Radiation after Open RP Question

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positive 1
New Member


Date Joined Sep 2010
Total Posts : 7
   Posted 12/15/2010 7:52 PM (GMT -6)   
Hi,

My dad had open RP on 10/4. He is doing exceptionally well from everything I read on here and also according to his doctor. My question is about radiation, which he's due to start in the late spring. A lot of people give the impression that it's not that bad -- that they just get fatigued. Is this really true, or are their much worse side effects possible? Also, does having radiation reverse the progress he's made/making in incontinence and ED? His stats are below.

Thanks for your thoughts!


Age: 67
PSA 2010: 8.5
PSA 2009: 6.5
Gleason: 6 on one side, 7 (3+4) on the other
One positive margin, not sure of size
Able to salvage nerves on right side, not on left
PSA 6 weeks post op: 0.04 (whoooooo hoooooo!)
Incontinence: Just a dribble here and there
ED: Not going well, from what I understand

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 12/15/2010 8:02 PM (GMT -6)   
Positive1,

Everyone is different, but I did fine with it. I felt tired at times, but was able to walk/run on a daily basis throughout. I had the expected loose stools

My incontinence was terrible after surgery. Oddly, when I started radiation it got better. Radiation probably made it plateau for awhile and weeks/months later it got much better.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

fulltlt
Regular Member


Date Joined Nov 2010
Total Posts : 264
   Posted 12/15/2010 9:56 PM (GMT -6)   
Fatigue is a definite side effect of radiation treatment as I can testify first hand. During my IMRT treatments I would get so tired at work I would have to go to the break room and sit on the couch and close my eyes for a few minutes. Another side effect I had was loose bowel movements. The doctor advised carrying imodium in my pocket at all times just in case.
age 57 2/2010
PSA 8.2 2/2010
biopsy 2/2010 - 2 of 8 left & 2 of 8 right positive, Gleason 3+4=7
attended support group - advised to get a second opinion
second opinion on pathology from Johns Hopkins 4+4=8
PSA 15 4/2010
5 weeks IMRT 4/2010-6/2010 at Copley Hospital in Aurora, IL
91 palladium 103 seeds 7/2010 at Chicago Prostate Center, Westmont, IL
PSA 3.97 10/2010
no ED or incontinence

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 12/15/2010 10:13 PM (GMT -6)   
Radiation was not bad at all. As others said, it was a but of fatigue and diarrhea. I was able to work all through the course. However, looking at your dad's stats I don't think thus is a foregone conclusion that he needs radiation. I would suggest another opinion.
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

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7080
   Posted 12/16/2010 12:06 AM (GMT -6)   
Positive 1,
 
Look at my IGRT path - I posted day by day. Fatigue, loose bowels, increased incontinence are all expected side-effects.
There is always the possibility of much more severe problems - you might have noticed David's posts (Purgatory). If there is any mis-direction of the radiation, rectal and bladder damage are possible. I was told that the more serious side effects, if they were to happen, might not show up until several years after treatment.
 
So far (at 6 months after), I still have significant fatigue, a more frequent bowel than I would like, and my incontinence is now worse than it was 4 months after DaVinci surgery. Nothing to write home about.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 669
   Posted 12/16/2010 12:30 AM (GMT -6)   
Positive, I made it through radiation with no urinary side effects - in fact, the only significant side effect was fatigue, which completely ended about 6 weeks after the treatments ended.
My rad oncologist told me that urinary complications such as stricture, etc. are less than 2%, and secondary cancers due to the radiation happens in about 1 in 2000-3000.

