Posted 2/8/2015 4:13 PM (GMT -7)
The problem I have with "studies" or "reports" like this, is it does one no good if you end up being the exception or the 1 in a 1000, etc. It doesn't look at individuals, just a cold statistic based on simple math and data supplied.
Both my oncologists, current with my PC for nearly 4 years now, and my previous, dealing with my 3 bouts of porocarcinoma, had strong opposing views to this position in this thread. Part of the problem, is that a secondary cancer (caused indirectly from the original), can take 10-20 years to show up in some cases, and some patients simply have died prior to the "new" cancer being a problem to them.
In my case, it seems to 100% certainty that my first major radiation event in 2000, 70 gys. of radiation directly in my throat, was the cause of all my teeth, gum, and cheek bone damage. My new VA doctor ,in advance of verification of whatever is going on behind my right eye, and the growth in my left cheek, would be attribute to the same radiation event. It's been 15 years since the radiation.
Coming back to the PC side, I had 72 gys to the prostate bed via IMRT in 2009, so coming up on 6 years. My greatest fear is having bladder cancer or PC to the bladder or surrounding area. Since there is no possible way to inspect my bladder outside of a long, complicated, and ruled very dangerous operation to remove my non-working, non-connected bladder, I would never know if it was cancerous until it was Stage IV according to my urologist.
Both he, my current oncologist, the VA doctor, and the Head of Urology at MUSC in Charleston, all agree mutually, that removal of the bladder should have been done at the time of my Urostomy surgery in 2010, why it wasn't, my urologist never fully explained to my satisfaction, other than it would have complicated things greatly. But the risk is there, all the time, never out of my mind.
Since my bladder has long since shrunken and collapsed totally (wall to wall), there is no way to get a scope into it, as my urethera has long scarred closed completely, and since there is no exit at all from the bladder, even if it were bleeding from the inside, there's no way to exit any blood for fluid.
So for someone like me, and for someone dealing with a secondary cancer like ziggy above, stats and studies on the subject offer little comfort.
In both my cases, I guess I must take the ultimate blame ,because after all, the patient agreed to what was suppose to be sound medical advice by supposed good doctors. As far as the porocarcinoma events, there was (at that time, and still) no proven protocol to use radiation post surgery. It was just a gamble in the dark at the time. And with the SRT post PC surgery, we have discussed that subject in depth here, and the problem I always have, is that RO's can not prove by scans or any other means, that the patient's remaining PC is actually in the prostate bed.
If you are dealing with PNI, then as my oncologist has said many times, cancer cells have all kinds of routes to escape the prostate bed, and could be anywhere in the body over time, even in multiple sites, as is suspected in my case. For me to be producing PSA in the high 40's this far out, yet no mets big enough to show up on scans, tells me that there must be quite a few sites, each producing small amounts of PSA, collectively producing the total number. This is my oncologist's opinion.
I wouldn't tell anyone to refuse SRT based on an irrational fear of secondary cancers, but there's got to be a better way to determine if its needed, and where to administer the radiation, other than just using what is an educated guess. Need some better medical technology there, not sure what it would be. Need to take the guess work out of it.
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