Radiation Concerns

richfordgreg

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.

MACH1

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?

Clevelandguy

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

MACH1

My oncologist used Barigel for my brachytherapy. Said it was better than SpaceOAR for brachy. Not sure if SpaceOAR would be better for external beam.

richfordgreg

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.

MACH1

https://csn.cancer.org/discussion/comment/1725884#Comment_1725884

They told me that after brachy there would be no more biopsies or MRIs. Strictly PSMA and radiation.

Steve1961

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

richfordgreg

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.

Steve1961

https://csn.cancer.org/discussion/comment/1725898#Comment_1725898

your psma scan will determine if the cancer is still contained

Old Salt

Yes, the PSMA scan will make a biopsy superfluous.