Based on my research and what the docs told me: you are most likely to end up at a permanent level of continence / incontinence corresponding to where you were when you began radiation treatment. In other words, the radiation can prevent you from further progress. That is one reason why they tend to want to delay radiation after surgery as long as feasible. It sounds to me that your father will probably be in pretty good shape by late spring.
Jeff
Gleason,3+4;PSA 7.9,Nerve-sparing RRP,03/2008(Age 48 then),confirmed 3+4 Gleason,pT2c, 60g, neg margins; perineural & lymphatic invasion;3 lymph nodes removed,clear; seminal vesicle invasion:absent;Gleason 4 was 5-10%; PSA <0.1 until Oct 09:0.1; retest <0.1; scans clear;monthly results from Jan 2010:0.2,0.2,0.17,0.17,0.24,0.31,0.29,0.41, IGRT SRT started 8/4/2010, PSA@5 weeks into SRT:0.17

Aussie Bloke
Regular Member


Date Joined Feb 2010
Total Posts : 22
   Posted 12/16/2010 4:00 AM (GMT -6)   
I must have been one of the 2%. Severe scarring of the urethra resulting in total continence...emergency surgery followed and I'm OK now, but not nice.

Another rad thing...your healing ability is severely impaired...wounds in the irradiated area from further surgery take weeks and weeks to heal.

But if it kills the cancer...

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/16/2010 4:36 AM (GMT -6)   
Positive 1 -- WHY are you being told of the need for radiation.
I can't help the feeling that we are not aware of all the story..

Radiation is an absolute last resort ,
Radiation kills things, bad and good.. Radiation causes things to get worse as flesh hardens or dies..

Did the Pre-Op bone scan show up other "Hot Spots"
.
.
Nov 2009 = First-PSA 5.3 @ 60yo - Asymptomatic - DRE-Non-Palpable
Jan-'10 = TRUS Bx DX - AC T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
May-'10 = RRP-Nrv-Spare
Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
MI(xtensive) Post, Grade3 x 8mm
+8week PSA<0.01, ED-85%, Incont-30%
+16W PSA<0.01, ED -85%, Cont -5%
+17W First 'DRY' day. ED -90%
+26W ED -60%

positive 1
New Member


Date Joined Sep 2010
Total Posts : 7
   Posted 12/16/2010 12:50 PM (GMT -6)   
It's so interesting that many of you brought up his needing radiation. I was questioning it as well, especially at his age. Plus, it was some ridiculous (in my opinion) length too -- like 9 weeks or something (but perhaps this is the "norm" and I'm just not aware).

His doctor is ULTRA conservative, so that's probably some of it. Also, I think his positive margin was near the bladder, so maybe he's afraid of a future metastasis? BuiDoi -- no hot spots on bone scan or CT scan. I think I might have him ask the doctor about the risks of forgoing the radiation in his case.

Thanks so much for the replies! You've really made me feel better (for the most part) about his ability to make it through the radiation without too much stress/discomfort. He's a very positive person and a great patient (always follows the orders he's given so he can get well super-quick). So, for that I'm also grateful.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/16/2010 1:31 PM (GMT -6)   
positive, i too dont understand why radiation is already planned for your father. he does not have recurrance, or any evidence this early on that he will. his positive margin doesnt mean he will have recurrance, just means he might.

radiation is a serious matter, not to be taken lightly, if he uses it, it will be his secondary treatment and his last curative shot available.

my radiation went badly. i ahd 39 session totalling 72gys. It was the 2nd time in 11 years tht my body went through major radiaton for cancers.

for me, it was painful from the start, i still have chronic fatigue a full year later, and the radiation damaged my bladder and bladder neck so bad, that i had to have a suprapubic catheter for a full year after, and eventually and recently, had to have a urostomy, so now i pee into a plastic bag from a stoma, and will for the rest of my life.

rare, perhaps. but its not all roses for those undergoing radiation. my advice would be for you father not to have radiatio until and unless he has firm evidene of the cancer recurring.

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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 12/16/2010 9:52 PM (GMT -6)   
Your surgeon knows the extent of that one positive margin..None of us here have any knowledge of that..But that's the reason for the adjunct radiation...Hopefully, the PSA will stay where it is or improve..These ultra-sensitive tests tend to float around a little...If they stay "undetectable", I would be in no rush to undergo RT....But you should know this..The sooner they start RT, the better it works...In the really high-risk guys (like myself) it's almost automatic regardless of the post-op PSA number....
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec
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