radiation

alfmik50

I am scheduled to talk to a radiation oncologist on friday. Could those of you who opted for radiation versus removal let me know how it went and was it the right choice?

Kongo

Welcome
Alf,

Welcome to the CSN forum. Many men who post here have recently had one form or another of radiation treatment and will undoubtedly share their experiences and knowledge.

It is difficult to provide meaningful insight without knowing your statistics when you were diagnosed with prostate cancer. Could you please share with us your age, general health, PSA scores, biopsy results, Gleason grade, stage, DRE exams and so forth?

As you may know by now after reading the literature the urologist probably gave you when you were diagnosed or through internet searches, there are many forms of radiation and depending upon the characteristics of your cancer some may be more appropriate than others. Today, radiation can be external beam radiation (XBRT), image guided 3-D (IGRT), intensity modulated (IMRT), stereotactic body (SBRT), brachytherapy (radioactive seeds), high dose brachytherapy that is temporary internal radiation (HDR brachytherapy), and proton radiation. Much of the literature available does not address the newest delivery methods of radiation such as SBRT.

Except for proton beams, all radiation uses ionizing radiation to disrupt the DNA within the cancer cells which (theoretically) causes them to die. The differences between each type depends on the delivery methods and dosage used and there can be a large difference between these techniques. Proton beam radiation uses proton particles to excite the cells to accomplish the same thing but since protons have mass it is delivered in a different way. Radiation has been used to treat cancers in humans for over 100 years with varying degrees of accuracy and success.

As you will discover, every form of prostate cancer treatment, including radiation, carries risks of side effects and some of these can be quite debilitating. Frequently the degree of adverse side effects is a function of your pre-treatment condition. For example, if you have urinary or erectile dysfunction issues before treatment, you are more than likely going to have them after treatment. Sometimes pre-treatment issues improve but most often they do not. Make sure when you visit the specialists that they explain in detail the potential side effects of whatever treatment you are considering.

Depending on your statistics and aggressiveness of the prostate cancer, radiation treatments are used in conjunction with hormone treatments. Sometimes radiation is used shortly after a radical prostatectomy when there is evidence that the cancer has spread beyond the prostate.

In my own case of early detected low risk PCa, I elected to receive SBRT delivered with the CyberKnife system in June as a monotherapy. So far there have been no side effects but keep in mind that if side effects from radiation develop, they often occur several months to several years afterward. And, like having the prostate removed, many men who choose radiation will see a measurable recurrence (known as biochemical failure) of PCa at some point in the future. Different forms of radiation have different statistics in this area.

It is also important to keep in mind that for men with low risk cancer (PSA <10, Gleason <7, normal DRE) there is virtually no difference in the long term mortality statistics between RP, radiation, or active surveillance. More than 95% of the men who are classified as low risk will end up with something other than prostate cancer killing them. What you have to balance, if you fall into that category, is tradeoffs between potential side effects from treatment, quality of life, and the realistic extension of life that the treatment gives. For the low risk patients, treatment only provides an actuarial life extension from a few months to about a year and a half, depending upon which study you use as a baseline. And since you can’t take a Mulligan on treatment if it doesn’t work, make sure you choose carefully.

In any event, when meeting with specialists it is a good idea to have all of your medical records in one place, seek a second opinion on your original biopsy, and learn to become your own advocate in treatment and ask lots of questions.

Best of luck and please post your statistics:

=========================
Age at Dx (Mar 2010): 59. PSA 4.3 which dropped to 2.8 before treatment after eliminating dairy. Biopsy showed 1 of 12 cores positive with 15% involvement and was confirmed by second opinion. Gleason score 3+3=6. Stage T1c. DREs were all normal and there is no history of PCa in family.

Treatment: SBRT in five fractions delivered by CyberKnife in June 2010. Side effects. None

alfmik50

Kongo said:

Welcome
Alf,

Welcome to the CSN forum. Many men who post here have recently had one form or another of radiation treatment and will undoubtedly share their experiences and knowledge.

It is difficult to provide meaningful insight without knowing your statistics when you were diagnosed with prostate cancer. Could you please share with us your age, general health, PSA scores, biopsy results, Gleason grade, stage, DRE exams and so forth?

As you may know by now after reading the literature the urologist probably gave you when you were diagnosed or through internet searches, there are many forms of radiation and depending upon the characteristics of your cancer some may be more appropriate than others. Today, radiation can be external beam radiation (XBRT), image guided 3-D (IGRT), intensity modulated (IMRT), stereotactic body (SBRT), brachytherapy (radioactive seeds), high dose brachytherapy that is temporary internal radiation (HDR brachytherapy), and proton radiation. Much of the literature available does not address the newest delivery methods of radiation such as SBRT.

