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Radiation Concerns
New guy here. Had brachytherapy in 2019 and psa stayed low at 1.2 ish until about 2 years ago and started to creep. Now at 4.1 with a 24 month doubling time. New urologist now since old guy retired and the recommendation is to do external beam radiation on the prostate and full pelvic region as a salvage as they call it. I have concerns about the long term impacts from the radiation. I am curios to hear fedback from others who have been challenged by such a decision matrix. I am aware of the many choices.
Comments
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Sorry to hear that. I had brachy in July of last year and my first PSA afterward was .7 and urologist said it should continue to drop. Radiation oncologist I met with after the brachy said that if it ever got back up to 2 that they'd do another PSMA to see where the cancer was and then do localized external beam. Have you had a follow up PSMA?
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Hi,
Make sure if go the external beam route to ask about the gel they place between your colon and Prostate to protect the colon from excess radiation. Another external beam alternative would be Proton beam which had a fixed beam length and less likely to go past the intended target. As stated above a PMSA PET scan would not be a bad idea to look for cancer outside of the Prostate.
Dave 3+4
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Yes had a PSMA scan 2 years ago when PSA was 2 and was all totally negative even in the prostate itself. They told me it might be present and even spread but just not detectable yet. Maybe another PSMA is in order. At this time I plan to have a biopsy done of prostate and nearby lymph nodes before any treatment decisions. I also am aware that one of the hospitals here does sterotactic radiosurgery which sounds like maybe is a good idea to lessen chances of negative side effects from radiation. Not sure if that can be applicable to a larger area or not.
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here’s my story take it or leave it back in 2018. I had radiation therapy with a bracky therapy booster, which I thought was odd that they did it because the cancer that I had was aggressive rather than the you probably should have this thing removed. I was so scared of surgery. I did the Radiation routr granteda was only 57 years old and now I’m wondering like you almost 10 years later is that radiation gonna give me cancer? I sure hope not anyway iI was good like you for about six years and then mine crept up from 0. 8 to 1.8 in a matter of nine months right Away a biopsy was taken . They told me the cancer is still there, but it’s contained. He wanted to do breakthrough therapy one more time they wanted to do cryotherapy I said you know what the heck with all of that I’m gonna do is have it removed which I should’ve done the first time I found a very skilled surgeon called Dr. Robert Reiter out of UCLA he performed salvage surgery on me and my prostrate is gone. Cancer is gone. I’m going on two years undetectable I would not keep messing around radiation. I hope they told you you could only treat the prostate twice so if you do the radiation round again and it comes back again whenever you’re done you can’t remove it. You have hormone treatment after that That’s it Let me ask you a question the cancer that you have in there is it Cribiform you really need to find out if it is Cribiform is radiation resistant I’m living proof of it. That’s why it didn’t work with me. this is a very very important. You need to ask him if they see any cribiform patternand if they didn’t send it out dor testing, they really should I am telling you that cribiform is radiation resistant I surgeons. Tell me that is why the cancer is still there. It was right next to the marker where the radiation was targeted so you tell me I surgeons I would not believe a radiologist they believe in what they do and they’ll back it up no matter what and if you do have cribiform I think the only route that you have is hormkne treatment depending on your age or have it removed like I did that’s just my opinion. I’m living proof. I’m just trying to give you suggestions and then you make your own decision. The sad thing is I did not trust my radiologist. I asked him about crib form no big deal. I asked him about the space or he said it wasn’t necessary and that patients complained about it. The whole thing was bad. I have permanent side effects from radiation. I have bad bowels to this day. I have loose stools and then I had bloody hemorrhoids for two weeks and I was scared to death so much blood was pouring out of me and then I leaked feces for about six weeks. It was awful, absolutely awful, and it was unnecessary, and I will never ever forgive that radiologist
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Thankyou everyone for the responses and please keep them coming. This is all very valuale information for me. I have requested both a PSMA scan and a biopsy of prostate and adjacent lymph nodes. I want more information before making any decisions. It is staggering to hear how the physicians make all kinds of different decisions. Are they just guessing? I have received conflicting information along my route so for me….lets start with current data. Much appreciation here.
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Richford Greg back here with update. I had an MRI and a PSMA scan recently both if which confirmed cancer is back in prostaste and in left seminal vesicle. Nothing metastatic was detected. I am currently planning to move forward with external beam radiation for 4 weeks and a 4 month hormone shot of Luprone. The radiation does not concern me nearly as much as the hormne shot. It seems to escalate many health risks beyond just the hot flashed and loss of libido. Experiences out there ?
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Ask for Orgovyx (Relugolix) instead of Lupron. It's a once a day pill instead of the shot. Easier, no testosterone spike and just as effective. Also faster testosterone recovery after stopping it. It's often prescribed with an ARPI drug like Zytiga (Abiraterone) or others which adds considerable effectiveness. In my case, before, during, and after 40 rounds of IMRT I've been on this regimen for a recommended total of 2 years which I'm into it now about 16 months. It's worked well with a nadir of <.05 PSA considered undetectable. 😀 The escalated health risks you speak of are mostly a concern for long term usage or those with other existing ailments. If you're in relatively good health other than your prostate cancer I wouldn't be afraid of the ADT because of it's effectiveness. For me the first year of this was very tolerable. The side effects like fatigue and hot flashes are annoying, but I haven't had any other issues with it. Your doctor should should be monitoring your blood work to determine if any issues arise.
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Thanks for that recommendation on Orgovyx. After doing additional reading and research I have had my plan changed to that and I will take it daily for 4 months. I will skip the ARPI drug since that seems to just add an additional layer of concerns and it appears they typically add predinose to that script. I prefer to avoid prednisone. Thanks again.
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I agree with you about prednisone. There are other ARPI drugs such as darolutamide (Nubeqa) which don't require prednisone. I believe adding an ARPI does offer significant efficacy with little to no additional side effects when taken short term. In any event, Sounds like you have a good plan. Old Salt is spot on about exercising helping. Hang in there!
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From what I've read, the consensus is that routine resistance exercise (weight lifting) is most beneficial to avert muscle loss during ADT but sounds like you're only going to be on it for 4 months. You'll likely not have to worry much. Eat healthy and keep your weight down. I probably should, but I don't lift weights. I do however walk 3 miles every day the weather permits and do some push-ups.
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