Second thoughts on IMRT and brachythrrapy

From what I understand, Radiation will cause (temporary) increased urinary frequency. So you my be getting up. Few times a night. Others will reply who are more knowledgeable/experienced, though.

While I do not know if what your oncologist said about secondary chances is accurate (I've heard that said as well), I do know the chances are very, very low. Not zero, but you'd have to be very unlucky for that to happen.

And while you don't have a signature on your post with your diagnosis, I'm assuming that you're high risk if you're looking at IMRT/brachy combo. So let's say, you opt for surgery instead. As a high risk guy, your chances of needing follow-up radiation are pretty good. So you may be in for radiation anyway at that point. In my case, I didn't want to have the SEs of surgery and radiation so I cut to the chase and had radiation.

As to diarrhea and nausea...I certainly wouldn't say everyone gets it although bowel issues can happen. (Nausea I think is pretty rare.) In my case, the biggest acute SE was burning after the brachy, which lasted a week or so. Re fatigue, the process did wear me down a bit, but that also could have been the ADT.

All in all, the radiation was a bit or a slog, but it was doable. You don't mention ADT, but assuming that's part of your regimen I'd bet most guys would say that's the hardest part. It was for me.

Regarding being able to sleep at night, while no one comes out of this completely unscathed, most of us really do quite well. As a G9, I never would have thought I'd be doing this well coming up on six years after my diagnosis.

Thanks I think the lack of sleep is giving me anxiety....decifer says high risk ..right now still intermediate...they r suggesting I don’t watch this ...just don’t like surgery or feel lucky right now ..Kinda have a phobia about surgery..soo glad both outcomes are tb3 same actually the combo has more favorable results ..thanks again

Stan1961 said...
hmmmm really all over the internet everywhere says...

"internet everywhere" is not a good source for making decisions - it's full of anecdotes and myths. At least in my articles I link to published studies in peer-reviewed journals. Your doctor was right. Here's some solid info on the subject:

/pcnrv.blogspot.com/2016/08/the-real-risk-of-secondary-malignancies.html

Fatigue and nausea may become an issue with longer duration of treatments, but with your 20-25 treatments it should not be a problem as long as you keep up a vigorous exercise regime throughout.

/pcnrv.blogspot.com/2017/11/radiation-induced-fatigue.html

If anxiety is keeping you up, get a scrip for some sleeping pills. You are right that being fatigued from lack of sleep will make your anxiety worse and cause a vicious cycle. Break the cycle with some Ambien. Just avoid tweeting while taking it ;-)

Radiation therapy for cancer treatments have been used successfully by millions of people for decades. Every year it gets better at improving cancer control and reducing toxicity that causes side effects. Remember, every treatment and drug has side effects. If there were no side effects theni wouldn’t be doing anything. Want anxiety? Read the warning label of common aspirin.

With radiation to the prostate there are the side effects that are most often very mild and stop within weeks of the radiation stops as the healthy cells recover. Most people are more troubled by a cold than the effects of the radiation. Radiation induced cancers are rare and take a very long time to develop. As far as secondary cancers go it has long been known that once a person has had a cancer they are at a higher risk than those that haven’t as it shows potentially weakened immune system. My wife had two unrelated breast cancers 14 years apart. You mention bladder cancer. This is one of the more common cancers in men anyway. My brother in law had prostate cancer treated successfully by radiation. Three years later he had bladder cancer. Radiation induced? Of course not. He had bladder cancer before he was treated for PCa. He was 75 years old and had smoked for many years. He was already at risk. The two cancers were unrelated.

The positive pieces of advice I have seen include being diligent and on the look out for other health conditions and understand you may be at higher risk. Stay calm in spite of what you are seeing, reading and hearing. Managing stress is very important to strengthening our system to fight the cancer and more quickly overcome the side effects that will accompany any and every treatment regimen we choose. Use fact based information to learn by and do not ad hoc or anecdotal information unduly influence our thinking. Especially if it come with emotion an drama.

Thanks fellas ...but right now I am not meantaly good Physically I’m ok l...I am on antidepressants a darn sleeping pill and some anti anxiety....I sleep about 5 or 6 hours a night and that’s not straight ..I am afraid this radiation may tear my down of course dr won’t tell you that ..it’s easy to say get more sleep but when you can’t its screwed. It just seems like surgury now isn’t sounding that bad ..seems like a lot les side effects ...if u done care about ed and incontinance does not seem to be ana issue ...let’s not forget I’m choosing this as primary treatment Anyone else that has chimed in choose this as primary..

Stan...I wouldn't say surgery has fewer side effects (arguably it has more), but it definitely has different side effects. Since none of us is guaranteed to get a free pass in that area (although you could), it is important to be comfortable with the potential SEs of any treatment. In the years I've been here, I've certainly found that some guys are more comfortable with the SEs of one treatment over another.

It would be helpful if you could include your stats in your signature. If you're in a risk group in which surgery is likely to be "one and done" then it could make sense. What you do need to be cognizant about is what are your chances at needing surgery AND radiation.

The stress part sounds terrible...I hope you find ways to treat and/or cope with that. I wish you the best with that.

All good/excellent responses.

Exercise and changing your schedule prior to bedtime might help as well. In the latter context, eating and drinking habits may affect sleeping.

Thanks for adding the stats. I'm no doctor, but at first glance the combo treatment seems like more than you need. If you're concerned about SEs, I would also consider brachy as a mono therapy. It would certainly mean much less of a slog (which I referred to in my initial post.)

But...if you're still on the fence I would tell the doctor that you need more time to decide beyond Monday. Well, unless you feel that more time won't help you.

Tall Allen said...
Stan-

Here are the side effects of each with their approximate prevalence:

/pcnrv.blogspot.com/2016/08/adverse-effects-of-primary-imrt.html

/prostatecancerinfolink.net/2015/12/14/understanding-the-range-of-risks-associated-with-prostate-cancer-surgery-today/

And here is the only study that ever compared their patient-reported outcomes:

/pcnrv.blogspot.com/2016/09/patient-reported-outcomes-from-protect.html

Useful, thanks

Much to ponder. There are not many of us here, so our anecdotes are only marginally useful for you. Best is to really look at, to really try to understand what's in the links Tall Allen posted. His references are usually the best available, and reading them to understand them is a worthwhile effort.

For what it's worth, and our cases are rather different, my experience with primary radiation therapy was blessedly uneventful. Mine was only external, but used some implanted markers for accuracy ("IGRT"). It went about as high as they do with external beam therapy. My side effects, almost 5 years later, are essentially zero from it. Sexual capability as good as most my age, and never any continence issues. PSA so far is pretty stable at around 0.7 +/- 0.1. That's higher than I wanted, but so far so good. My case is in a high risk category, so we'll see. I'm pleased with the radiation treatment. Most of my side effects came from the 3 years of ADT I was on.

Hang in there, it's a lot to consider. The good news is with capably delivered care, your outcomes are likely to be pretty good no matter what you choose.

Stan - I looked at all of the options. I wasn't thrilled with radiation in the end for various reasons. I'm approaching my 5-week post surgery and very comfortable with my choice. There are great surgeons out there and many that will give you statistics on their outcomes. I went in accepting any issues with incontinence that I might be left with and came out with a full recovery.

I appreciate your anxiety in your decision. I found exercise, quality sleep, and rounding out my time with different activities other than deep diving into my choice to be very helpful.

Best wishes, hang in there and you will make the right choice for yourself.