Anyone have prior radiation to your PC diagnosis?

[floridagirl2018]

My husband was recently diagnosed with prostate cancer, Gleason 9, no distant spread. He had rectal cancer 9 years ago and underwent external beam radiation, chemo with rectum/colon resection. Doctors are telling us that options are limited due to this prior cancer treatment. We found one doctor who wants to try hormone therapy with radioactive seeds using Spaceoar gel to protect the rectal area. He said he normally would do these two treatments plus external beam radiation, however my husband can't do the external beam part of it. Just wondering how effective this will be with just seeds. Has anyone tried this approach after having a previous cancer treated with radiation?

[Dr_WHO]

Welcome. Sorry that your husband is dealing with cancer again. From my (not an MD) option his doctors are correct. The overlap of his radiation for his first cancer will make surgery not an option nor external beam radiation. A lot of men go for the radioactive seeds so that is a legitimate choice. I would strongly suggest that he be put on the Stampede/Latitude therapy of being on the two hormonal drugs, Lupron and Zytiga at the same time. When taken together they have shown tremendous improvements. It should also make the radioactive seeds that much more effective.

Since you unfortunately had to deal with cancer in the past you know that information is your best weapon. Here are two general references dealing with prostate cancer. The Prostate Cancer Foundation has a booklet that you can download. They can be found at

PCF.org

The American Cancer Society also has some good introduction information on prostate cancer. You can find them at

cancer.org/cancer/prostate-...

Listed below is some information on the Stampede and Latitude trials we discussed.

ascopost.com/News/55699

ascopost.com/News/55700

I firmly believe that it is harder on the caregivers than those with cancer. So sorry that the two of you have to deal with it again. Please know that we are all here for you! You are not alone! Remember, people like us we have to stick together! We will be there for you!

[axd198 in reply to Dr_WHO]

It would not hurt at all to get another opinion and you can do it by sending all of the Images and history to someone well reputed. I would suggest Robert Reiter, M.D., at UCLA.

My Best Wishes!

[floridagirl2018 in reply to axd198]

I've been thinking about doing that and having them double check the gleason score. Thank you!

[floridagirl2018 in reply to Dr_WHO]

Dr Who,

Thank you for the reply and information. I have not heard anything about adding Zytiga to the ADT. I will ask his doctor about it when we see him this week. Currently he is just on Lupron (shot) and 15 days of bicalutamide (Casodex).

Do you know where I can find statistics on seeds and ADT combined treatment for high risk patients? Another option we are consulting on is HDR - high dose rate brachytherapy. I've looked online and success rates on both these methods always include surgery or external beam radiation. We have been told that surgery and external beam are not options for my husband because of the previous cancer treatment. Also his biopsy showed perineural invasion. One surgeon said that removing his prostate would not cure him due to the perineural invasion.

Thanks again for your help!

[Dr_WHO in reply to floridagirl2018]

Hope this is of help

ncbi.nlm.nih.gov/pubmed/281...

[floridagirl2018 in reply to Dr_WHO]

Thanks!

[Dr_WHO in reply to floridagirl2018]

No worries! People like us we have to stick together!

[JoelT]

What the doctor has suggested could work. Given his past history, I would urge you to consider surgery instead of more radiation. Radiation, including seeds like surgery, is invasive. Also, the insertion of the seed is a surgical procedure.

I am not saying that surgery is the direction to go in, I am suggesting that you consider it along with the seeds.

Joel

[floridagirl2018 in reply to JoelT]

Hi Joel,

Thanks for the reply. We consulted with three urologists and they all said no to prostate removal. One mentioned that since his biopsy had perineural invasion the surgery would not cure him. He suggested we meet with a radiologist to see if seeds or HDR might be an option. I'm not finding much data showing cure rates with gleason 4+5 and doing hormone therapy with seeds alone or hormone therapy with HDR alone. I wish he had more options.

[JoelT]

There is research that shows that men postsurgery who have perineural invasion are more likely to have a recurrence. If we reverse this we could say that men with known PI are more likely to also have a recurrence. Given this, the ideal treatment would be to target the gland and the prostate bed. The only real treatment that could do this is IMRT, but he is not a candidate for IRMT.

Surgery is a localized treatment (it only treats the gland) so this wouldn't lower the risk for a recurrence. In the same way, seeds should be considered a localized treatment and will not treat the tissue surround the gland, unless the doc modifies the seed placement to also catch the surrounding issue. Is this what is planned?

Hormone therapy should definitely be used no matter what else he does.

I would ask the urologists (all three) why they believe that surgery is off the table. If it really is then yes, go forward with seeds and hormone therapy.

Joel

[floridagirl2018 in reply to JoelT]

We are meeting with the radiologist on Wednesday to discuss his plan. I don't know yet what he has in mind. A technician did an ultrasound last week and verified that the prostate is not enlarged and not blocked by pelvic bone. He said they can access the whole gland and seeding is a possibility. He said they usually wait until patients are on hormone therapy three months to allow for tumors to shrink.

The first urologist discovered the cancer via MRI and sent us to Moffitt cancer center. She said she couldn't do anything for my husband because of his prior cancer treatment and surgery. She said he needed a multifunctional hospital like Moffitt and no other place could treat him due to his complicated history. Moffitt urologist said prostatectomy would be quite challenging with very high risk >50% chance of significant side effects including bowel injury needing permanent colostomy and difficulty curing the cancer with surgery and limited radiation due to prior pelvic rads and need for dose escalation due to high grade disease. Moffitt also said that primary cryotherapy is not an option due to high volume and high grade disease. They recommended hormone therapy for 9 months then check to see if cryotherapy would be possible at that time. The third opinion urologist said that he would not do surgery due to the nerve invasion, removal would leave disease behind. He recommended hormone therapy start right away and go consult with radiologist to see if seeds were an option. The radiologist also referred us to another radiologist to see if HDR is an option. We meet with him on February 7th