Except for proton beams, all radiation uses ionizing radiation to disrupt the DNA within the cancer cells which (theoretically) causes them to die. The differences between each type depends on the delivery methods and dosage used and there can be a large difference between these techniques. Proton beam radiation uses proton particles to excite the cells to accomplish the same thing but since protons have mass it is delivered in a different way. Radiation has been used to treat cancers in humans for over 100 years with varying degrees of accuracy and success.

As you will discover, every form of prostate cancer treatment, including radiation, carries risks of side effects and some of these can be quite debilitating. Frequently the degree of adverse side effects is a function of your pre-treatment condition. For example, if you have urinary or erectile dysfunction issues before treatment, you are more than likely going to have them after treatment. Sometimes pre-treatment issues improve but most often they do not. Make sure when you visit the specialists that they explain in detail the potential side effects of whatever treatment you are considering.

Depending on your statistics and aggressiveness of the prostate cancer, radiation treatments are used in conjunction with hormone treatments. Sometimes radiation is used shortly after a radical prostatectomy when there is evidence that the cancer has spread beyond the prostate.

In my own case of early detected low risk PCa, I elected to receive SBRT delivered with the CyberKnife system in June as a monotherapy. So far there have been no side effects but keep in mind that if side effects from radiation develop, they often occur several months to several years afterward. And, like having the prostate removed, many men who choose radiation will see a measurable recurrence (known as biochemical failure) of PCa at some point in the future. Different forms of radiation have different statistics in this area.

It is also important to keep in mind that for men with low risk cancer (PSA <10, Gleason <7, normal DRE) there is virtually no difference in the long term mortality statistics between RP, radiation, or active surveillance. More than 95% of the men who are classified as low risk will end up with something other than prostate cancer killing them. What you have to balance, if you fall into that category, is tradeoffs between potential side effects from treatment, quality of life, and the realistic extension of life that the treatment gives. For the low risk patients, treatment only provides an actuarial life extension from a few months to about a year and a half, depending upon which study you use as a baseline. And since you can’t take a Mulligan on treatment if it doesn’t work, make sure you choose carefully.

In any event, when meeting with specialists it is a good idea to have all of your medical records in one place, seek a second opinion on your original biopsy, and learn to become your own advocate in treatment and ask lots of questions.

Best of luck and please post your statistics:

=========================
Age at Dx (Mar 2010): 59. PSA 4.3 which dropped to 2.8 before treatment after eliminating dairy. Biopsy showed 1 of 12 cores positive with 15% involvement and was confirmed by second opinion. Gleason score 3+3=6. Stage T1c. DREs were all normal and there is no history of PCa in family.

Treatment: SBRT in five fractions delivered by CyberKnife in June 2010. Side effects. None</p>

stats
I will be 53 this coming Saturday. My PSA was 4.5. My Gleason was 7 and my stage was Tc1, I think. All twelve samples from the biopsy came back positive with a total involment of 82%. Other than this cancer I am pretty healthy but I do take medicine for high Cholesterol.

Kongo

alfmik50 said:

stats
I will be 53 this coming Saturday. My PSA was 4.5. My Gleason was 7 and my stage was Tc1, I think. All twelve samples from the biopsy came back positive with a total involment of 82%. Other than this cancer I am pretty healthy but I do take medicine for high Cholesterol.

Your Statistics
Alf,

Your oncologist consult this week will undoubtedly explain this in more detail but your statistics suggest that you may have a worrisome level of cancer.

Within the Gleason rating, there is a big difference as to whether it is a 4+3=7 or a 3+4=7, the former being an indication that most of your cancer cells tend to be more poorly differentiated, a sign of advancing stage cancer. 4+3 is worse than 3+4. As prostate cancer cells become less regular in appearance (indicated by the Gleason grade) they tend to produce less PSA which is what may be happening in your case as the PSA reading is not particularly high.

Additionally, given that the biopsy suggests you have cancer pretty much throughout the prostate at a high percentage of involvement, there is a good possibility that it has spread outside the prostate capsule at least at the microscopic level. Doctors frequently talk about treatments in relation to whether or not the cancer is "contained" within the prostate or not. In actuality, prostate cancer cells probably leaves the prostate via lymphatic action into the blood stream fairly early in its histology but since it is such a slow growing disease, it won't show up with the methods we have today to detect it because it remains at the microscopic level. Most of these roaming cancer cells never take hold and start a colony somewhere else, but eventually some of them will and once they find a place they like, they will begin to multiply and eventually be detected with scans or other testing methods.

