Radiation, Hormones and Side-Effects

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Wife of Lot
New Member


Date Joined Sep 2010
Total Posts : 4
   Posted 9/2/2010 8:01 AM (GMT -6)   
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.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 9/2/2010 8:23 AM (GMT -6)   
i began hormone therapy three months before brachytherapy.  i had my catheter removed by my urologist the day after getting the seeds and he then gave me my second 3-month shot of lupron.  i just finished IGRT last week and i get my third and final shot of lupron in two weeks.
 
the worst side effects so far have been the month after brachy therapy.  urinary urgency and constricted flow were scary for awhile but at no times have side effects been intolerable.
 
the treatment is aggressive but so is my disease.
 
F8
age: 55
PSA on 10/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
ADT, brachy and IGRT

Wife of Lot
New Member


Date Joined Sep 2010
Total Posts : 4
   Posted 9/2/2010 8:27 AM (GMT -6)   
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.
PSA at Dx: 14.8
Age 65
Biopsy 4/1/10: 12 cores, 6 - no prostate glandular tissue
5 of 6 cores +
Gleason 4+3 x 2 - 90% of cores (R Apex) w/perineural invasion; Gleason 4+4 x 2 - 50% of cores (left mid) w/perineural invasion; Gleason 3+4 - 40% of core (left apex)
Stage T2(a) or (c) - two different opinions
Seed Implant: 7/14/10 (79)
IMRT: 8/13/11

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 9/2/2010 8:29 AM (GMT -6)   
Any pre-existing urinary restriction is likely to be made worse for a while after brachytherapy. Indeed considerable restriction of the uretha is one of the few contra indicators of seed implant surgery. However, if the IMRT is done correctly it should not make the condition worse since the total radiation from IMRT is much less than that received with brachytherapy, and spread out over time. I experienced side effects similar to those you describe for your husband but they did not get worse with IMRT and improved considerably about a month after it ended. I assume your husband meets with the radiation oncologist every week to discuss the side effects?

Hormone therapy is a standard protocol for patients with high risk PCa but is not normally given in conjunction with seeds + IMRT for those who are low risk and intermediate risk.
You can read more about HT as an adjuvant therapy at http://prostatecancerinfolink.net/2010/08/26/adjuvant-and-neoadjuvant-use-of-adt-in-management-of-prostate-cancer-today/
Also here. http://prostatecancerinfolink.net/2010/08/05/does-local-therapy-with-adt-for-locally-advanced-prostate-cancer-improve-patient-outcomes/

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2010 + hormone therapy (Lupron + Casodex) + IMRT on Novalis, 45 gy, 3/2010.

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06

Post Edited (Sancarlos) : 9/2/2010 8:37:36 AM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 9/2/2010 8:32 AM (GMT -6)   
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.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 9/2/2010 8:43 AM (GMT -6)   

Wife of Lot -- HT shrinks the cancer and stops its growth, which is desirable while receiving radiation.  i don't like to play doctor but it would seem to me your husband is an ideal candidate for HT.  here are a couple of guys he may know who opted for HT, BT and IMRT...

Article: Taking on Prostate Cancer by Andy Grove, Fortune Magazine 5/13/96

http://www.usatoday.com/news/health/spotlighthealth/2002-10-14-giuliani_x.htm

is there a particular reason he's opposed to HT...after all the treatment he's receiving is pretty aggressive like his disease?

BTW, welcome and i wish you both the very best!

F8


Post Edited (F8) : 9/2/2010 9:00:10 AM (GMT-6)


F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 9/2/2010 9:17 AM (GMT -6)   

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


Wife of Lot
New Member


Date Joined Sep 2010
Total Posts : 4
   Posted 9/2/2010 11:46 AM (GMT -6)   
Thank all of you very much for the nice welcome and the information. I put my husband's stats in the signature, but for some reason it's not showing up.

