So after having a robotic assisted prostatectomy in February last year my PSA has risen slowly after an initial jump from .02 to .15 after 6 months and is now .17. Due to having some issues with my stomach, IBS, bad indigestion my oncologist has referred me to the digestive diseases unit before considering radiotherapy.
I have had an endoscopy and waiting results, but the surgeon said all looked good and just completing a SeHCAT scan to assess my bile function.
What I would like to know is what should I be asking my oncologist at my appointment next week? What are the options if I am unable to have radiotherapy? I am also concerned that if I can have radiotherapy it may impact on both my ED and bladder control as both are working well post surgery.
As ever any advice much appreciated from this wonderful forum. It is like a hive mind sharing the experience and knowledge to help the person find reassurance and the pathways open to them.
Many thanks!
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MotoGuzziFan
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It does sound like radiation therapy may have to be postponed. But there are plenty of ADT drugs available until you get your problems straightened out.
The caution against radiation in men with IBD originated when they used a less precise method for delivering the radiation (3D-CRT), as you can see in this study from twenty years ago:
ROs have done a lot of work defining bowel dose constraints that are only possible with modern IMRT techniques. This is something to discuss with an experienced radiation oncologist. With salvage radiation, IGRT is less precise than with primary radiation because fiducials do not hold well in the soft tissue of the prostate bed. They usually sight on long bones, which do not move as organ motion moves the prostate bed. The best they can do is (1) recalibrate using CBCT every few days or stereoscopic Xrays at the start of each session, and (2) use a fast linac so that bowel motion doesn't have time to change much during the treatment (a low fiber diet can help), and (3) set tight dose constraints, including point dose constraints to the rectum (ask your RO).
You are right that the risk of urinary incontinence and ED is higher. You might protect the NV bundles with daily ED meds starting with the first session.
To spell it out John...first you buy the bike then, following the life changing experience of riding this wonderful beast, you become the fan of said bike, in this case a Moto Guzzi!
Hopefully this goes some way to explaining but If not try this simple formula:
Man buys Moto Guzzi
Man enjoys Moto Guzzi
Man becomes fan of Moto Guzzi
So as you will see Moto Guzzi make fans. Unless that is you were making some low comment and word play on the word fan and it being the same as a device for blowing wind.........
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