I suspect that the oncologist will discuss radiation treatment with you in conjunction with hormone therapy, which has shown to have promising long term results in cancers at the stage you seem to have. There are side effects with the hormone treatments and be sure that the doctor explains these to you in great detail.

mrspjd, another frequent poster on this forum is pursuing a treatment with her husband that invovles HDR brachytherapy, hormone treatment, and IMRT radiation...sort of a triple whammy to stop the growth of the prostate cancer, attack it in the prostate, and zap it in the areas surrounding the prostate where it first tends to settle. She may be able to add some further insight into the benefits and drawbacks of this protocol and I would ask your doctor to elaborate on it.

Have they done tests to try to detect cancer involvement in the lymph nodes or seminal vesicules? Did they do a bone scan, chest x-ray, or blood panel to look for indications that the cancer may be in your bones, liver, or lungs? Given your pathology, these are questions I would want to know before I decided upon a course of treatment.

If the PCa has spread beyond the prostate, as might be suggested by your statistics, removing the prostate is not going to do much to curb the spread of the disease and you will need additional treatments of radiation and hormone treatment to address the remaining cancer, which will inexorably grow after the prostate is gone.

I hope you use the time before your appointment to gather as much information as you can so that you are equipped to asks lots of intelligent questions. I would also take along your wife, significant other, or close friend to help you take notes. There is going to be so much information at you it will be like trying to take a sip of water from a firehose on solid stream. You will also want a second opinion on your biopsy and the doctors will explain to you how you can get this done.

2ndBase

Radiation
I had radiation as my treatment for gleason 9 and psa 24 over six years ago when I was 53 years old. I was given a 50% chance to survive two years at that time.
The treament was no big deal with little in the way of side effects. The one shot of Lupron before radiation had worse side effects, like ED and hot flashes I was told it was necessary to shrink the tumor.
I do not believe my treatment made much, if any, difference in my long survival. Mostly I give credit to getting the stress out of my life and living as if I never had cancer. If your cancer has spread and you want to take any treatment then you will probably be taking the radiation. It could help slow the cancer and give you some peace of mind.
Whatever choice you decide on, you have to believe it is right for you and keep a positive outlook. Live your life with hope and maintain a positive outlook. Keep active and keep working toward a goal of surviving 5 years, and when you get there another five. It worked for me. I am in hospice care now as I have chosen to have no further treatment so as to have the best quality of life. I still have two jobs, a big garden, and a 12 handicap. Life is good.

griff 1

2ndBase said:

Radiation
I had radiation as my treatment for gleason 9 and psa 24 over six years ago when I was 53 years old. I was given a 50% chance to survive two years at that time.
The treament was no big deal with little in the way of side effects. The one shot of Lupron before radiation had worse side effects, like ED and hot flashes I was told it was necessary to shrink the tumor.
I do not believe my treatment made much, if any, difference in my long survival. Mostly I give credit to getting the stress out of my life and living as if I never had cancer. If your cancer has spread and you want to take any treatment then you will probably be taking the radiation. It could help slow the cancer and give you some peace of mind.
Whatever choice you decide on, you have to believe it is right for you and keep a positive outlook. Live your life with hope and maintain a positive outlook. Keep active and keep working toward a goal of surviving 5 years, and when you get there another five. It worked for me. I am in hospice care now as I have chosen to have no further treatment so as to have the best quality of life. I still have two jobs, a big garden, and a 12 handicap. Life is good.

2ndbase
man you are awsome, what an attitude you have i don,t think i would. i,d like to ask you why you did not have surgery to have the prostate removed, maybe they told you radation was better? just wondering and all the best to you 2nd griff

Kongo

griff 1 said:

2ndbase
man you are awsome, what an attitude you have i don,t think i would. i,d like to ask you why you did not have surgery to have the prostate removed, maybe they told you radation was better? just wondering and all the best to you 2nd griff

Second 2nd
I agree with griff about 2ndbase. He is an inspiration to us all. As Seneca said, "Not how long, but how well you have lived is the main thing."

2ndBase

griff 1 said:

2ndbase
man you are awsome, what an attitude you have i don,t think i would. i,d like to ask you why you did not have surgery to have the prostate removed, maybe they told you radation was better? just wondering and all the best to you 2nd griff

Surgery
My urologist took my case to the tumor board at the hospital and in coordination with the radiation oncologist it was determined that there was no doubt that the cancer had already spread outside the prostate. Therefore, I was told there was no benefit in removing the prostate and that the radiation would kill all the cancer in the prostate as well as some in nearby areas. It turns out they were absolutely correct. I had a follow up biopsy four years after the radiation to see if there was any cancer in the prostate and believe it or not there was none. Had there been some cancer left there they were going to retreat the prostate. Thank you for your concern.

