recent surgery, now likely radiation

lallamarie

Hello,

My husband was diagnosed with PC in early November, discovered in a routine check. Two weeks ago he had RP. He's 69 years old.

His PSA had risen to 6 pre-surgery and the Gleason was 3+4. After the pathology report came back, we know the lymph nodes are clear, thankfully, but the cancer had grown outside the prostate capsule in three places. In one of those places, just anterior to the rectal wall, the cancer was more aggressive. The surgeon said due to proximity to the rectal wall, he chose to spare the rectal wall and not leave a hole there which would also need repair. The post-surgery Gleason is 4+3.

The surgeon is now saying it is likely my husband will need cone beam radiation for six weeks should the PSA be .4 at the highest. 

My question is whether anyone has had radiation this soon after RP and what to expect, how it went, side effects, etc. We won't have the next PSA until early March.

Thank you for your thoughts.

The Worried Wife

Old Salt

My thoughts

Maybe I misunderstood, but your post states that the radiation would be FOR six weeks once the PSA reaches 0.4. With luck, this could be way into the future. Results from the next PSA test (in March) should provide clarity on that issue.

PS: It's my understanding from (casual!) reading that radiation should only be initiated once the wounds from the surgery have healed.

PS#2: Radiation after (prostate removal) surgery is not uncommon. 

ASAdvocate

The threshold for starting

The threshold for starting salvage treatment after an RP is usually .2, using a psa taken 2-3 months after the RP.  IMRT,  the most common type of radiation, is usually used if the surgery has failed, as indicated by the psa. There are some trials with SBRT, an advanced, powerfully focused type of radiation for salvage purposes, but IMRT is the most common.

lallamarie

Old Salt said:

My thoughts

Maybe I misunderstood, but your post states that the radiation would be FOR six weeks once the PSA reaches 0.4. With luck, this could be way into the future. Results from the next PSA test (in March) should provide clarity on that issue.

PS: It's my understanding from (casual!) reading that radiation should only be initiated once the wounds from the surgery have healed.

PS#2: Radiation after (prostate removal) surgery is not uncommon. 

Yes, you read that correctly;

Yes, you read that correctly; his regimen would be for six weeks, five days a week. We were told that this would start after he's had sufficient healing from the RP. I'm overwhelmed and scared and somehow I missed this--the not uncommon need for radiation after--in our prior readings on PC.

I recently read that the psa has to be between .2 and .5 for them to decide on radiation. When I asked the surgeon, he said .4 at the highest. We are scheduled for the psa early March.

One thing the surgeon did say was that if radiation is needed, it usually knocks out the cancer.

I also read that hormone therapy is sometimes combined with radiation. Are you aware of the success with this treatment?

Thank you for your response.

lallamarie

ASAdvocate said:

The threshold for starting

The threshold for starting salvage treatment after an RP is usually .2, using a psa taken 2-3 months after the RP.  IMRT,  the most common type of radiation, is usually used if the surgery has failed, as indicated by the psa. There are some trials with SBRT, an advanced, powerfully focused type of radiation for salvage purposes, but IMRT is the most common.

Thank you for your response.

Thank you for your response. I am not familiar with either type you mentioned, so will look those up and read. I appreciate your thoughts.

AZ Guy

.40 at the highest

That's interesting the RO said .40 at the highest. So at .50 no radiation? 

lallamarie

AZ Guy said:

.40 at the highest

That's interesting the RO said .40 at the highest. So at .50 no radiation? 

Hi, it wasn't the RO, it was

Hi, it wasn't the RO, it was the surgeon who told us this number. We haven't seen a RO yet since we don't know if radiation will be needed, yet. Now I'm wondering if we should see one anyway, as in now. ?? Thank you.

lallamarie

Old Salt said:

You misunderstood (AZGuy)

This doctor has decided to start radiation at a PSA level of 0.4. But, as ASAdvocate already pointed out, many other specialists recommend an even lower level to start salvage radiation.

Thank you for the "you

Thank you for the "you misunderstood." I will definitely push to find out further and not wait until it reaches .4. THANK YOU.

Old Salt

AZ Guy said:

.40 at the highest

That's interesting the RO said .40 at the highest. So at .50 no radiation? 

You misunderstood (AZGuy)

This doctor has decided to start radiation at a PSA level of 0.4. But, as ASAdvocate already pointed out, many other specialists recommend an even lower level to start salvage radiation.