The impact of salvage radiotherapy

[MotoGuzziFan]

Hi, just following up on my previous question re rising PSA post RP, my Gleason was 3+4 and a T3A tumour. I have been referred by my surgeon to an oncologist and have been advised by them that as my PSA level is .16 I may need radiotherapy depending on next result. I am also having an investigation of my colon as I get IBS as well and radiotherapy might not be appropriate. I wondered if anyone could advise me what might be the further impact of radiotherapy on my bowel, and especially on continence and ED given that both are working quite well post surgery and also what are the risks if I choose to not being treated if there are cancer cells in the Prostate bed?

Any help much appreciated and I should just add that I find the support and camaraderie of this network incredibly helpful!

[Blueslover]

I had surgery then RT to prostate bed 5 years later. Although it did return my PSA to undetectable for another 4 years, now 5-6 years later I have radiation cystitis and moderate fecal incontinence. It also gradually destroyed my ability to have an erection which necessitated an implant.

Swings and roundabouts!

Hugh

[Tall_Allen]

You should be talking to a radiation oncologist about this ASAP. If you want to be cured, you require salvage radiation very soon:

pcnrv.blogspot.com/2019/09/...

Inflammatory Bowel Disease was not aggravated by primary radiation treatment in this study:

ncbi.nlm.nih.gov/pmc/articl...

But it may be different for salvage radiation - salvage usually has worse toxicity.

If you don't get treated, the risk is of eventual metastasis and death. Perhaps your life expectancy is less than 10 years for other reasons (e.g., age, heart disease)?

[MotoGuzziFan in reply to Tall_Allen]

Thanks Tall Allen, as ever very helpful advice. I am 59 years old and otherwise in good health.

[JLINSCHEID]

I can’t speak to the effects of RT, but do know about not having it following surgery. Because of a history of Crohn’s disease (an inflammatory bowel disease) and because I am on immunosuppressant drugs due to a liver transplant, doctors feared my body would not be able to heal any bowel aggravation from radiation. A rising PSA has been treated with intermittent courses of ADT (Lupron) which has increased my ED and urinary incontinence. I wish I could have had salvage radiation, although, given my particular situation with immunosuppressant meds affecting my ability to heal from bouts of Crohns, I think the doctors judgment was sound. But if the docs had cleared me I would have opted for the radiation.

[julianc]

I seem to recall reading about a del that could be injected to protect the bowel, sorry not much detail but it was something being looked at.

[garyi]

I had SRT soon after surgery missed a tumor on my prostate cavity wall. My PSA was up to 0.54 within four months of RP. I have ulcerative colitis, but it was in remission for 20 years. I knew the risks of RT and took a chance. Radiation woke my UC up, and it's taken over a year to cool down again.

You need a RO and a GI gastro to be working collaboratively to help you through. Good luck!