Radiation, Hormones and Side-Effects

Hello,

My husband is currently receiving IMRT after having brachytherapy implantation on July 14, 2010.  I have some questions about side-effects and also the use of hormone therapy with radiation.

My husband was having urinary side-effects prior to his diagnois.  Mainly slow or stop and go urine stream.  After the seed implant on July 14th, he had a very difficult time.  He could not urinate for a while and his bladder would not fully vacate.  He is still having these issues.  He is not bleeding, but has to take two Flomax daily and also takes about four Advil.  We fear that the tumor, radiation, or both could be cutting off the urethra.  We are a little worried that the urethra will be damaged by the radiation as the treatments continue.  Presently, he is not seeing a urologist in tandem with the radiation, but I'm wondering if a urologist should be consulted about this issue. 

Also, he was not prescribed any hormone treatment by the radiation oncologist.  I think there is an opinion at the clinic that hormone treatment makes the PSA lower but ultimately does not work to effect a cure.  Two urologists we consulted with recommended that he receive hormones along with the radiation.  I'm just wondering if any of you have an opinion as to what the advantages to hormone treatment would be.   My husband is dead set against hormone treatment, but I've seen so many folks on the forums mention that they are receiving hormone treatment in tandem with radiation that it makes me wonder about it.

Thanks F8. Is there any reason why my signature is not showing? I've added it with all of his stats, but I don't see it attached to my post.

Also, did your doctors say why they recommeded the hormones? Does it help with your shot at a cure? Just wondering.

Hello Wife, and welcome. Very sorry to hear about your husband’s brachytherapy/urination issues, and I know you are also struggling with him, but I’m glad to see that you have reached out for inputs. Perhaps others here with more direct experience with brachytherapy can help answer those specifics, but I will comment at a high level about your inquiry on hormone therapy (HT).

The optimal treatment/management for patients with PC is infrequently crystal-clear. Depending on each case’s clinical characteristics (PSA history, Gleason score, DRE results, biopsy results, etc.), the patient will be more prone or less prone to having the cancer be contained within the prostate capsule; and, if it is beyond the capsule, the second question is whether it is “local” or “distant.” In choosing a radiation treatment, the doctors never really “see” inside (an imaging is not very reliable), and so they rely fairly heavily on the clinical measurements before and after treatment.

The primary (not exclusive) objective of HT for PC patients is to treat (control) cancer in patients with a high likelihood of having cancer which has spread beyond the prostate capsule, and especially those who are prone to having had the PC spread outside the prostate bed to “distant” sites. It does, as you note, suppress the PSA result, but this simply means that a new baseline must be established after HT is undertaken.

I might suggest that in order for more helpful inputs/comments to be provided in a meaningful way, that you reply back with your husband’s case characteristics. This would help us understand a little about where is case “lies.” I don’t know if you are a golfer, but I like the metaphor one well known doctor uses to describe prostate cancer. He (Dr Myers) says: “Prostate cancer is like golf. You need to play it as it lies. Because the disease is variable, each treatment solution requires a unique strategy.”

If you look at the “signatures” of many of the contributors here, you can get an idea of what info, in addition to what I listed above, might be valuable for you to provide.

Sancarlos -when i started IGRT my flow was normal but i still was having to get up 4-5 times a night to urinate.  when i began IGRT my doctor told me not to expect any urinary improvement while being treated and it could get a bit worse.  turned out to be true.

i have a slightly restricted flow from IGRT but nothing like after BT.  night time urgency has also spiked up probably as bad as when i had BT but shorter lived and i can now actually pee so it's not as bad.  i also took prednisone for the last six days of IGRT and it helped ... in fact one day i felt so good that i almost felt "normal".

one doctor told me that IGRT is easier than BT by a factor of 10.  i'd say by maybe a factor of three but clearly easier even tho there are some "new" side effects like bowel issues.

i should also add that daytime urgency was only a slight problem briefly after BT and in general hasn't been an issue for me. 

F8

I now tend to take percentages with a grain of salt. Whenever a doctor tells me 98% do fine, I know where my 2% is.

On the other hand, your husband should not "be strong" when talking to the doctors. We are dealing with radiation, so my suggestion is to dump on the doctor big time with anything remotely out of the norm. And I tend to say what my observations are - I went x times in y hours, first time x milliters, second time y. I pay the doctor to decide what normal is.

Casey59 said...
Hello Wife, and welcome. Very sorry to hear about your husband’s brachytherapy/urination issues, and I know you are also struggling with him, but I’m glad to see that you have reached out for inputs. Perhaps others here with more direct experience with brachytherapy can help answer those specifics, but I will comment at a high level about your inquiry on hormone therapy (HT).

The optimal treatment/management for patients with PC is infrequently crystal-clear. Depending on each case’s clinical characteristics (PSA history, Gleason score, DRE results, biopsy results, etc.), the patient will be more prone or less prone to having the cancer be contained within the prostate capsule; and, if it is beyond the capsule, the second question is whether it is “local” or “distant.” In choosing a radiation treatment, the doctors never really “see” inside (an imaging is not very reliable), and so they rely fairly heavily on the clinical measurements before and after treatment.

The primary (not exclusive) objective of HT for PC patients is to treat (control) cancer in patients with a high likelihood of having cancer which has spread beyond the prostate capsule, and especially those who are prone to having had the PC spread outside the prostate bed to “distant” sites. It does, as you note, suppress the PSA result, but this simply means that a new baseline must be established after HT is undertaken.

I might suggest that in order for more helpful inputs/comments to be provided in a meaningful way, that you reply back with your husband’s case characteristics. This would help us understand a little about where is case “lies.” I don’t know if you are a golfer, but I like the metaphor one well known doctor uses to describe prostate cancer. He (Dr Myers) says: “Prostate cancer is like golf. You need to play it as it lies. Because the disease is variable, each treatment solution requires a unique strategy.”

If you look at the “signatures” of many of the contributors here, you can get an idea of what info, in addition to what I listed above, might be valuable for you to provide.

Casey,

 

I entered his stats in the signature and pasted them in.  It would seem that he falls in the high risk category, due to the Gleason Scores, amount of cancer in the cores, and the location of the cancer.  I believe he should be receiving HT, but he does not believe it will help and does not want the side-effects.  I appreciate the responses that I've received thus far on this thread.  I'm hoping to arm myself with information to persuade him that he needs to be aggressive and either discuss it with the urologist or the radiation oncologist. 

Wife,

While your husband definitely has some high risk characteristics, you will find that even among radiation oncologists, they can argue pro and con on the subject of adding HT to the mix at this point. I went through this process late last fall, once it was determined that my surgery failed, and that i would be needing SRT. Hope you can get at least 2-3 good opinions, but don't be surprised if those opinions are on opposite sides.

The study sancarolos cites above is a good one, and should provide some valuable info on the subject.

my best to you and your husband.

david in sc