I had Salvage Radiation two years ago after a slow rise in PSA since my original RP surgery in 2002. The exam in preparation for the SRT turned up one enlarged lymph node on my left side near the prostate bed. The RO showed me and my wife the xrays and was kind of on the fence as to if he should proceed with the SRT or not -- he said that because I also had seminal vesicle involvement at the time of my original surgery, the prospects of the SRT working were probably not good. He agreed to go ahead with SRT - 67.5 Grays over 37 days plus 20mg Casodex for 90 days during and after SRT. For the first 25 or so daily treatments a portion of the radiation was targeted directly at the enlarged lymph node. The node was not targeted for the entire 37 days because of the danger of excess radiation in that
location damaging other organs near the lymph node.
I had my first PSA test about
3 months after the SRT ended and my PSA had fallen to 0.00 (it was 0.44 before the SRT). My RO thought, since I'd been off the Casodex for only a couple of months the Casodex might still be masking PSA. But each subsequent PSA (every 3 months) remained at 0.00.
I saw my RO again this past January and he said he was surprised I was still 0.00, given the seminal vesicle and lymph node situation, but he also said someone has to do better than expected -- someone has to be at the edge of the curve.
Since that meeting I've now had a PSA of 0.01 --absurdly low, but also the first measurement above 0.00 in two years. It could be nothing, or it could be the first sign that there is something going on. But I have no doubt that the SRT plus Casodex did something -- presumably knocking out or knocking back whatever was in the prostate bed.
Whether this result will have any actual long term effect on my prognosis is knowledge above my pay grade. However I can say that, other than my insurance company having to spend a lot of money for the SRT, there were no lasting negative effects from the treatment. There were few weeks of urinary urgency during the latter weeks of SRT treatment and for a few weeks after. I also developed rectal bleeding beginning about
6 months after the end of SRT, which got gradually better over a year or more. I think it is now entirely gone, but can't say for sure. In the early months when the bleeding occurred I would sometimes (maybe 6 or 8 days out of a month) feel cramped up and have liquid blood in the bowl. This soon became less frequent and the blood amounts gradually reduced to mere spotting (sorry for being so graphic, but I'm trying to be accurate).
Also, because I was working full time as technical writer, I was able to arrange with my employer to work at home, dial into meetings, and remain working full time during my SRT and for a couple of recovery weeks afterward before I returned to the office. I had none of the fatigue that some report from radiation therapy.
I don't know if this helps with your decision. But in summation I have no regrets, I had no real downside from this treatment, but can't say for sure if there is a long-term upside.
Current Age 66
--DX March 2002 based on PSA 9.0, DRE, and needle biopsy
--RP April 2002. Pathology report showed Gleason=7 (3+4), plus seminal vesicle involvement. No sign of lymph node involvement. PT3B N0 MX
--Post-surgery PSA dropped to a low of 0.01 followed by gradual rise to 0.44 (August 2009).
--SRT Jan/Feb 2010. Enlarged lymph node near prostate bed noted and also targeted. Took Casodex 3 months during SRT
--PSA after SRT remained 0.00 for 2 years
--PSA of 0.01 as of April 2012
Post Edited (Bohemond) : 4/10/2012 7:28:45 PM (GMT-6)