Trew

Proton Therapy?
If you are going for radiation, by not consider proton therapy? I hope you have at least looked at that option. but maybe you have a very high gleason and proton isn't an option for you?

mrspjd

Kongo said:

Your Statistics
Alf,

Your oncologist consult this week will undoubtedly explain this in more detail but your statistics suggest that you may have a worrisome level of cancer.

Within the Gleason rating, there is a big difference as to whether it is a 4+3=7 or a 3+4=7, the former being an indication that most of your cancer cells tend to be more poorly differentiated, a sign of advancing stage cancer. 4+3 is worse than 3+4. As prostate cancer cells become less regular in appearance (indicated by the Gleason grade) they tend to produce less PSA which is what may be happening in your case as the PSA reading is not particularly high.

Additionally, given that the biopsy suggests you have cancer pretty much throughout the prostate at a high percentage of involvement, there is a good possibility that it has spread outside the prostate capsule at least at the microscopic level. Doctors frequently talk about treatments in relation to whether or not the cancer is "contained" within the prostate or not. In actuality, prostate cancer cells probably leaves the prostate via lymphatic action into the blood stream fairly early in its histology but since it is such a slow growing disease, it won't show up with the methods we have today to detect it because it remains at the microscopic level. Most of these roaming cancer cells never take hold and start a colony somewhere else, but eventually some of them will and once they find a place they like, they will begin to multiply and eventually be detected with scans or other testing methods.

I suspect that the oncologist will discuss radiation treatment with you in conjunction with hormone therapy, which has shown to have promising long term results in cancers at the stage you seem to have. There are side effects with the hormone treatments and be sure that the doctor explains these to you in great detail.

mrspjd, another frequent poster on this forum is pursuing a treatment with her husband that invovles HDR brachytherapy, hormone treatment, and IMRT radiation...sort of a triple whammy to stop the growth of the prostate cancer, attack it in the prostate, and zap it in the areas surrounding the prostate where it first tends to settle. She may be able to add some further insight into the benefits and drawbacks of this protocol and I would ask your doctor to elaborate on it.

Have they done tests to try to detect cancer involvement in the lymph nodes or seminal vesicules? Did they do a bone scan, chest x-ray, or blood panel to look for indications that the cancer may be in your bones, liver, or lungs? Given your pathology, these are questions I would want to know before I decided upon a course of treatment.

If the PCa has spread beyond the prostate, as might be suggested by your statistics, removing the prostate is not going to do much to curb the spread of the disease and you will need additional treatments of radiation and hormone treatment to address the remaining cancer, which will inexorably grow after the prostate is gone.

I hope you use the time before your appointment to gather as much information as you can so that you are equipped to asks lots of intelligent questions. I would also take along your wife, significant other, or close friend to help you take notes. There is going to be so much information at you it will be like trying to take a sip of water from a firehose on solid stream. You will also want a second opinion on your biopsy and the doctors will explain to you how you can get this done.

award for best posts
If I were giving the csn-mrspjd award for best informational and helpful posts, I think Kongos posts today would be the recipiant! I don't have much to add since Kongo has pretty much covered all the bases. If there is actually an 82% involvement with most cores positive, as indicated, I would question the accuracy of a T1c stage--the high percentage would seem to correlate more with a T2c or perhaps T3 staging. Would also want to know if the biopsy report indicated PNI (peri-neural invasion)-- meaning that there was a likelihood of PCa extension outside of the capsule, perhaps into the prostate bed, to the seminal vesicle(s) or lymph nodes? As recommended, a second opinion from one of the few labs nationwide specializing in reading PCa biopsy lab slides is critical. That certainly made a difference for pjd in his research, in pursuing add'l testing, and ultimately in his treatment choice of ADT, HDR-B, & IMRT (he elected not to have RP-surgery, even though it was an option). In February this year, at diagnosis, after second opinion biopsy slide read (Johns Hopkins pathology lab) pjd's Gleason was 3+4=7 (first read @ local lab was 3+3=6), PNI confirmed, 9/12 cores positive with many at 100%, PSA 2.4, with no rapid doubling, with nodule on DRE being the "red flag"--not the PSA, that intiated the biopsy.

BTW, my very first post on this forum back in April actually posed the same question Alf is asking: RP or RT (w/ADT--hormones). What I (we) know now is this: Alf--it's too early to be deciding on a tx--right now it is more important to make sure the PCa is correctly & properly staged (as in T1-T4) because once proper staging is confirmed it will further define the treatment options available to you with the best/highest percentage of successfully containing the spread of PCa.
Best,
mrs pjd