Radiation following surgery

Because of my positive margins, my doctors encouraged me to look at the studies showing that radiation therapy within the first year will help prevent biochemical relapse.  After a good PSA of .01 followed by a .08 at the five month mark, this seems more of a necessity, rather than an option.  I see the radiologist next Tuesday to further review and set things up.  While the radiation doesn't scare me, using hormone therapy along with it for a couple of years does.  (As my surgeon said, there go the nerves he spared.  However, longer life is more important to me!) 

I've seen some postings with those who have gone or are going through similar therapies.  I would like some ideas on what to expect, what kind of things I should discuss with my radiologist prior to commencing therapy, etc.  Thanks.........

hawkfan 75,

I finished my 37 treatments of radiation (IMRT) last week (6/14) and have had minimal side effects. I stopped wearing pads a few weeks before radiation treatments (5 1/2 months after RP) but I now have to occasionally wear them. I thought I was going to have problems with diarrhea and fatigue after 4 or 5 weeks but was told that at my age I wouldn't have any fatigue issues and fortunately I had no diarrhea.

The treatments are like getting a dental x-ray but longer. I'm sure everyone is different but my treatment consisted of being lined up on the table (using 3 period sized tatoos for guides - 1 on each hip and 1 at the base of the penis) and then having 2 or 3 x-rays to be sure I'm properly positioned. I was then "zapped" for about 30 seconds each from 7 different angles (360 degrees at every 45 degree angle except 180 degrees). You should have a full blatter during the procedure so I drank 24 oz. of water 1 to 1:15 hours before my treatment time. I only live 20 minutes away so I called before I left the house (self employed, home based business) to make sure they're weren't backed up. If they were I just partially emptied my bladder and drank more water. They did a blood test once a week to check my blood cell count and I saw my radiologist once a week also.

I was not given the option of using hormone therapy along with the radiation so I can't offer any insight on that. But I am curious about the comment that your surgeon made about the nerves. Does radiation destroy or harm the nerves permanently?

They'll give you a consent form to sign with all kinds of nasty side effects listed but the worst of them are rare. You'll get to know your radiation technicians very well. I can't say enough good things about the group that took care of me, they were fantastic. Good luck and keep us posted.

Here is an article I just found about hormones with radiation therapy.  This is one of the things that has been so frustrating about this whole disease; there's so many options with studies backing all of them.  As for radiation getting the "saved nerves", since the prostate bed is where they will be shooting at, the nerves will be in the line of fire.  (This is not one of my major issues - having consistent "0" numbers is what I want.

Lee AK.

Department of Radiation Oncology, University of Texas- M.D. Anderson Cancer Center, Houston, 77030, USA. [email protected]

Standard-dose radiation therapy has limited capacity to cure bulky and locally advanced prostate cancer. Multiple randomized trials have shown a clinical benefit to adding androgen suppression therapy to external-beam radiation therapy in several subsets of prostate cancer. These studies have made combining hormonal therapy with radiation therapy the standard of care for men with locally advanced (T3-4) and unfavorable prostate cancers (Gleason score >or=8 and/or prostate-specific antigen >20 ng/mL). The clinical impact of hormonal therapy has been seen in biochemical control, local control, distant metastases, disease-specific survival, and overall survival. If hormonal therapy is to be combined with radiation, it should be initiated before the start of radiation and continued during the radiation course rather than used only in the adjuvant setting. Typically, shorter-term hormone therapy is defined as regimens of 4 to 6 months, with longer-term hormone therapy describing durations beyond 24 months. Historically, longer-term hormone therapy was thought to have a more profound systemic effect; however, with the emerging use of hormonal therapy for less-advanced disease, the overall impact of shorter-course hormone therapy is being seen. This review will summarize trials using hormonal therapy and radiation with an emphasis on phase III studies and describe the more recent integration of hormone therapy with radiation for prostate cancer. 

Hey ~ Hawkfan…   Adjuvant therapy began June 26 with Zoladex injection   Radiation to commence in late August                                Thinking of you!!!   Just a little note to let you know you are in our thoughts and prayers as you begin a new path in “Your Journey”…     Thank you for staying close….      In Friendship ~ Lee & Buddy     Threads started by:   Hawkfan 06-22-07   Radiation following surgery 03-06-07   Good News - Finally 01-30-07   Post Surgical Pathology Report 08-21-07   Pomegranate Extract