Radiation following surgery

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hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 6/22/2007 9:20 AM (GMT -7)   
Because of my positive margins, my doctors encouraged me to look at the studies showing that radiation therapy within the first year will help prevent biochemical relapse.  After a good PSA of .01 followed by a .08 at the five month mark, this seems more of a necessity, rather than an option.  I see the radiologist next Tuesday to further review and set things up.  While the radiation doesn't scare me, using hormone therapy along with it for a couple of years does.  (As my surgeon said, there go the nerves he spared.  However, longer life is more important to me!) 
 
I've seen some postings with those who have gone or are going through similar therapies.  I would like some ideas on what to expect, what kind of things I should discuss with my radiologist prior to commencing therapy, etc.  Thanks.........
PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006
1 of 10 cores positive 5% LEFT Side
2 others questionable (small gland proliferation)
Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01


AEG
Regular Member


Date Joined Nov 2005
Total Posts : 154
   Posted 6/22/2007 11:17 AM (GMT -7)   

Hi Hawkfan75,

Why is your radiologist recommending hormone therapy as well as radiation?  Please get a second and third opinion about this.  Let's see what others have to say about this.

AEG
 

Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 6/22/2007 11:45 AM (GMT -7)   
hawkfan 75,

I finished my 37 treatments of radiation (IMRT) last week (6/14) and have had minimal side effects. I stopped wearing pads a few weeks before radiation treatments (5 1/2 months after RP) but I now have to occasionally wear them. I thought I was going to have problems with diarrhea and fatigue after 4 or 5 weeks but was told that at my age I wouldn't have any fatigue issues and fortunately I had no diarrhea.

The treatments are like getting a dental x-ray but longer. I'm sure everyone is different but my treatment consisted of being lined up on the table (using 3 period sized tatoos for guides - 1 on each hip and 1 at the base of the penis) and then having 2 or 3 x-rays to be sure I'm properly positioned. I was then "zapped" for about 30 seconds each from 7 different angles (360 degrees at every 45 degree angle except 180 degrees). You should have a full blatter during the procedure so I drank 24 oz. of water 1 to 1:15 hours before my treatment time. I only live 20 minutes away so I called before I left the house (self employed, home based business) to make sure they're weren't backed up. If they were I just partially emptied my bladder and drank more water. They did a blood test once a week to check my blood cell count and I saw my radiologist once a week also.

I was not given the option of using hormone therapy along with the radiation so I can't offer any insight on that. But I am curious about the comment that your surgeon made about the nerves. Does radiation destroy or harm the nerves permanently?

They'll give you a consent form to sign with all kinds of nasty side effects listed but the worst of them are rare. You'll get to know your radiation technicians very well. I can't say enough good things about the group that took care of me, they were fantastic. Good luck and keep us posted.
PSA - 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06
Post-Op Biopsy, still Gleason 6 (3+3),
T2c, right apical margin positive
CT Scan 1/07, tumor discovered on right
kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07
IMRT (37 Treatments) started 4/23/07


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 6/22/2007 4:14 PM (GMT -7)   
My surgeon said that the hormone treatments assist in the radiation destroying any prostate cancer cells left.  While hormones don't kill those cells, but just stop them from growing, hormones will make the radiation work better.  This is why I'm doing investigation first.  I don't fear the radiation, but would like not to have the hormone therapy, since I've read and heard that those side effects are worse.

PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006
1 of 10 cores positive 5% LEFT Side
2 others questionable (small gland proliferation)
Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 6/22/2007 4:39 PM (GMT -7)   

Here is an article I just found about hormones with radiation therapy.  This is one of the things that has been so frustrating about this whole disease; there's so many options with studies backing all of them.  As for radiation getting the "saved nerves", since the prostate bed is where they will be shooting at, the nerves will be in the line of fire.  (This is not one of my major issues - having consistent "0" numbers is what I want.

 

Lee AK.

Department of Radiation Oncology, University of Texas- M.D. Anderson Cancer Center, Houston, 77030, USA. aklee@mdanderson.org

Standard-dose radiation therapy has limited capacity to cure bulky and locally advanced prostate cancer. Multiple randomized trials have shown a clinical benefit to adding androgen suppression therapy to external-beam radiation therapy in several subsets of prostate cancer. These studies have made combining hormonal therapy with radiation therapy the standard of care for men with locally advanced (T3-4) and unfavorable prostate cancers (Gleason score >or=8 and/or prostate-specific antigen >20 ng/mL). The clinical impact of hormonal therapy has been seen in biochemical control, local control, distant metastases, disease-specific survival, and overall survival. If hormonal therapy is to be combined with radiation, it should be initiated before the start of radiation and continued during the radiation course rather than used only in the adjuvant setting. Typically, shorter-term hormone therapy is defined as regimens of 4 to 6 months, with longer-term hormone therapy describing durations beyond 24 months. Historically, longer-term hormone therapy was thought to have a more profound systemic effect; however, with the emerging use of hormonal therapy for less-advanced disease, the overall impact of shorter-course hormone therapy is being seen. This review will summarize trials using hormonal therapy and radiation with an emphasis on phase III studies and describe the more recent integration of hormone therapy with radiation for prostate cancer. 


PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006
1 of 10 cores positive 5% LEFT Side
2 others questionable (small gland proliferation)
Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology
     Stage T3a, Gleason 3+4, positive margins and
     capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01
5 month PSA, June 13, 2007:  0.08
 


veteran1
Regular Member


Date Joined May 2007
Total Posts : 133
   Posted 6/22/2007 5:11 PM (GMT -7)   
hawkfan75

Yes, have made the same decisions you are now confronting. Four months after I had surgery, I opted for adjuvant proton radiation therapy. Seven weeks, 35 treatments.
Why? Seminal Vesicle Involvement. Like you, my cancer had grown or extended out of the prostatic capsule. Radiation treatment offers good recurrence free survival.
MAKE sure you ask the
radiation/oncologist about distant metastasis or distant failure. This a worry that should be addressed. Also, clinical trials have shown that radiation therapy combined with hormone therapy, improves
recurrence free survival results.
Ask oncologist about intermittent hormone
therapy. Side affects of HT can include
ED, hot flashes, bone density loss, muscle
mass loss, ect.
I am doing a good job of scaring you. I don't mean to. I do what I have to so that I have the best chance possible to live a long happy life.
And please get a second and third opinion if your not satisfied with risks vs. benefits.

Good Luck, Veteran1

Diagnosed: 12/03/05
Biopsy: Gleason 10
Hormone Therapy (intermittant) 12/15/05
EBRT:Photon...06/05/06 thru 07/25/06
Diagnosis: T3b Seminal Vesicle Involvement, Gleason 9 both lobes
Current PSA---- .01

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 9/1/2007 7:01 PM (GMT -7)   

Hey ~ Hawkfan…

 

Adjuvant therapy began June 26 with Zoladex injection

 Radiation to commence in late August

 

                             Thinking of you!!!

 

Just a little note to let you know you are in our thoughts and prayers as you begin a new path in “Your Journey”…    Thank you for staying close….     In Friendship ~ Lee & Buddy

 

 

Threads started by:  Hawkfan

06-22-07  Radiation following surgery

03-06-07  Good News - Finally

01-30-07  Post Surgical Pathology Report

08-21-07  Pomegranate Extract

 

 

    

 

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