Posted 5/6/2014 9:18 PM (GMT -6)
Lot of differing opinions about having SRT with, or without HT. Good arguments can be made in either direction. Going back to 2009, when I had to make the decision. I met with 3 different RO's at the center radiation center. 2 of them, strongly felt, that not to include HT with the RT. They believed that it was best to do the radiation on its own, to see if it worked and would do the job of killing off any remaining PC. The biggest assumption on any of the RO's opinion, is the issue of, is the cancer in the prostate bed or not. No one can be 100% sure of that answer, no way to tell positively certain where the remaining cancer is located.
The 3rd RO I met with, at the same clinic, tried to encourage HT along with the RT, but when I pushed him for evidence of his thinking, he couldn't really come up with any hard evidence (keep in mind, this was nearly 5 years ago, and a lot of thinking on the subject has changed since then). In the end, he admitted to me, that he couldn't prove that it would help, and he couldn't prove that I needed the HT in addition to the RT. So that wasn't a very convincing argument to me at the time time.
To make a long story short, I had the RT without HT. Not only didn't the RT fail to get the cancer, but the treatments were administered incorrectly, and as a result, I lost the use of my bladder, and was left with extreme radiation damage and perm. chronic fatigue and severe chronic pain, both which I fight with every day of my life. Ended up with a stoma (Urostomy) as the result of all the damage done to my bladder and bladder neck. Rare? Perhaps, but there are lots of cases hidden away by patients with severe radiation damage, the RO's don't like to talk about that part, based on my personal experience.
If they knew where the cancer was located, then a salvage radiation decision would be easier for a patient to make. However, if its not in the prostate bed, then the radiation, and all its associated risks, not even counting the ordeal and the cost, are going to be done in vain.
While many men here will tell how the radiation was a walk in the park (so to speak), not putting words into anyone's mouth, there are known risks with any type of major radiation events. I have been through this twice over a 10 year period of time, so I am speaking first hand knowledge.
In some cases, the remaining cancer takes on the form of multiple sites of "micro-mets', and according to my oncologist (who only deals with advanced prostate and advanced breast cancer patients), these micro mets, once they escape the prostate bed, (sometimes as the results of PNI), they can be almost anywhere in the body. And until, when and if any of these sites are large enough to be picked up by scans, there's just no telling where they are.
I still have no problem with men undergoing SRT, if there is a reasonable chance of the cancer still being in the prostate bed, but as I have stated, not sure how any RO could give you or anyone else the assurance that is really the case.
So it is a tough personal opinion to have to make. If the cancer is still there, then SRT makes sense, despite the assumed risks, and you have a good and final curative shot at ridding the remaining cancer.
That's my take, based on my personal experience. In my case, it was a life changing ordeal, that left me disabled at age 57 at the time, and since then, my PSA has sky rocketed out of control, despite having had both surgery and salvage radiation. If I could only go back in time. I had such bad feelings about the SRT, based on my first major radiation event in year 2000 (for neck and throat cancer). Only wished I had trusted my gut feeling on that decision. But at the time, with a quickly failed surgery, it seemed like the right thing to do. All 3 RO's I did meet with, all agreed that I absolutely needed the radiation.
Good luck, on what I feel will be a tough decision for you to make.
Age: 61, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incontinence & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA: Too High
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries