Radiation after Chemo?

beanlee73

Hi!  My dad (75) was diagnosed last August PSA 31 up to 92 after biopsy, had spread beyond prostate (bone mets, lymph nodes) began Lupron and Casodex, began Chemo in December and completed 6 rounds of docetaxal in March.  Chemo was tough but the chemo and hormone therapy did the trick as his PSA was down to .08ish in April and follow up and MRI showed lymph nodes and bone mets were "down"- we know they will never be completely gone- now we are going back to Duke for 3 month follow up of bloodwork and to discuss the possibility of radiation to "prolong his remission"- I've done tons of research throughout this process and stalked these boards for many hours as they are so helpful!  I go with him to every appointment/ chemo etc. to take notes and record everything the doctor says- But I'm not finding much on radiation after chemo and just wanted to know what to expect/ side effects/ is it worth it, etc!  I have read about the usual side effects but  any advice or insight from you all would be greatly appreciated!  He is just starting to get his hair back and feel more like himself- but I obviously want him to do it if it will help! 

 

:)RLS

Max Former Hodgkins Stage 3

Basics

Rls,

It is great that you are so involved and monitoring the data regarding your father. It is a blessing to him.

He is Stage IV and elderly.  You read between the lines very well...  Chemo is never curative of PCa, but like the hormonal treatments (HT) it can keep a man healthy if things go well. Sometimes they do go well, sometimes not.  It is a great balancing act, deciding what is worth it.  Radiation Therapy ("RT") AFTER chemo is uncommon, given that chemo is usually 'the last hurrah' in this process.   One use of RT is "spot welding," killing off larger tumors to prevent bone fractures, a common thing in advanced disease with bone metastasis.  Ask specific questions and demand specific answers.

Continue talking with his doctors directly, the only way to make an informed set of decisions.

I too have assisted men dying with this disease.  It is not easy, but a noble act of love on your part,

max

VascodaGama

Risk of fistulas

Yes, I would reserve RT for spot intervention not as the means to try keeping remission. Pain from the bone mets is expected to occur in the future and the only way to get a relief will be with spot radiation, as commented by Max. Surely your dad could get radiation included in the present protocol as adjuvant to the chemo+HT combi, but the areas radiated would not accept additional doses of radiation (even spot rads) latter. The risk of causing fistulas is high.

I think that the benefit in such approach (full protocol of chemo plus RT) would be only optional if the cancer is localized. In any case, your dad is in remission so that many of those metastases may have been eliminated for good. The present low PSA can be a result of tumour shrinkage that would not be feasible for being detected in an image exam to localize targets. In this case, radiation is used as a palliative approach. Not as curative.

Radiation as salvage treatment after chemo failure is possible if the case relates to oligometastatic disease (a fewer number of metastases). In such a case the treatment requires sophisticated image exams to pinpoint the location of the bandit, which would then be attacked with precise spot radiation.

Your may be interested in details on the above image exams that could provide targets for any RT you may plan in the future. Here are links on the subject;

https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/92981-clinical-impact-of-68-ga-psma-pet-ct-in-prostate-cancer-patients-with-rising-psa-after-treatment-with-curative-intent-preliminary-analysis-of-a-multidisciplinary-approach.html

http://www.diagnosticimaging.com/articles/f-18-choline-petct-trial-notes-caveats-prostate

http://jnm.snmjournals.org/content/47/8/1249.full

Best wishes,

Vgama

 

Clevelandguy

Radiation?

Hi,

It kind of sounds like radiation(RT) is about the only thing left to do.  Cyberknife or Proton radiation treatments might be worth looking into.  Sounds like beanlee's Dad has been through most of the other treaments for Pca.

Dave 3+4

beanlee73

Thanks for your responses!

