting to see if radiation cures it.

It always pains me to hear stories about men whose cancer has spread even after RP. It seems that shit gets out of the prostate ahead of surgery. I just don't understand why that happens so often. Can you share your backstory leading up to RP and how long ago?

[Hidden in reply to tucker_man]

Recurrence after treatment is something we all dread.

[Pherndz in reply to tucker_man]

In early 2017 I noticed I was having trouble with urine flow and going several times at nighttime’s. It’s seemed strange, and told my primary care that I was concerned. After three visits a PSA was done in the fall, and it came back at 5.7. Okay, I asked what was the next step! I was told we’ll do another PSA. Not acceptable I thought. My luck was on my side. I came down with kidney stones, and went to the ER. They confirmed kidney stones, but not on one side. I had stones in each kidney. I then told the doctors about my going at night, and urine flow plus PSA score. Oh, after being asked about family history. I told them yes, three uncles, brother, and other relatives with cancer or died from cancer. Advice, you should see a urologist. I did, gave the same story. He suggested a biopsy. Six out twelve came up positive with one at 4+3=7. DRE also showed enlarged prostate. I was given all the option in January 2018, and elected RP route. In March the procedure was done. Post RP pathology looked pretty good, but again I saw the words PNI. This time on the left side of the prostate. In June I had my first PSA, and it came back at .29. In July .314, August .337. Finally November .55, with flank pain on the right.

Finally today, first of many hormone treatment. Cystoscopy tomorrow, and PT-Scan followed by bone density next Friday. MRI with contrast scheduled for New Year’s Eve at eight pm. Happy new year! Doctors note, “I explained that short course ADT with prostate bed IMRT is my

recommendation pending completion of other studies.”

I found my angel, and hopefully in time.

Thank you for listening.