Completed 40 EBRT, you can make it through as well

I turned 57, August 2015 and had prostate surgery October 13, 2015. Yesterday I complete 40 EBRT, going 5 days a week, and fortunately the SE were minimal.

On most days, my morning BM became an urgent mater and when the second BM hit and was loose, I took 2 Imodium and the pills took care of it for the rest of the day. For some reason, BM’s on 3 Sunday mornings presented more times going to the bathroom for a BM so I just took an extra Imodium on those days.

As most have reported, after about 3 weeks the fatigue set in. Some days I took an afternoon nap while on other days I just keep real busy and slept really hard on those nights. I have felt normal on every morning, (except BM), so far since starting RT.

I had to hit the Imodium this morning, but my RO says the SE should diminish over time.

My initial PSA in August last year that started all of this was 6.75 and the next draw is in 2 weeks. The first draw after surgery was .044 and the second was .041. So the PSA waiting game continues.

Good luck to all who are living with PC, like or not we have to deal with it.

The initial path GS from the 12 core biopsy:
2 of 2 were benign
2 of 2 had <0.3mm foci present
5+5=10, in 1 of 2 cores and 1 was less than 0.2mm
4+5=9, in 2 of 2 cores
4+4=8, in 2 of 2 cores
4+5=9, in 2 of 2 cores, with perineural space invasion identified
Weight 40 grams

Second opinion of the slides, GS 9

Final Path:
All 17 lymph nodes were negative.

Prostate size: 4.1 x 3.7 x 4.9 cm

Prostate weight: 53 grams

Total GS 9 (4+5=9)

40% of the prostate involved

Seminal vesicles invasion: Identified

Margins: Minute focus of left posterior margin involved by the tumor. In the right and left apex there is focus approaching the edge, but due to the absence of ink in the portion, it cannot be definitively said that it is a true margin

Perineural invasion: Present, extensive

Path staging: pT3bNO

NTZGuy, congrats on completing RT. The morning mandatory BM and filling of the bladder got old real fast... but that is the past. Good luck my brother! Take care - JR

I had Adjuvant therapy, not salvage. The RO said 40 treatments in my case were enough as the prostate was gone. I do not know the dose of RT I received.

My uro recommended radiation without hormone treatment to see if the RT had worked to kill any remaining cancer or not. Uro said that HT would keep the PSA down as long as I was taking it. He went on to say that the use of HT could change if the PSA starts to rises in the future.

I talked a lot about HT with my MO and he agreed with the RT approach and we held off on the HT for now, like I had requested.

My RO said it could be a year or more before we know if the RT worked to kill all of the remaining cancer cells. He also talked about a possible PSA spike in a year even with the prostate gone.

I am not saying I made the right choice, but I want to know how effective the RT was. Each of us has to make our on PC treatment decisions.

ntzguy-

I was wondering about 40 treatments because the typical adjuvant or salvage schedule is about 35 treatments at 2.0 Gy per treatment, or sometimes 38 treatments at 1.8 Gy per treatment, for a total of about 70 Gy. He may have given you a higher total dose to compensate for the lack of HT in your case, or he may have reduced the dose per treatment. I was just curious. I've seen a fewer number of treatments with a higher dose per treatment (hypofractionation) used experimentally, and it seems to work well too.

Evets-

As ntzguy pointed out, the Zolodex will depress your PSA, so it will be awhile before you can use it to evaluate the effectiveness of your adjuvant radiation. The reason why HT is continued after ART is to kill off any remaining hormone-sensitive cancer cells before they have a chance to become castrate resistant, and to take advantage of the temporary boost in Killer T cells from the combined effect of HT and RT.

As for the optimal duration of HT - all we can say for sure is that at least 6 months is a good idea. We don't yet know how long beyond that is optimal when used with ART. For primary RT, we do know that 28 months is better than 4 months in high risk patients, but we don't know if that's applicable to ART as well.

Here's an article about this subject:

Combining ADT and salvage radiation therapy improves outcomes

- Allen

ntzguy

I am hoping that these 40 zaps hit the target and killed all of the remaining cells. Time will tell but glad you have completed this aspect of the journey for now.

Been a while since posting – sharing some good news.

October 13 marked the one year anniversary of my prostate surgery. My first PSA test after surgery was 0.044, then in May 2016, 2 weeks after EBRT the PSA was 0.026 and Tuesday’s PSA was 0.020. I am feeling good and my surgeon is smiling with me.

I was told it would take up to a year for all of the radiation treatment to kick in and I hope my PSA will drop some more.

My surgeon spared no nerves, but with a pump (OTC), Cialis, and muse things are really a lot better in the sex dept. I go back on November 2 for instructions on using the injections for erections. My Dr is also going to “appeal” my insurance company’s stance that VED are “experimental”. Since I have met my yearly deductible and out of pocket, I hope to get going on the injections and switch to a compounding RX for the trimix or bimix injections and get stocked up before the end of the year. I also hope we can get approval on the medical VED and have hopes of a closer to normal sex life with the wife by having the injections, pills and pump in the mix to alternate the method of erections.

Good luck to all of us out there.

The initial path GS from the 12 core biopsy:
2 of 2 were benign
2 of 2 had <0.3mm foci present
5+5=10, in 1 of 2 cores and 1 was less than 0.2mm
4+5=9, in 2 of 2 cores
4+4=8, in 2 of 2 cores
4+5=9, in 2 of 2 cores, with perineural space invasion identified
Weight 40 grams

Second opinion of the slides, GS 9

Final Path:
All 17 lymph nodes were negative.

Prostate size: 4.1 x 3.7 x 4.9 cm

Prostate weight: 53 grams

Total GS 9 (4+5=9)

40% of the prostate involved

Seminal vesicles invasion: Identified

Margins: Minute focus of left posterior margin involved by the tumor. In the right and left apex there is focus approaching the edge, but due to the absence of ink in the portion, it cannot be definitively said that it is a true margin

Perineural invasion: Present, extensive

Path staging: pT3bNO

ntzguy

Congrats and hope you have killed the bandit!

I start my SRT Tuesday 35 fractions 2Gy per treatment and Lymph Nodes also at about 54Gy's -

Bobby Mac

The average nadir for maximal side effects from external beam radiation therapy is 3 years after treatment ends.

I am currently enjoying those maximum side effects a bit more than 3 years after my (80 Gy over 40 treatments) EBRT. (The radiation side effects are much worse now for me than they were immediately after treatment ended) My colon lining is covered with large gas blisters. I have pictures of those my gastroenterologist took 2 months ago when I got a routine colonoscopy. He cut one open and it deflated. They are likely the source of my cramping and the continuation of my 'radiation craps', which started a couple of months after I was done with the radiation. My hemorrhoids bleed profusely every other week as well - much worse than they ever did before. I have adjusted my schedule to accommodate my 'new' (since radiation treatment) bowel habits which remain frequent, loose and explosive when they are not 'radiation craps' (lots of painful effort for very small returns with noticeable quantities of mucous). They are limited to a regular time window, however, so this is not too big a deal. Often delays my morning run with my Labrador, no worse.

Some of the side effects from radiation take a very long time to show up, then take a much longer time to fade away. My doc told me that ADT chemo duration started at 3 years a while back, then they dropped it more and more down to about 3 months, when the stats started looking bad. Since that time, he says, they have been increasing at back upwards. My effective duration was 3 years and it has been very slow recovering from it. Still is. Details below.