Advice on Adj. radiation?

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Regular Member

Date Joined Jan 2010
Total Posts : 28
   Posted 4/26/2010 9:13 AM (GMT -6)   
My uro /surgeon is strongly suggesting adj radiation after PSA rise from 3 mo. < .1 to 6 mo. .1 What I'm curious about is side effects/reactions. Does the rad knock you out, can I still work? Will I be able to drive myself to treatments? I've read all the stats, which of course are all over the place but what's been the general experience from those here who have actually experienced it. My recovery from surgery has been slow and I don't relish another 8 weeks of misery.
Also, Every other Tuesday morning at the hospital where I've been treated, an oncologist, urologist, radio onc., and a prostate nurse navigator who seems to serve as coordinator/facilitator review current prostate cases(with the patient's consent) and put their heads together for various input and thoughts and recommendations. My primary care doc for 25 years will be attending as well next Tuesday's where my case will be discussed. I will look to the wisdom of that collective group to help give me some direction. I don't know if such a group is common practice in all hospitals, but It certainly sounds like such meetings can be of value. Anybody familiar with such programs at various hospitals?
Advice here continues to be most valued and appreciated.
60 year old, sometimes happy, sometimes grumpy guy
Robotic RP 11/09
Otherwise good health
Gleason 8, T3a
Margins uninvolved
extraprostatic extension present,
Seminal vesticle invasion: absent
One nerve bundle spared
PSA 1/25/10 <.1
4/12/10 0.1
Bone scan, CT scan 4/10 neg
Great support, wife, family, employer

Regular Member

Date Joined Mar 2010
Total Posts : 495
   Posted 4/26/2010 9:31 AM (GMT -6)   
I think you have a reasonable chance for a long life, based on the stats you present. To your question: The definitive study for adjuvant radiation is SWOG 8794, a clinical trial run by Trump, Thompson et al, and superbly designed and conducted. It is available for free from the JAMA (Journal of the AMA) plus there has been a more recent update. This trial was for men such as yourself. The results were unequivocal and the authors said that these results of radiation after surgery should become the standard of care. Recall that these doctor-researchers are at the pinnacle of learning for our disease. Their results must be taken seriously.
The results they produced from the 1990's should be replicated with improvement given the perfection of radiation technology in the past twenty years. The risk is failure to improve urinary or erectile function as radiation may stop any healing in the affected area.
Multi disciplinary teams are a great idea and more hospitals should employ them. They are more common in larger cities with competing hospitals.
Your surgeon did all he could. Your support system you mention is a superb resource. Your team at the hospital and your own intelligence will lead you to the best result.

Veteran Member

Date Joined Jan 2009
Total Posts : 2243
   Posted 4/26/2010 12:09 PM (GMT -6)   
A lot of men continued to work while having SRT. I worked until 2pm and then had my tx. and took 3 hours sick leave. Probably could have worked but was still recovering from surgery. I exercised in the morning as after tx I was ready for a nap on certain days. Frequent urination and loose bowels were about the worst of it, so not bad in the theme of things. Completed tx om 3/12 and almost back to full strength, maybe one more month and I will be there.
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10, Completed 39 tx at 72 gys on 3/12/10
Great family and friends

Veteran Member

Date Joined Nov 2008
Total Posts : 697
   Posted 4/26/2010 12:35 PM (GMT -6)   

I went through salvage radiation while working. No problems with that at all, for me. My hospital is only 5 minutes or so from work, and the radiation dept. offers VIP parking right at the door. I'd leave work about 15 minutes before my treatment time, go get treated (easiest thing I've ever had done medically) and 20 minutes after that I'd be back at work. Okay, maybe I'd stop at Starbucks on the way back. The treatments themselves are totally painless. No sensation at all, except for some boredom and occasional muscle complaint from laying totally still. I enjoyed the little breaks from work and visiting with the radiation technicians and nurses.

I did develop a side effect, but it built up over time and only became a real nuisance toward the end of the 38 treatments. I developed proctitis, which I was able to treat with a prescription topical foam. That did the trick. These days, I don't have any side effects that I can attribute to radiation.

As soon as my radiation therapy was completely done, we went to Disneyland and had a great time. I had been warned about fatigue, but I didn't really notice any. Went on all the rides, walked about 15 miles a day all over the parks.

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1

Regular Member

Date Joined May 2009
Total Posts : 476
   Posted 4/26/2010 9:54 PM (GMT -6)   
The one consideration could be the trade off between earlier treatment (better chance of disease control) vs. healing after RRP (continence, ED). Once radiation starts, the recovery stops.

As far as the treatment itself, it was easy for me. I too walked to and from treatment from work. Since this was early fall, the walks were very enjoyable and I was looking forward to them. While there are some who have bad side effects (like brother David aka Purgatory), most have only minor discomfort towards the end of treatment.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

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