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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2006

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Post-RP radiation

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juniper - 23 May 2006 07:46 GMT
Dominic said, in another thread
< My rad onc said RP patients generally have less side effects than
< primary RT patients. My se's were minor some bladder urgency and
very,
< very minor fatigue.

Why do you think this is?  Or would be.  Has anyone else had both EBRT
and seeds after RP?  Even just any experience with RT after RP would be
nice. TIA, laurel
ronju99 - 23 May 2006 12:14 GMT
Not sure how you could have seeds after RP. Post may need a correction.
Ron S
juniper - 23 May 2006 19:46 GMT
> Not sure how you could have seeds after RP. Post may need a correction.
> Ron S

The radiation onc did an ultrasound and found (depending on method of
measurement) between 11 and 17 gms of prostate tissue remaining in the
bed.  However, we just got the MRI and it doesn't mention any.  Maybe
I'll call them and ask specifically.

At any rate, there is apparently no guarantee that an RP will get 100%
of the prostate out.  The rad onc says (I keep saying that because he
has his own agendas) he sees it all the time.

laurel
ronju99 - 23 May 2006 21:56 GMT
I agree that they usually don't get all the tissue removed. However, the
path report should determine if any cancer cells were left behind in the
remaining tissue. I had mentioned in a past post that my urologist told me
his father had tissue left that evenually grew back to almost the original
size. That is another reason one can have low levels of PSA after surgery
and not to worry about ultra-sensitive test.

Ron S.
juniper - 24 May 2006 06:11 GMT
> I agree that they usually don't get all the tissue removed. However, the

I don't even know what I feel about this.  Just one of those little
details the medical professionals left out.  All those SEs, just to
leave it behind.

> path report should determine if any cancer cells were left behind in the
> remaining tissue. I had mentioned in a past post that my urologist told me

Well, yes, we were hoping for a cure and would have stood on that but
the bladder neck had cancer, as well as a lymph node.
Steve Kramer - 25 May 2006 00:22 GMT
> At any rate, there is apparently no guarantee that an RP will get 100%
> of the prostate out.  The rad onc says (I keep saying that because he
> has his own agendas) he sees it all the time.

My surgeon warned of this possibility, but at least one surgeon wrote that
it is more often a measure of the surgeon.

Signature

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA  .1  .1  .1  .27  .37  .75
EBRT 05-07/2002 @ 47
PSA  .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06
PSA  .07 .05 .06 .09 .08 .132
Non Illegitimi Carborundum

Bob C - 24 May 2006 01:23 GMT
   I had EBRT three months after RRP due to visible cancer  on the surface
of the bladder. That was about 5 1/2 years ago. For the seven weeks of
radiation treatments, the only SE's were minor bladder spasms and diarrhea,
both of which started well into the program. They did not shield the
bladder, or maybe not as much as normal, due to known cancer at that site.
It maybe would not have been too major a problem had I not been driving 50
miles to go to work after each session and restroom facilities were not
always where you needed them. I learned about Imodium AD and Metamucil and
with the Imodium especially was able to carry on pretty much like normal.
Without the Imodium I would have had a major problem, and  a friend of mine
who went through a similar scenario of RRP followed by EBRT was not able to
function at work due to the frequency and urgency of bathroom visits. After
I told him how I did it, he tried the Imodium and said it made all the
difference in the world. Another elderly friend who went with seeds
developed pretty major diarrhea and again was "saved" by the same little
pills. I do not know if he still relys on them or not. The first guy does,
as do I.
   After a couple years, when they said that after two years "what you have
is what you got" in regards to SE's from radiation,  I continued to go
downhill with increasing bladder spasms and incontinence. An artificial
urinary sphincter was finally put in a little over a year ago and works
pretty good, and medications help quite a bit with the spasms. I had pretty
extensive EBRT so maybe fared a little worse than some? I hear of guys who
do not experience many problems from the radiation, so I do not know what is
average.
   In summary, the EBRT for me resulted in probable permanent colon
problems which are controllable, and bladder spasms whic are mostly
controlled, and I would have major incontinence if not for the implant. I
hear that new things may be on the horizon for incontinence control. A MAJOR
point here is that none of this really impacts my lifestyle or my activities
too much. The Lupron now, that's another story! I am thankful for the tools
we have to fight this thing, even the Lupron, and the tools we have to
minimize the SE's. Good luck in your research,

 Even just any experience with RT after RP would be
> nice. TIA, laurel
Steve Kramer - 25 May 2006 00:32 GMT
> The Lupron now, that's another story! I am thankful for the tools we have
> to fight this thing, even the Lupron, and the tools we have to minimize
> the SE's.

Are you back on Lupron?  Last I recall, you went off about 2 years ago.

Signature

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA  .1  .1  .1  .27  .37  .75
EBRT 05-07/2002 @ 47
PSA  .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06
PSA  .07 .05 .06 .09 .08 .132
Non Illegitimi Carborundum

Bob C - 25 May 2006 13:49 GMT
Steve, I was on it for one year, off for about 1 1/2, then back on for two
years due to a fast rising psa. I am just now down to the end of that two
year period. My last injection was two months ago. The psa has now begun to
rise, even though I am still on the Lupron, with the last four month
readings being .08, .012, and now .18. Not the best of news. Scary. I wish
you the best of luck with your June reading.

