Radiation side affects

I had an RP 5 years ago, PSA starting to show up again. Oncologist recommending radiation. The list of possible side effects is not something I wish to gamble with. Has anyone chosen to not do this. I'm 57 yrs old.

galtexjohn said...
I had an RP 5 years ago, PSA starting to show up again. Oncologist recommending radiation. The list of possible side effects is not something I wish to gamble with. Has anyone chosen to not do this. I'm 57 yrs old.

The side effects from radiation isn’t something you want to gamble with, but you are willing to gamble with the prostate cancer at age 57? You are still young and have another shot to control your cancer. Don’t muck up the opportunity.

A lot of Urologist will tell you following diagnosis that If you choose radiation treatment you can’t have surgery if the radiation fails which is mostly true. Most will not tell you that 20% to 35% of RP’s as a monotherapy fail and will require radiation or possibly ADT. Surgery can be a good option especially for guys having BPH or other issues; however, every treatment option including AS does have risks. Unfortunately you have a fairly common recurrence and need follow up treatment. This disease is a marathon and not a sprint.

In the last ten years the precision of radiation treatment has increased greatly and the side effects both short and long term are very small. To minimize risk I suggest seeking out the best RO you can find including one who specializes in PCa. If you post your location and details of your situation possibly someone will offer specific recommendations. There’s a lot of very informed people who follow this forum. Good luck and keep us posted.

Thanks for the replies. Side affects I'm worried about are could be the result of radiating the bladder and rectum during the process ie: rectal leakage..eww, incontinence. I had to use the pads for a very short time post op.The ED I've experienced is very minor (luckily) Muse fixes that. I'd have to callback for the gleason score, they went thru it so fast I don't remember the numbers. The RO I met with is from Texas Oncology near Houston.

TexJohn,
You’re fortunate to have some of the best facilities in the world in Houston. M. D. Anderson is a center for excellence. Good luck.

They wouldn't give me an Axumin scan until my PSA hit 3. Reason: not enough cancer to get a clear image.

I got the maximal amount of radiation when they did it right after surgery. The side effects were the 'radiation craps' - lots of effort for small results, diarrhea and cramps. Those side effects started soon after radiation therapy ended and reached a maximum ("nadir") in a little more than 3 years after therapy ended. The side effects have been fading since then. No anal leakage, a minor increase in stress incontinence and tenesmus which has also backed way off.

Any treatment will have side effects, as will no treatment. I personally would trade enduring some more side effects if I could lose the cancer.

GalTexJohn--

It would help to know your Gleason score, pathology (staging, margins, EPE, SVI, lymph node involvement), and recent PSAs..

Because you've had a good 5-year run before BCR and clean Axumin results, I'm guessing your RO will target the prostate bed rather than radiate the whole pelvis. Most men get through prostate bed salvage RT with few if any bowel and urinary side effects. There are exceptions, of course, and it's hard to predict who's gonna have a hard time of it, but, as others have said, salvage RT sure beats having to treat metastatic PC later on.

Good luck!

Make sure that any studies you read about radiation only involve patients treated since about 2007. That is when the now-available types of equipment came into general usage.

I often see where somebody is citing a long list of side effects with RT. When I ask them where they got that data from, they post a link to some article. When I drill down into the article's source, I find a study or studies with patient groups treated 25 or more years ago.

There have been great advances in RT accuracy since then. Don't be mislead by out-of-date information.

Two years after my robotic prostatectomy, I had IMRT/IGRT (39 sessions @ 1.8 grays, total 70.2 grays) five years ago without any problems.

I had ZERO side effects during and afterwards. I never had to change my diet or routines. My RO told me that in his experience it is rare for side with IMRT/IGRT, and told me to do exactly like I have always done, and if there are any problems then we can deal with it. In fact it wasn't even any inconvenience. I got up at 4:30 am to go to work and I would leave work at 3:00 pm and stop at the oncology center on the way home. I was usually in and out in 15 minutes.

Yes, the doc did bring up chemically castrating me with the hormone therapy. I am single and the thought of not having the ability or drive to please a woman is a definite no. I am aware testosterone can feed the cancer.

galtexjohn - Depending on your current PSA, you may not require hormone therapy although it seems to be used more often than not regardless of PSA. Something to discuss with your RO.

The key to IGRT/IMRT is having a consistent full bladder every day and an empty colon. The equipment is quite precise nowadays but your body is not so agreeable and organs move around a little so they try to adjust for that. The concept is to apply a small depth of radiation to the bladder and colon where the prostate was to catch any rogue cells in those areas.

I did not really have any significant issues after ART last year and certainly not any of the bad ones you read about. It does have some effects on you, notably tiredness at the end, but most are minor and go away after some time. I had nothing worth bothering the RO about after I was done.

I'm late to this thread...and first let me say that I'm sorry about what sounds like a recurrence. I know from your last post you're looking to hear from guys that have chosen not to follow up with radiation--over the years I know there has only been a handful of guys here that have gone that path. Hopefully someone can respond.

Regarding where you currently stand, this is clearly a very personal decision. But the effects of end stage PCa are almost certainly greater than the SEs from radiation. As for your comment about hormone therapy, that's very understandable. While in general ADT does make the radiation more effective, I could see skipping that if you were strongly averse to it.

Lastly, although I had radiation as a primary treatment--not salvage--other than a few short-term issues, I pretty much sailed through. Good luck--I certainly understand your concerns.

galtexjohn - there are number of calculators from the major cancer centers that can help assess the post-op probabilities. A link to one is below:

https://www.mskcc.org/nomograms/prostate/post_op

The problem is you need to know what your post-op pathology report says (scores, margin, etc) and as well as your PSA history to complete the forms and get the probabilities. You should make an attempt to obtain this info so that you can make informed decisions.

Lot of people do well after surgery and are never heard from again or spend time on forums. There are some here that are doing well long after surgery even with high risk conditions (ie: DjinTonic, logo). The common denominator is that most have not experienced rising PSA's which is why they are "doing well". Once your post-op PSA rises over 0.20, most doctors say you are having a recurrence and should be looking at secondary treatment. When your PSA is >2.0, there is no question about the recurrence.

The fact that you have gone for 5 years without your PSA rising is a good sign that nothing is happening too fast. The fact that you are 57 is a problem in that you would probably want to live for 30 more years and there is little data to extrapolate out that far with most cancers. Like Pratoman indicated, the general odds are not in your favor if you expect to live 20+ years without doing anything.