Heading for Stereotactic Radiotherapy

[Bcgkelly]

I thought it was time i put up an update. In December my PSA increased to 0.063 and I was advised to check with Heidelberg University Hospital in about a PSMA-PET scan. While it was not clear if my PSA below the level required for the hospital to locate the cancer they were confident and I had it done on 28th January. On the day my PSA was 0.123. The cancer was detected in a lymph node in the left iliac area which is consistent with the fact that I had two positive nodes removed during surgery both on the left. Everywhere else is clear at present and it is believed that the node was missed during surgery. I have had diverticular disease for 20 years and my bowel is difficult to manage. It is worse since surgery and having taken a lot of advice I have opted for stereotactic radiotherapy to the effected area which is being done in the next few weeks. I am not going on hormone treatment until we establish if the stereotactic radiotherapy is successful in keeping the cancer at bay. I have been told it may take 9-12 months before the PSA falls and settles. I’m still struggling with Incontinence and ED. Caverject injections have not been successful enough for penetration and I am looking at an implant later in the year. I have been told that because of the complications following surgery I’m only suitable for the more basic type of the coloplast genesis malleable type. While I know others are in a worse position than me I am finding it a long and tough road.

[Tall_Allen]

If you are hoping for a cure, I would suggest you treat all the pelvic lymph nodes, not just the area around the one you found. You didn't need a PSMA scan to tell you that you have other affected lymph nodes- when some are found by PLND, there are always more. There are many more than the one you can see at your low PSA.

It is also a bad idea to wait to do ADT. Adjuvant ADT serves two purposes: (1) it radio-sensitizes the cancer and (2) it kills off any remaining cancer cells not killed by the radiation. It is important to do this all at once and not wait. If you wait, the cancer will form ADT-resistant clones that may be impossible to kill later. You are much better off doing the ADT while the cancer is hobbled by the radiation.

It is particularly important to do long-term ADT with radiation when there are known metastases.

Your diverticulosis should not be a problem if you have IMRT on a modern linac rather than SBRT, and if margins are held to zero.

[Bcgkelly in reply to Tall_Allen]

Is that called proton beam radiotherapy as well.

[Tall_Allen in reply to Bcgkelly]

No.

[Bcgkelly in reply to Tall_Allen]

Thanks for the reply it’s always better to be fully aware of all of the issues with a particular plan.