PSA at Dx: 14.8
Age 65
Biopsy 4/1/10: 12 cores, 6 - no prostate glandular tissue
5 of 6 cores + for PCa
Gleason 4+3 x 2 - 90% of cores (R Apex) w/perineural invasion; Gleason 4+4 x 2 - 50% of cores (left mid) w/perineural invasion; Gleason 3+4 - 40% of core (left apex)
Stage T2(a) or (c) - two different opinions (Radiation oncologist said he could palpate one side, surgeon we consulted with said he could palpate tumor on both sides)
Seed Implant: 7/14/10 (79 seeds)
IMRT: began 8/13/11

My husband had a tendency to down-play some of the urinary issues before the diagnosis and I think he is doing that now with his radiation oncologist. The stop and go stream had been a problem for quite a few years but he told the doctor he was "pretty normal." He did have urodynamics before the seed implant and I assume they would not have done the implant if they thought it would be an issue. But we weren't anticipating this b/c the radiology clinic said only 25% of the patients have this issue. Sounds like they glossed over the side-effects a bit.
PSA at Dx: 14.8
Age 65
Biopsy 4/1/10: 12 cores, 6 - no prostate glandular tissue
5 of 6 cores +
Gleason 4+3 x 2 - 90% of cores (R Apex) w/perineural invasion; Gleason 4+4 x 2 - 50% of cores (left mid) w/perineural invasion; Gleason 3+4 - 40% of core (left apex)
Stage T2(a) or (c) - two different opinions
Seed Implant: 7/14/10 (79)
IMRT: 8/13/11

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6948
   Posted 9/2/2010 12:38 PM (GMT -6)   
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.
My IGRT journey -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 9/2/2010 7:52 PM (GMT -6)   
Wife, I am seeing your signature fine.
No comment on the HT with SRT except that I found research that indicated that testosterone levels at or below 300 provided the desired improvement. I have "naturally" had low T for the last 3 years, presently about 120-180, and opted against additional HT with SRT. Time will tell.
Jeff
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09: 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear
PSA after, 2010: March, 0.17; April, 0.17; May, 0.24; June, 0.31; July, 0.29; Aug, 0.41
Started salvage IGRT on August 4, plan 72Gy total, 40 doses

Wife of Lot
New Member


Date Joined Sep 2010
Total Posts : 4
   Posted 9/3/2010 1:41 PM (GMT -6)   
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. 

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 9/3/2010 6:33 PM (GMT -6)   
Wife of Lot,

I agree that your husband appears to fall in the high risk category and studies have consistently shown that ADT offers cancer-specific survival benefits for persons with high risk localized cancer when used as an adjuvant therapy.

Show him this study

http://prostatecancerinfolink.net/2010/08/05/does-local-therapy-with-adt-for-locally-advanced-prostate-cancer-improve-patient-outcomes/

where the findings were:

* Studies of immediate versus deferred ADT without local treatment consistently showed only limited benefit for overall survival and prostate cancer-specific survival.
* Studies of ADT as an adjuvant to radiation therapy in patients with high-risk localized prostate cancer or locally advanced prostate cancer have consistently shown substantial benefit favoring overall and prostate cancer-specific survival.
* Studies of ADT as an adjuvant therapy in patients with proven systemic disease (e.g., node-positive patients after radical prostatectomy) have also consistently shown substantial benefit favoring overall and prostate cancer-specific survival.
* There appears to be a statistically significant and a clinically important survival benefit associated with adjuvant ADT when a local treatment has been applied to the primary tumor.

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2010 + hormone therapy (Lupron + Casodex) + IMRT on Novalis, 45 gy, 3/2010.

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06

Post Edited (Sancarlos) : 9/4/2010 1:02:20 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/3/2010 7:11 PM (GMT -6)   
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
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.
New Topic Post Reply Printable Version
Forum Information
Currently it is Thursday, June 21, 2018 4:46 AM (GMT -6)
There are a total of 2,974,054 posts in 326,246 threads.
View Active Threads


Who's Online
This forum has 161226 registered members. Please welcome our newest member, echevarriacarisa.
290 Guest(s), 3 Registered Member(s) are currently online.  Details
SantaZia, isitlyme, neo_4789