Radiation of prostate

Hello,

Do all forms of radiation treatment kill all prostate cells (Both Good and Bad in the gland over time?).   In other words does radiation have the same impact as having the prostate removed under a radical it just takes 2 years or so to get to that undetectible PSA level?

What actually happens to the gland itself after all of this radiation and how does it impact the uretha that still runs through it?

When I looked at Prostrcision (Which is seeding plus IMRT) he said in 2 years the PSA should be at 0.2 or less meaning the entire prostate gland is dead (No more PSA readings).  Over those 2 years I guess the PSA may fluctuate up and down.  What fall back do you have if the PSA starts to rise during these 2 years?  (If the PSA trajectory is going down at every reading then I guess it is continuing to work).

At what point would additional treatment be recommended to treat a rising PSA under a radiation treatment?

Thanks In Advance

 

F8 said...

honestly if your PSA rises after this treatment the cancer is almost guaranteed to be systemic.

My RO at Vanderbilt University Hospital said they find the same thing for their current IGRT methods combined with ADT. Definitely considered primarily for high risk people, so may not apply to kdeinv's situation.

Brachy boost really seems that it should be helpful, but it also increases side effect risks and isn't necessarily "settled science". Vanderbilt is a regional referral center for those dealing with complications from that combination therapy. How much risk it involves, and how much more effective it is for what specific cases, who knows? The RO community argues about this stuff, so how are we patients supposed to decide? Every person's diagnostic particulars have to be considered when selecting their treatment plan.

The RT technologies continue to evolve pretty rapidly, so long term results with current techniques still need time to mature. Some published studies sure seem to show the combo treatment is most effective, but great care must be paid to their patient selection to interpret their results.

My RO at Vanderbilt University Hospital said they find the same thing for their current IGRT methods combined with ADT.

because beam radiation also treats the prostate bed.  the point that maybe i wasn't too clear about is you often hear:  "i went with surgery so i could have radiation as a back-up".  surgery does not treat the prostate bed, but surgery and radiation does.  i see straight surgery as more of an incremental approach -- you may or may not need radiation -- and seeds + IGRT as a more complete approach. 

so to say that seeds + IGRT is inferior to surgery because there's no back-up plan is incorrect, or uninformed. or disingenuous.

ed

 

F8,

For the appropriate patient, surgery can be a complete cure, without the need to radiate anything. Seeds and IGRT may well subject someone to unneeded and harmful radiation.

In that case, to say that radiation is not inferior would be incorrect, uninformed....Well, you know the rest.

k,
Radiation changes the DNA of prostate cancer cells so they can't divide and grow. Cancer cells are far more receptive to radiation than normal cells and in time normal cells repair themselves. The prostate is also left "fallow" which means that future cancers cannot grow. The urethea is more resistant to radiation than other tissues so it is normally not damaged. The chance of a reoccurrence with both brachy and IMRT is extremely rare. Dattoli did not find one instance in 1400 consecutive high risk patients; all reoccurrence were systemic, cancer outside the prostate, when treatment as given.
A reoccurrence after radiation is usually defined as nadir plus 2 for psa. In the rare event of a local reoccurrence, cryosurgery is the most common salvage treatment. HIFU and cyberknife can also be used.

F8, just a quick correction. My comment above, referencing the recurrence being systemic, was not meant to have anything to do with surgery. It must have been a misunderstanding about "so to say that seeds + IGRT is inferior to surgery because there's no back-up plan is incorrect, or uninformed. or disingenuous.

I intended no such comment, intending only to relate my RO's comment that recurrence after current IMRT+ADT was typically systemic, in line with the comment of recurrence after seeds+IMRT being typically systemic. No reference to anything whatsoever regarding surgery. Sorry if that wasn't clear.