Radiation post surgery

The deal is that if PC is still in the prostate bed (which is possible) then the RT will get it and you're still in the curable zone.

Often RT is combined with HT (ADT) to weaken the PC cells and make the RT more effective. In this case the HT is short term. The RT has a few side effects, most manageable and nothing worse than he's had due to surgery. HT causes a few more SEs, but normally recovers once HT is completed.

If it's let to progress, there is the danger of developing distant mets which would put him on a path of palliative care which would include HT for the rest of his life.

Yes, quality of life matters, but the balance act here is that a bit of short term treatment might be curative. Balance the risk of that treatment against a life time of deal with it.
Andrew

I think you're raising a very good question about whether ADT is really necessary in this case. Could you please supply more details from his pathology report - any positive margins (if so, how big and what grade), and stage (T2, T3a, or T3b). Also 33 treatments are recommended, but what dose - 66 Gy? All of these considerations are important in arriving at a decision. I can explain more after you respond.

I will say for now that at such low PSA (and only a single one), and with only Gleason 3+4 detected, ADT might not add any benefit.

If, as Allen suggests, he doesn't need the ADT, then the RT is easy. Side effects are mild in most cases and don't last long after treatment ends.

Honestly, it's just an endurance test. Some guys get a bit of fatigue, maybe some bowel issues and other minor irritations. Most clear up post treatment with in a few weeks.

Andrew

Thank you so much to both of you for your input. It is odd that a negative margin would contribute in that way. For clarification, the report states 'margins uninvolved by invasive carcinoma. Benign glands at surgical margin'. I took that to be 'negative' - is that accurate?

This is certainly alot of information to digest. I will do so over the next few days and touch base again.

Thank you again to you both. Truly appreciate the input

Got it now. Thank you again for taking the time to explain it to me. Will definitely loop back for an update.

Tall Allen said...
There are two separate questions:
(1) How likely is it that I am having a recurrence?
(2) How likely is it that salvage radiation will cure my recurrence?

A positive margin increases the likelihood you are having an occurrence , but it also increases the likelihood that salvage radiation will cure it .

Think of it this way: If you know exactly where the recurrence is coming from in the prostate bed, radiation to the prostate bed is more likely to cure it. If you don't know for a fact that it is in the prostate bed, then it may nevertheless still be there (only too small to find) or it may be coming from a distant place. If it is distant, ADT may kill it even if the local radiation can't, but the outcome is less certain.

Interesting take on SRT. Currently I'm on ADT and was scheduled to begin SRT last month. Now awaiting surgery to implant an AUS next month. I had 3X extraprostatic extension (2 posterior, one at sphincter) and 2X seminal vesicle invasion. I'm guessing in my case the location of residual cancer is fairly certain, and my low PSA prior to initiating HT would indicate to me (I guess) little possibility of distant mets.

I suppose relative to this thread that my case is slightly worse than the OP's partner, who is T3a. So it sounds like his locally advanced staging is based solely on the EPE and would call for generalized flooding of he prostate bed with radiation. For the OP I should say that my RO emphasized the importance of initiating HT before SRT and continuing thru treatment and beyond as contributing to a greater likelihood of successful outcome.

Thank you George

Famida,

If you mentioned the duration suggested for his ADT I missed it. For cases such as his they usually seem to do six months along with salvage radiation. I mention the duration because it can make a big difference in how much impact the ADT has on a man's quality of life. Six months shouldn't be that big a deal. A healthy man his age will generally recover quickly when the ADT is stopped. Six months of shots, then three or four months to get back to normal. That's not so bad. It sucks during those nine or ten months, mind you, but the time passes eventually.

The trick to minimizing the side effects of the ADT is to plan ahead of time and follow the plan. It's important to stick to some sort of an exercise regimen. The combination of radiation and hormones tends to make a man fatigued and less inclined to be active. While it may sound odd, the more a man makes himself exercise, the less fatigued he will be. A hard workout several times a week will make him less tired. It will also help to slow the bone and muscle loss that often comes with ADT.

It's also a good idea to have a plan in place for continuing to work on his ED. The hormones will, of course, make that worse. He will lose both ability and interest while the ADT is in effect but there are ways to continue his rehabilitation during the treatment. Both vacuum devices and injections work well during ADT. I used both during my two years of ADT. I think it helps. And, at the very least, it gives a man something to do...

Allen, we confirmed that the radiation dowse is indeed 66

Vmost66...what I understand...from others on the forum...RT does stop your continence progress at the point it is at the time of RT....Im vague on ED ramifications...{pun...get back...back I say...whoosh...}