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RP Salvage RT Side Effects and psa outlook

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Posted 11/18/2023 8:48 PM (GMT 0)
Am a 73yo whose Psa progressed from 1.1 ten years ago to 9.9 at end of last year, at which point my biopsy produced a 4+4 gleason rating. Pre-biopsy scans revealed no mets, but showed prostatic extensions. Had RP surgery this last April, with post-op pathology showing a 3+4 gleason with positive margins and perineural invasion. Subsequently PSA has progressed from 0.06 three months after surgery to 0.12 six months after. Have now been scanned in prep for salvage RT, which I expect to start in the next few weeks. Following surgery, after about 6 weeks, incontinence was pretty bad, but has now regressed to where now down to no pads. For RT I've learned that I might experience return of incontinence and may also have diarrhea.

My salvage RT will have about 38 sessions over 8 weeks (corrected) at 180 cg/day. Would appreciate input from anyone who has had similar salvage RT as to how manageable any subsequent incontinence or diarrhea was for them, particularly as far as being house-bound because of it. Also any experience with bleeding if on blood thinners, and experience with PSA decline after salvage RT.
Posted 11/18/2023 9:18 PM (GMT 0)
I had robotic prostatectomy 10 years ago and because of a small positive margin and PSA hit 0.2 ng/ml I underwent radiotherapy two years later (IMRT/IGRT 39 sessions at 1.8 grays totaling 70.2 grays). I had zero urinary or gastric side effects during and after the RT. I didn't have to change my diet or lifestyle during or after the process. Ever since surgery, I have had very light stress incontinence sometimes when I lift heavy objects, but has never been a problem. My ultrasensitive PSA tests stayed undetectable (<0.02 ng/ml) until two years ago when it became detectable at 0.02 ng/ml. The funny thing is that my PSA this past month became undetectable again (<0.02 ng/ml). My oncology urologist told me that such a low PSA value for this long of time basically means I will die from old age way before prostate cancer can rear its ugly head if it does.
Posted 11/18/2023 9:59 PM (GMT 0)
rp - I had surgery followed by adjuvant radiation and did not have any issues with incontinence or bowel problems. Like lapilot, I had 37 treatments at a lower dosage so you may have a different deal with less treatments at a higher dosage. There was increased urgency and tiredness near the end of RT which lasted for a short while after treatment eneded. I do not recall any specific bowel issues other than constipation after surgery but I am sure I am not remembering everything. Time heals all. ED is another matter with ART since it is so close to surgery and does nothing to help nerves recover. SRT may or may not have similar effects.
Posted 11/18/2023 11:33 PM (GMT 0)
rp, welcome to Healingwell. Sorry you need to have additional treatments but it's, from my experience, pretty manageable.
What's very important, in order to minimize the side effects you are concerned about, is to make sure you have a very full bladder and an empty rectum/lower colon. Your nurse and/or technicians will talk to you about this, and should be checking you on it before each treatment. This keeps the bladder and colon/rectum away from the radiation.
I had detectable PSA 2 years after surgery and a year later I had radiation along with ADT (are you getting ADT/Hormone therapy as well?). I had 40 treatments over 8 weeks, if I recall correctly, it was a total of 72 grays.

I found the radiation not very bothersome. Near the end, and a couple or three weeks afterwards, I found I had urinary urgency...I went often and when I had to go, I really had to go. fast. I don't recall having any issues with diarhea. My RO Nurse instructed my to take Metamucil every day during the treatment and to limit my fiber intake, lite on the veggies. I had some fatigue near the end but I think that was from the Lupron/Hormone Therapy.
Other than that, no real issues. It's a long slog, but it will be over before you know it. Good luck, do stick around and keep us posted.
Posted 11/19/2023 12:27 AM (GMT 0)
Thanks guys for the quick, but detailed replies. I will talk with my RO doc about the number of sessions planned vs total dosage. Also about doing concurrent ADT. I think I read somewhere that ADT is usually only triggered at psa over 0.5 ng/ml. However I believe it is in the AUA prostate cancer treatment standards.

One more thing. I am on Pradaxa "blood thinner" drug due to low protein C. Has anyone reading this had salvage RT while on a blood thinner like Pradaxa or warfarin/coumadin? If so, any bleeding result?

Post Edited (rp-2343) : 11/20/2023 1:57:42 PM (GMT-8)

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