Recently diagnosed with prostate cancer, gleason 10

VascodaGama

Confirmed localized case is good news

Thanks for sharing the results. The report states a localized affected area similar to what was indicated in the MRI report. The treatment RT + HT seem correct. Lupron is a good substitute to triptorelin but adminestered during two years may be prejudice to your dad's diabetes. I think that 6 months post RT would be enough. I recommend you to inquire with a medical oncologist.

Surgery with adjuvant RT may also be an option for the characteristics of the cancer (Gleason 10) and the spread at the seminal vesicles. Surgery would debulk the big tumor (the whole gland), and the radiation would focus the bed plus the tissues confirmed by the PET. Surely two radicals would increase the risks and side effects. I wonder what may be the opinion of his doctor on such approach now that a more reliable image was obtained.

Best

VG

gleason10

Treatment Radiotherapy update

Hi All,

Here is the treatment update regarding my father's RT:

- RT started 1 week back, he has completed 8 RT sessions

- After 1st day of RT only, there was urinary retention and he had to be put on catheter.

- He is continuing his RT sessions with catheter. However, he has some side effects w.r.t. catheterization which worries me. Symptoms as follows:

    -> He has been put on Foley 18F catheter, but even being on catheter, he sometimes feels urinary pressure in bladder, and urine would come out from the sides of the catheter instead of coming in the urine bag.

    -> He also has blood clots coming out from the sides of the catheter.

- Also, oncologist has said that he would need to have catheter put on till about 1 month after RT as well.

Have a couple of questions:

- Are these symptoms with catheter while on RT common? Anybody else experienced this?

- Are there any chances of infection for long term catheterization? Do we need to have latex or silicone catheter?

Any pointers would be very helpful.

Thanks

gleason10

 

Grinder

Catheter

I can tell you this. Keep the catheter as absolutely sterile as possible. One of my catheter experiences got infected... even though I was being careful. It was one of my many ER visits to have catheters put in, or a catheter taken out. After that, I was ridiculous in my diligence, using diluted colloidal silver to wash out the Legbag and Bedbag, and assorted antiseptics to wipe everything down including tubes, anchors, etc and especially my junk. Be sure he gets a leg anchor positioned close to his junk so the catheter tube doesn't pull on it every time he moves. 

And yes, I used to have it leak around the sides of the tube, especially if I was straining, as my muscle contraction would push urine past the entry into the catheter tube into the urethra, especially if something is blocking the entry... like a blood clot. 

As much as I hated Foley catheters, they were better than the alternative. And I don't remember a variety of self-catheters available at the time. I would never recommend self catheterization, but then again I have never used the wide assortment available. Maybe someone else can give you better advice than I can about that.

Once he gets his  Foley installed, he should go on Amazon and see what peripherals are available to ease  some of the issues.

Somebody else will have to advise you on the blood clots... My clots had typical reasons for their presence... When I got the needle biopsy, when I got infected, when the ER personnel made a bloody mess of things when they couldn't get the Foley passed a massive infected prostate, etc. 

Also, I  was told a Foley should not be in longer than two weeks. And that was my experience BUT this is your doctor's call.

Just wanted to throw a few things out there.  There are others here that are way more knowledgeable about the procedures and treatments, and hopefully they will continue to advise you, but I do want to help your dad through his unpleasant catheter experience... Been there done that.

gleason10

Side effects and symptoms after RT

Hi All,

Posting an update here after some time.

My dad complete the RT treatment in last week of March. He was on catheter for the entire duration of the RT, and then around 20 days after RT.

After catheter removal, he was able to pass urine, for which his doctor was also happy that healing would be proper. He asked for a repeat PSA in first week of June. However, he started developing multiple symptoms 3-4 days after cathether removal only which is of great concern to me.

Symptoms as follows:

- Frequent urination during day, and especially at night - almost 7-8 times per night

- Temporary urine blockage at night, and he had to get up and walk or just be restless and not get any sleep at night. It took 3-4 hrs to be normalized again as the next morning progressed.

- Weak stream of urine during the day as well, at some time it will be so less that it feels it might lead to urinary retention

- Pain and discomfort in pelvic region

He had the ADT Triptorelin injection in first week of April as well. After about being 20 days off catheter, with all the above symptoms, one night suddenly he had full urinary retention and had to be catheterized again. During this period, he was complaining of fever and Urine RE and culture showed UTI as well. Doctor has given him FOSIROL (fosfomycin trometamol) antibiotic which worked and decreased the fever. He needs to take this antibiotic now every 7 days for 3-4 weeks.

After this catheterization, he is complaining of persistent pelvic region pain and bladder/pelvic muscle spams. Doctor has advised to keep the catheter for 2-3 weeks, and then try removing it.

My question is - are all these symptoms commom after RT? Or are these happening for my dad because his cancer was aggressive - gleason 10? Till how long after RT, do the symptoms stabilize?

Any pointers and info would be very helpful.

Thanks in advance,

gleason10

 

Grinder

IMHO

Someone else will have to address the RT potential side effects, but the symptoms you describe are typical of acute prostatitis... an infection of the prostate, urethra, and sometimes the bladder as well...

"Symptoms of prostatitis include painful urination; blood in the urine; pain in the groin, abdomen, or low back; fever, and painful ejaculation or sexual dysfunction" ...medicinet.com

If he had a culture done, what was the result? What was the pathogen causing the infection? Typical pathogens that infect the prostate are E coli, Staph, Chlamydia, etc. I am guessing the antibiotic your doctor prescibed was pathogen-specific which would account for the long duration of treatment. Plus, the prostate is very difficult to treat under the best conditions. Add a difficult to treat pathogen like Staphylococcos, and 3-4 weeks is not surprising.

If it was a UTI only, it would be easily treated because antiobios can be introduced in the urine flow.. But the prostate is buried deep, and is accessible only through the bloodstream, and  with difficulty at that. So the antibiotic prescribed is a blood borne antibiotic. Any antibiotic normally used to treat UTIs are ineffective for prostate infection.

 

Grinder

TURP

I just read in your original post that he had TURP procedure done...

Welcome to the catheter - prostatitis merry go round.

The prostate gets infected from catheter use... causing it to swell up and shut off urine flow, which requires use of Foley catheter to relieve retention, continuing the catheter induced infection, that causes continued catheter use.

Add a TURP procedure, and I suspect the exposed tissues of the prostate that urine passes through could be even more susceptible to infection from the tube of the catheter. But that's just a guess.

This is probably another reason for the duration of antibiotic treatment... your doctor wants to treat the infection for as long as the Foley catheter remains inserted. Earlier I mentioned that Foleys should not remain inserted longer than 2 weeks... this is why, but unfortunately, there is no other alternative in this case, so your doctor is keeping him on antibios as long or a bit longer than the catheter.

VascodaGama

Is retention real or is that a faked sensation

I agree with the comments of Grinder above. Long time catheterization could be behind the symptoms from the very beginning. Radiation has caused inflammation which may have progressed to infection of the tissues in contact with the catheter. The all area become very sensitive and any movement or squeezing of bladder wall would lead to sensations of urgency and frequency in urination, even if the bladder was/is empty. Standing or in laying position easily causes irritation of local nerves faking any need to urinate. One should be sure that additional catheterization is in fact required for voiding. I have experienced retention three times due to blood clogs in the urethra (hematuria). I had urgency but when peeing nothing come out. I could sense in my tummy the urine flowing backwards so I forced it and the pressure unclogged the thickened blood that I saw in the sink. My situation improved since I stop taking the daily aspirin (blood thinner).
Improvements from radiation therapy may take 4 months to get to acceptable levels. In my SRT I did have frequency and pain when urinating during three weeks for which I took some medication. Soft stool and occasional diarrhea was there too but it all improved in three months past RT.

Best wishes for fast improvements.

VG

 

gleason10

Grinder said:

IMHO

Someone else will have to address the RT potential side effects, but the symptoms you describe are typical of acute prostatitis... an infection of the prostate, urethra, and sometimes the bladder as well...

"Symptoms of prostatitis include painful urination; blood in the urine; pain in the groin, abdomen, or low back; fever, and painful ejaculation or sexual dysfunction" ...medicinet.com

If he had a culture done, what was the result? What was the pathogen causing the infection? Typical pathogens that infect the prostate are E coli, Staph, Chlamydia, etc. I am guessing the antibiotic your doctor prescibed was pathogen-specific which would account for the long duration of treatment. Plus, the prostate is very difficult to treat under the best conditions. Add a difficult to treat pathogen like Staphylococcos, and 3-4 weeks is not surprising.

If it was a UTI only, it would be easily treated because antiobios can be introduced in the urine flow.. But the prostate is buried deep, and is accessible only through the bloodstream, and  with difficulty at that. So the antibiotic prescribed is a blood borne antibiotic. Any antibiotic normally used to treat UTIs are ineffective for prostate infection.

 

Urine culture showed E coli

Hello,

Many thanks for your reply.

Urine culture report showed E coli bacteria.

Doc had given the antibiotic based on the sensitivity report in urine culture.

Thanks

gleason10

Grinder

Vasco... a question

Did you quit the aspirin regimen entirely?

My GP has been pushing me to do low dose aspirin. But my mother was doing aspirin daily and started hemorrhaging in her stomach. Not only does aspirin thin your blood, but can also lacerate your stomach and intestinal walls, from what I understand.

I have been trying anti-inflammatory blood thinning like ginger tea and the like, and trying to avoid large doses of vitamin K in hopes of thinning blood without aspirin or meds.

How do you handle blood thinning? Or is it an issue for you?

MK1965

Enteric coated

Aspirin 81 mg, also known as baby aspirin is recommended when MCH and MCV values are elevated.

THis 2 mentioned lab values measure viscosity of the blood.

When Aspirin 81 mg is recommended it is always recommended to be enteric coated, which means it wont dissolve in the stomach but rather in the lower G.I. tract , in the small intestine.

So, stomach is sparred.

MK

Grinder

enteric

I appreciate the advice... however my issues are a little more complicated.  I wohld not risk even enteric coated low dose aspirin because I was dealing with a GI infection, gastritis, GERD, and a hiatal hernia during my PC issues. The hernia and GERD issues border on Barretts Esophagus which is the precursor to esophageal cancer. And with my painfully slow metabolism, I cannot afford to put inflammatory agents into my GI system on a daily basis. (If my wife and I eat the same thing at the same time and get food borne illness, she will feel the effects in an hour. I wont know it until 8 hours later.) If, and thats a big if, it got past my stomach, it will still act as an inflammatory agent.

Keeping in mind even though aspirin is considered an ANTI inflammatory agent... it can create inflammation and damage to the stomach lining and intestinal wall through excessive use, hence the enteric coating.

I'm not down on aspirin as a remedy for temporary pain relief or even emergency blood thinning in case of a heart blockage... but daily aspirin regimen is not practical for me.

Before all this happened, my GP was concerned about a prothrombin gene mutation. But it is only one of two markers, so that puts me at moderate risk for DVT and pulmonary embolism. As it is I am always on the lookout for anti-inflammatory naturopathic blood thinners, such as ginger, wanting to steer clear of major meds like Warfarin and Xarelto unless absolutely necessary.

I am guessing that Vasco needed blood thinners at the time to speed healing during his radiation bouts by delivering adequate blood circulation through the affected area. So I 'm still looking for suggestions beyond aspirin and meds... though this may not be the forum for  it.

Something I should mention to anyone reading this... Watch for Vitamin K, the clotting agent, in your multi vitamin, even the over-50 ones. There is plenty of K in a wide range of foods sufficient to clot blood. It does not need to be supplemented unless you have a ridiculous processed food junk diet.

Keeping in mind this is all my opinion only.

 

gleason10

PSA after three months of RT

Hi

Update on my father's treatment. Oncologist suggested to go for PSA test 3 months post RT.

Yesterday, we got the PSA done and surprisingly, it came as 8. Before RT, his PSA was around 4.5. I was expecting it to come down significantly.

I am very surprised by this result, and scared too. We have appt with oncologist tomorrow.

Does anybody has any pointers to this? Can PSA increase after RT?

 

Thanks,

gleason10

 

VascodaGama

It could be a laboratory error. Your dad is on ADT  which would cause a drop in the PSA.

Refractory is possible but I would get another PSA test together with a testosterone test (same blood sample) to verify the effectiveness of the hormonal shot. If T is lower than 30 ng/dL then refractory is on.

Do the tests at a reliable laboratory. Also get the PSA in two decimal digits assay (0.XX ng/ml).

Hope for the best.

VG