From: dmarrese@gmail.com (DominicM)
Well despite smooth RP and recovery and a "clean" path report ( except
maybe extracapsular extension into margin) some of those Gleason 8's
(3+5) must have have gotten loose as my 7 week post-RP PSA is 0.55 PSA.
I was tested twice by two labs with same result.
My uro is now recommending I see the Radiological Oncologist to get
zapped.
Has anyone been thru a similiar process? How often and frequency? Side
effects? Can work same day after etc?
Thanks guys....
===========
hi Dominic - the psa shows that there are some prostate cells producing
psa.  where, they don't know.    is it cancer?  is it BPH?  or is it
prostate tissue?

the only thing the surgeon knows is that they prostate cells are in the
prostate bed and that is why he wants to radiate you.  to kill those
cells before they get a chance to get into the lymph nodes.

usually, you will be given a series of radiation treatments.   i believe
it takes about 5 minutes for the actual treatment.  but you have to come
in 5 days a week for about a month or so.  

they will go over the side effects to watch out for at the onc's office.  

others at the ng,  will add to what S.E.'s to watch out for.

given the fact that the gleason was an 8 and that your secondary number
was a 5, and you already have a .55 psa number, i would push for a quick
radiation treatment too.  

if you want.  wait 30 days, take the psa test again.  if that number has
gone up any, then your decision for radiation treatment has been made
for you.

hope this info helps,

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

I'm your Huckleberry....

First, however, was it 5+3 or 3+5?  You first reported the latter, which is
not good, but better.

As to RT, mine was EBRT (External Beam Radiation Treatment) where they use
an particle accelerator and zap your prostate bed from six direction each
treatment.  I had 35 treatments; once every weekday for seven weeks.

There really is nothing to it.  They set you up by doing a lot of scanning,
looking at your innards (technical term), mark your sides and belly with
aiming points, and the next day or next week you start the treatments.
Treatments consist of dropping trow, telling the nurse to quit oggling your
manhood, and watching this machine work around you.

Most likely side effects are diarrhea, burning while urination and general
fatigue.  You can combat all three by daily or every-other-daily
cardiopulmonary exercise (I walked 3-5 miles a day, 3-5 times a week),
drinking gallons of water (I drank 2-4 liters daily), and getting plenty of
rest (I went to bed an hour early every night).  The side effects still got
me to a minor degree, but I didn't miss a day of work.

On February 2, DominicM inquired:

(snip another sad tale of recurrence)

As for working the same day, yes, it can be done. Some fatigue may be
noted late in the tx course.

This same question was asked 1/30 on another help group. Here is my
detailed answer. I have been informed that the experience of others is
essentially the same:

*********

Ending in October, 2004, I underwent IMRT, and will try to outline my
experience.

Caveat! Each of us is different, and each tumor has its own individual
characteristics. My experience may or may not bear much resemblance to
anyone else's experience. In short, what I report is anecdotal and a tx
decision should not be based solely upon it.

Background: I had a low-PSA/high Gleason case. PSA was only 5.7; Gleason
was 4+5=9 in five of six specimens on one lobe. Very high-risk. There
was also a small occult 4+4=8 in the opposite lobe. Clinical stage: T2a.
Had cryosurgery 11/03, which utterly failed.

A year later, underwent IMRT, 76 Gy with 40-some to lymph nodes and
seminal vesicles. Also began adjuvant ADT (androgen deprivation
therapy), which continues with excellent results to this day.

First, there was a session in which a CAT scan located the relevant
organs so that a computer program could be written to control the tx.
This involved injection of a dye into my bladder via a Foley catheter,
my first and I hope last experience with it. Also, a mold of my hips and
legs was made (very high-tech: plastic foam in a garbage bag) so they
would be motionless during tx sessions. Being motionless is vital.

There were 35 sessions, five per week for seven weeks.

There is no sensation, but you'd better do all your scratching before
the start. I did watch a computer screen that told me what the shape and
strength of the particular "beam" was at each of the five stops of the
"gantry" around my body.