>> The Lupron now, that's another story! I am thankful for the tools we have
>> to fight this thing, even the Lupron, and the tools we have to minimize
>> the SE's.
>
> Are you back on Lupron?  Last I recall, you went off about 2 years ago.
Steve Kramer - 26 May 2006 11:31 GMT
> Steve, I was on it for one year, off for about 1 1/2, then back on for two
> years due to a fast rising psa. I am just now down to the end of that two
> year period. My last injection was two months ago. The psa has now begun
> to rise, even though I am still on the Lupron, with the last four month
> readings being .08, .012, and now .18. Not the best of news. Scary. I wish
> you the best of luck with your June reading.

Yeah, I remember now, though I don't think I knew your specific readings, I
do remember you saying it was slowly rising.  Same numbers a me and a couple
months ahead.

Signature

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA  .1  .1  .1  .27  .37  .75
EBRT 05-07/2002 @ 47
PSA  .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06
PSA  .07 .05 .06 .09 .08 .132
Non Illegitimi Carborundum

ralphv - 26 May 2006 13:56 GMT
Hi Steve,
Neither you or Bob C mention other than Lupron in controlling your
disease. Have you considered adding a 5-AR and an antiandrogen at any
time? Also wonder if you are tracking your testosterone, estradiol and
DHT levels?

Best,

RalphV
> > Steve, I was on it for one year, off for about 1 1/2, then back on for two
> > years due to a fast rising psa. I am just now down to the end of that two
[quoted text clipped - 18 lines]
> PSA  .07 .05 .06 .09 .08 .132
> Non Illegitimi Carborundum
Steve Kramer - 26 May 2006 17:31 GMT
> Hi Steve,
> Neither you or Bob C mention other than Lupron in controlling your
> disease. Have you considered adding a 5-AR and an antiandrogen at any
> time? Also wonder if you are tracking your testosterone, estradiol and
> DHT levels?

Thanks, Ralph.

I need a little more history to verify that it is not controlling my
disease.  However, my next appointment will include a Q&A session regarding
these and other issues.
Bob C - 26 May 2006 23:33 GMT
> Hi Steve,
> Neither you or Bob C mention other than Lupron in controlling your
> disease. Have you considered adding a 5-AR and an antiandrogen at any
> time?
Thanks Ralph, any input/ suggestions are much appreciated, especially at
this "inbetween" stage. There are established routes to go for early stage,
take your pick. Same with late stage, take your pick, and you might get one
or two that buy some time, you might not. This AIPC non-metastic stage does
not seem to have any clear cut directions in treatment. And everyone is
different, or not. My urologist, who works with an oncologist and radiation
oncologist, feels that we should get one more reading in four months to see
how fast this is growing. My Lupron will be wearing off about July and the
next psa check will be in September. He feels that the Lupron is still
working against the predominant cancer but that the AIPC is now finally
rearing its ugly head.  If the curve does not show an acceleration in
growth, I suspect he'll keep me off anything for a bit in the interest of
QOL. Once it speeds up, or progresses considerably, it will be back on the
Lupron plus I do not know what else. I also questioned him about doing
anything extra for bone health and he says that just staying on my current
daily dose of 630 mg calcium and 400IU Vit D was appropriate at this time.

Also wonder if you are tracking your testosterone, estradiol and
> DHT levels?
No, not that I am aware of. I'm pretty sure that we are just tracking the
psa on the assumption that T will be down where ever it belongs while on
Lupron. Do we really need to be more sophisticated than that? Knowing how
many varied and educated opinions there are on how to treat, what to test
for, and so on, I myself sure do not know. Thanks again, >
> Best,
>
[quoted text clipped - 27 lines]
>> PSA  .07 .05 .06 .09 .08 .132
>> Non Illegitimi Carborundum
LarryS - 24 May 2006 02:36 GMT
laurel wrote..."Even just any experience with RT after RP would be
nice."

I had EBRT Oct-Dec, 2003, after a failed Feb, 2002 RRP, thanks to
positive margins at the apex; 66 Gy over a 6 week period, IIRC. I had
diarrhea after the first treatment but only an occasional loose BM
after that, that I can recall. Most of my problems had to do with
constipation and what I thought were radiation burns to the rectum.
They turned out to be fissures caused by a strained BM, and cleared up
on their own over the following year. The hospital staff could have
done a better job of coaching me about the importance of a low fibre,
low residue diet, I felt.

The only remaining SE is light proctitus in the form of minor mucus
discharge with some BMs. This is caused by the intestinal lining still
dying off, I believe. It has never been a problem but has stollen the
pleasure of a good fart, if I may be so crude. :o) One constantly
worries that more might pass than just wind, so you learn to control
such urges until on a toilet, and then nearly explode. I think that I
may tire more easily but it's hard to say; I have been taking naps for
an hour after lunch as my tinitus gets bothersome when I get tired and
my ears start ringing around that time. I'm 65, retired and don't have
a lot of stamina but honestly don't know what role RT plays in that.
Not much, I suspect.

My pre-op PSA was 3.9 and pGleason 6. The cancer was detected by
pathological examination of the corings from a TURP. PSAs were
undetectable the first year post-RRP, but after three successive
increases (0.05, 0.09, .12) my urologist sent me for EBRT. It has been
undetectable in the 2.5 years since that finished.

Good luck to Steve and you.

Larry

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