Thanks for your responses!  Today's visits were encouraging as his PSA is down to .53 from .80 in April-(I mistyped.08 in earlier post)  The radiation oncologist would like to do a bone scan to see if there are any "spots" to treat or if she is just going to do 5 1/2 weeks of radiation on the prostate.  Although his PSA is trending lower any future "seed showers" as they said it could stem from the prostate and both docs today at Duke said that they thought radiation could definitely "get" many of the active seeds in the prostate, although as I said we know they are never gone and can still travel and resurface throughout the body. (They compared the prostate to a hornets nest)  Dad is 75 but even his radiation doctor today was suprised when she met him and said he looks at least 10 years younger.  He is active and still works pretty much full time at his financial planning business so although the care protocol is palliative and aimed at prolonging his remission and quality of life he is still very active and independent.  We make the most of his doctor visits and usually find good restaurants etc. to enjoy and most of all I've enjoyed spending time with my parents.  His primary oncologist wants to see him back in 6 months and has mentioned further treatments for when the hormone therapy he is currently on is less effective such as zytiga, xtandi, provenge, etc.  (all of which I have looked into and was prepared to ask him about today)  So good doctor visits, bone scan on Monday and not sure what he will decide about radiation.  They enjoy the beach on the weekends so it would be great if they could enjoy the rest of the summer!  Thanks so much for your input and any future input and advice! Also thank you for the links that you included I will look forward to reading them and researching further! 

Max Former Hodgkins Stage 3

beanlee73 said:

Thanks for your responses!

Thanks for your responses!  Today's visits were encouraging as his PSA is down to .53 from .80 in April-(I mistyped.08 in earlier post)  The radiation oncologist would like to do a bone scan to see if there are any "spots" to treat or if she is just going to do 5 1/2 weeks of radiation on the prostate.  Although his PSA is trending lower any future "seed showers" as they said it could stem from the prostate and both docs today at Duke said that they thought radiation could definitely "get" many of the active seeds in the prostate, although as I said we know they are never gone and can still travel and resurface throughout the body. (They compared the prostate to a hornets nest)  Dad is 75 but even his radiation doctor today was suprised when she met him and said he looks at least 10 years younger.  He is active and still works pretty much full time at his financial planning business so although the care protocol is palliative and aimed at prolonging his remission and quality of life he is still very active and independent.  We make the most of his doctor visits and usually find good restaurants etc. to enjoy and most of all I've enjoyed spending time with my parents.  His primary oncologist wants to see him back in 6 months and has mentioned further treatments for when the hormone therapy he is currently on is less effective such as zytiga, xtandi, provenge, etc.  (all of which I have looked into and was prepared to ask him about today)  So good doctor visits, bone scan on Monday and not sure what he will decide about radiation.  They enjoy the beach on the weekends so it would be great if they could enjoy the rest of the summer!  Thanks so much for your input and any future input and advice! Also thank you for the links that you included I will look forward to reading them and researching further! 

More Optimism

Beanlee

I am glad the responses above helped you.  We responded "clinically," regarding what various treatments can and cannot do. It appears you have a firm grasp on those particulars.

More generally and subjectively, it is worth stating that all cases vary a lot.  Your dad's PSA is very, very low currently, and his spirits and overall health are good.  He may be luckier than many. We read letters from men who have PSA readings of 500 or 1,000, not responding to HT. Obviously, a different situation from your father's.  Some men even seem to have the disease go dormant, and live years symptom-free.  The range of possibilities is unbelievably widespread.

Continue with the quality time. It may last a long, long time. In some cases it does,

max

VascodaGama

Great news on your dad's situation

I am glad for knowing about your trip enjoyment and successful consultation. I hope the treatment will not affect your dad's present way of living (probably fatigue will be disturbing) even if radiation becomes part of the protocol.

The 5.5 weeks regards an IMRT approach typical in localized cases. That signifies that your dad would visit the facilities everyday (except on Sundays) for a section that would take approximately 30 minutes off his daily routines. Other modalities exist such as the Cyberknife (discussed by Dave above) which shorten the number of days under the machine but that would still require additional sections to handle the lymph nodes and bone mets found in the image study.
Radiation treatments can be started at any time so that your dad can chose his best convenient timing without prejudice to his business.

The PSA at 0.53 in a patient with the gland in place (no surgery) is supper when one considers its initial level of 92 ng/ml. My words in the above post, stand even if you mistaken to write the PSA real levels (0.08 instead of 0.8). PSA=0.53 could mean remission forever. I would wait for proper image studies to locate the bandit, allow six month time to verify the outcome of the chemotherapy and only act after due analysis of the situation at that moment.

Best wishes,

VG