Before starting each day's session, the techs located my prostate using
BAT (B-mode Acquisition and Targeting) ultrasound. I was positioned on
the table using laser beams that were focused on three dots that had
been tattooed on my lower abdomen and hips.

Between each exposure, the gantry moves to the next position and one can
hear the metal leaves in the gantry move around to the programmed
positions. This is the intensity modulated feature.

After about a week, I began to notice some side effects (SEs). These
continued for several weeks after the end of the tx. Note that the
radiation continues to affect the tissues for some time after the
exposures are completed. Those SEs were urinary urgency and a degree of
fecal urgency that, fortunately, did not continue for long. I was also
fatigued, but how much was due to the ADT and how much to the radiation
I do not know. There was a very slight reddening and itch directly over
my prostate, which was quickly alleviated with a salve.

I also occasionally noted minor amounts of blood in the stool. This can
happen because the prostate is very close to, may even touch, the rectum
and the latter can be affected by the radiation. In my case, I don't
know whether the blood resulted from the radiation or my pre-existent
internal hemorrhoids or a little of both. Didn't amount to much, anyhow.

The urgency was not to the extent of incontinence (barring a couple of
accidents that were my fault), but when I had to go, I had to go *right
now* and had better act without delay. It could be addressed by watching
the clock and keeping track of what's going on internally.

After a couple of months of improvement, the SEs pretty much cleared up.

Objective info can be found on the authoritative website of the Prostate
Cancer Research Institute at:
http://www.prostate-cancer.org/education/localdis/Chaiken_IMRT.html
among other papers at PCRI. Search on IMRT.

*******

Hope this helps.

Regards,

Steve J

"The thing is to expect nothing in particular, but be aware of the lack
of enforceable guarantees or enforceable contracts with
nature/god/entropy as to the condition or durability of our bodies."
-- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate
Problems Mailing List
Thank you, Brian.

There's a recent research report from Sloan Kettering on salvage
radiotherapy.  See:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra
ct&list_uids=12560439&query_hl=5&itool=pubmed_docsum

They are citing 46% four year PSA relapse free results, with
up to 77% good results for patients with positive pre-treatment
indicators (and presumably lower than 46% for patients with
negative indicators.)

   Alan

Dominic,

I had RRP in August and tested fos PSA 3 weeks later.  It showed a small
detectable amount--I don't recall how much.  The doctor had me come back
three months later (December) and the PSA was <0.1.  I get checked again in
June.

really, really sorry to hear that.  

I don't know how much rad they give guys for these scrub-up
treatments.  

I had 25 days of IMRT followed by 97 palladium-103 seeds.  

For 25 days of IMRT, I barely noticed  the side effects. The
rad doc said that most guys start to notice something about the 4th
or 5th week.   Something being, maybe getting up once or twice a
night to pee, that sort of thing.

Supposedly, there's a chance of fatigue, uretha irritation, or maybe
bowel activity, like you went to an all you can eat chili and beer
party.

I can't say that I had any of that and most guys don't seem to, at
least doing the 25 day regime.  

If they schedule you for 35 days, then the side effects are more
noticeable but frankly, nothing like what you're already gone
through.

Seeds, which they probably won't give you, are more intense and I
did notice the side effects.  Notice.  I wasn't debilitated and did
not change my schedule, even during the worse of it.

I took Flomax for 6 months and was getting up 2 and 3 times a night
to "go".   I also had to make frequent pit-stops during the day.
Like about every hour to 90 minutes.  

I had a bunch of other things going wrong so, in the grand scheme of
things, the radiation was a nit, the side effects were barely on the
radar.  

During the worst of it, I was working an 11 hour day for idiots.
That's 2 and 3 hours of unpaid overtime each day while recovering
from the treatment.  

Then, after I bailed them out and cut back my hours to just what I
was being paid, they copped an attitude and fired me.  That was
harsh, it took me a whole 2 hours to find another job.  I even got a
nice raise, should-a bailed long ago.

Here's another funny.  I might have a case for a
discrimination suit, what with the cancer, being 59, and
blatant racist remarks at my firing meeting.

Won't bother though, I got too much to do to fool around with scum
like that.  The company is on the ropes again.