Adjuvant Radiation

My husband was diagnosed with prostate cancer last year. They caught it early (PSA was still within the "normal" range but had risen and there is a history in his family so they opted for biopsy sooner rather than later).

After a couple of months, we chose surgery (he is 67, but really, really active--great shape, if I say so myself, which I do). That happened in October. Boy was he a trooper. Overnight in the hospital, next day walked around the block, day after three blocks, third day home walked 2 miles (with me next to him saying "are you okay, are you okay" every three seconds).

Three weeks pass. Good news and bad news. Bad first, the post-surgery biopsy showed one little focal point of expansion beyond the prostate wall. The good news....negative surgical margin, no cancer in seminal vesicles or lymph nodes.

Three months pass. Next visit. Good news and bad news. Good news....PSA undetectable. Bad news....Genome DX test indicates higher than average likelihood of recurrence.

So now they want us to consider a full dose of radiation even though PSA is zero, the same routine we were initially offered to compare to surgery. His continence is great (always had control right after catheter removal ten days after surgery--maybe once a week few drops when he sneezes, but really....great...never more than a panty liner). ED. Eh. He can have an orgasm, not a real erection. But it's only been three months and that takes longer (or so we read), plus there are still lots of ways to be close with each other.

Upshot, doctors say if he starts radiation his continence and ED will probably stay where they are forever, and that's not ideal. Has anyone else had a Genome DX reading? Thoughts on this testing? US v. European interpretations seem to differ as to whether radiating before any signs of cancer return produces measurable results. What are folks thoughts on adjuvant radiation (vs. waiting to see if the PSA rises and then doing what they call salvage radiation--and can they please for the love of all that is holy change that name please?!).

Thanks. We feel like we're dancing one step forward and two steps back.

Thanks for the welcome. I noticed lots of folks put in their stats...I didn't since it's not me (it's husband). But if it helps the conversation, he was GS7 (3+4). They called it stage 3a (which apparently is better than stage 3b) after the surgical biopsy.

He had no pre-op ED...honestly, it was like he was 13 (say the word sex and he was ready in a second, thus post-op changes have been the most difficult to deal with, but we're dealing). He did have both nerves spared during surgery, so we remain optimistic, and he's on cialis daily for now (initially viagra, but health insurance wouldn't cover it--but would cover cialis. Go figure).

You might want to check out this recent thread that talks about the timing for adjuvant/salvage radiation for high-risk men after surgery. It refers to some studies which seem to indicate that he might be able to wait for a detectable (but very low) PSA before pulling the trigger on radiation.

Something to talk to his doctors about.

I had adj. radiation at an undetectable PSA, but I was a Gleason 9 and t3b.

she said...
do you have a link.

Sort of. I'm too cheap to pay for full texts most of the time so I read abstracts. Here's the abstract for the study Tall was talking about: Ultra-sensitive PSA Following Prostatectomy Reliably Identifies Patients Requiring Post-Op Radiotherapy.

Tall Allen also referred to an article: When should the patient and doctor consider salvage radiation therapy?

Many thanks to you both. This has been a really trying time (but it is for everyone, I know). In so many ways, husband is doing great, but it just feels like a serious sucker punch. He was asymptomatic to begin with (but here, cut out an organ). Just when he's beginning to feel--if not like his old self--then like a strong, new self, he's told....hey, no detectable PSA, but have you thought about seven weeks of radiation? Maybe we could start in a couple of months. A couple of wha, huh?

To say that it does not help that his younger brother passed away from prostate cancer a month after husband's surgery is the understatement of the century. Brother was diagnosed eight years ago, had a much higher PSA and was not a candidate for surgery so had radiation. Which clearly was not effective. Every case is different, and so many other folks have done so well. We'd hoped it would be a "no PSA, see you in three months" kind of chat, not a well.....how do you feel about adjuvant radiation kind of chat.

I'll go read.

My husband is in the same boat. No symptoms but elevated PSA. He had surgery and after surgery was up graded to G9 with small area of extra capsular extension. Dr. did the genomic study and it came back on the low end of highly aggressive. Post op uPSA was 0.01 at 6 weeks. So we are also trying to decide if radiation is indicated. Husband is still recovering from surgery and has some minor problems with incontinence and of course ED. He really would like to wait awhile and try to heal some more but we are going on Tuesday to talk to a radiology oncologist. It is so hard to make a decision because there seems to be so many different opinions. Hope things go well for you and your husband.

Thanks Tall Allen I read the article to my husband and he said the same exact thing.

And another question! Those of you who did decide to do aRT, did it affect (re-affect) continence? Our doctors were suggesting that husband would remain at the stage he was in when aRT began....but is there "backsliding"? Can you go back to less control?

142, you've suggested "side effects like crazy." Is this what you meant?

Shesaid,

My surgeon was working with me to delay ART as long as practical. I was not down to one pad a day until the week it started. We feared that would worsen once into the process, and it did.

My colo-rectal guy was concerned that it would cause troubles with a large area of colo-rectal scar tissue from a previous surgery. It did. The occasional bowel issues settled into a life of 4 BMs by 10 am (provoked by colon damage), most with blood from the burned scar tissue that refuses to heal.

My immune system went to nothing, and remains at that level. You sneeze, I contract pneumonia. I don't leave the house without a bottle of levaquin.

Every few weeks the burned spots in my bladder neck break open and bleed profusely for days, sometimes get infected, and are always painful.

The fatigue that developed during RT got slightly better, but remains a factor in planning any day's activity.

I'm sure there's something I missed, but you get the drift.

My symptoms with ART were mild at the time -- fatigue, mostly, and some hemorrhoids -- and as for whether the radiation made my incontinence worse I can't tell you. The combination of surgery and radiation left me incontinent but I can't know how I would have done without the radiation. The situation with impotence is even more confused. I am fairly sure I am impotent but how much of it is the surgery, how much the radiation and how much is the hormone therapy, I can't say. In theory I could still recover but since I had some ED prior to surgery -- and since none of this stuff helps in that department, I am probably toast.

But, I remain hopeful that the artificial sphincter and the penile implant I am scheduled for will get me back more nearly where I want to be, especially if the danmable hormones will ever wear off.

So the answer to your question for me is I dunno what effect the radiation had.