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continue with lupron therapy vs/ Dr. recommended radiation

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Posted 1/2/2015 2:45 PM (GMT 0)
71 yr old male

After Da Vinci Prostate removal, my PSA increased from .1 and 5 years later went to .12. In the next 3 months, it went to .17. I then began Lupron injections.

After 4 months, my PSA went down to .05. My doctor still recommends radiation. I have Irritable Bowel Syndrome, IBS, and it is impossible for me to leave the house at a specific time every day due IBS. Therefore, traveling 5 days per week for 8 weeks is not possible for me.
I had hoped and assumed to simply continue with the Lupron injections long as necessary, or indefinitely, without ever getting radiation treatments. I greatly fear the effect radiation would have on my already sensitive colon and diverticulosis. If the radiation hit my colon or hemorrhoids, I'd need a colostomy bag for the rest of my life!
Posted 1/2/2015 4:21 PM (GMT 0)
Hello Ken, welcome to the forum.

Do you remember your Gleason score from your post-operative pathology report, and whether you had positive margins after your surgery? Might make a difference.

Also, where do you live (nearest big city)? We might know a doctor you could see for a second opinion.
Posted 1/2/2015 5:34 PM (GMT 0)
Welcome to HW, sorry you need to be here.

Knowing more about you would help us.

Radiation would be the most commonly recommended next step. HT, while not curative, could keep the PSA down for a very long time. I assume your doctor knows about your IBS - it makes me wonder why he's recommending RT. Have you spoken to a radiation oncologist? If not you should at least have a consult.

If you're not going to do radiation, I wonder if you need to have the HT now. At the least you could do intermittent HT. The side effects of HT aren't all that fun and you'll want to avoid those too.

Hang in there,
Andrew
Posted 1/2/2015 10:32 PM (GMT 0)
Aggravating your IBS is a legitimate concern. While fiducials imbedded in the prostate fossa aren't usually necessary for salvage radiation, your RO may want to use them anyway to get more accurate. Some machines (e.g. RapidArc, Elekta Infinity, Tomotherapy,Vero, ViewRay, CyberKnife) have imaging systems built-in that can provide the pinpoint accuracy you may need.

If you decide to get the salvage radiation, you might want to visit your proctologist first and get those internal hemorrhoids taken care of. A lot depends on your specific anatomy. Lots of visceral fat can actually be a benefit in this case. I've read some cases where men took mesalamine prophylactically (pills, suppositories, or enemas) to prevent an inflammatory response.

- Allen
Posted 1/3/2015 12:08 AM (GMT 0)
Ken , in spite of what you have been told, radiation is indeed curable based on the information you have given. But the odds that it is curable could be high or low based on data neither your urologist, MO or RO or yourself know. So do you want " to give it a go" or are you comfortable with watching a very low psa rise very slowly over the next months or years and perhaps never be bothered by it , except in the mind. Its all possible and in spite of of all the data out there, it is a shame the data that can help with these decisions never seem to be there, except in a rube goldberg contraption kine way. If this was not true, we wouldn't need the medicos to give us hope. We wouldn't need hope, we would just take an aspirin and call in the morning.
Posted 1/3/2015 2:01 AM (GMT 0)
Since it took 5 years for your Post RP PSA to rise,
it does perfectly fall in to the Dx that RT could
give you a cure. It would be a shame to miss such
an opportunity.
Since your IBS is a serious problem, perhaps
SBRT [short 5 days of RT] might be a possibility.
I have read it can be equivalent to IMRT.
And I expect the RO's could accommodate a variable
time of day for treatment.

Just a suggestion.
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