Any possible negative effect to PCA/psa or rectal areas with sigmoidoscopy/biopsy 2 years after IMRT

VascodaGama said:

Sigmoidoscopy is not so invasive

 

Hopeful

Specialist physicians are the ones where to get trustful answers. I think that you should consult your radiologist to get a second opinion on your gastroenterologist suggestion.

My lay opinion is that the sigmoidoscopy is not so invasive so that it can be done to check for any scar tissue, etc., as far as it can reach deep (the end of the colon/rectum area), but a colon biopsy is very invasive and risky, particularly if there are any kind of colitis-like tissue that were caused by the radiotherapy (tissue not yet cured or healed).
Some patients have reported about problems (as bad as fistulas) from biopsies done at rectum tissue.

The radiologist knows the scope (radiated field) he has used in your treatment so that he can provide with an idea about the present status (degree of healing) of the tissue at the area. You could do a sigmoidoscopy alone and decide later on doing a biopsy at a different occasion.

It is typical to have a cystoscopy and colonoscopy done one year after the radiotherapy to check for scar tissue. I think that the practice is done because it is considered OK. Medications or enemas, etc., would not affect or cause prostate cancer to “flourish” so that it would not have any effect on the PSA levels.
In fact, you should be cured by now and you should care more for the after effects from the treatment or any other illness event.

Please consider using doctors that have experiences in similar cases as that of yours. In cancer centres (like JH, Mayo clinic, etc) doctors of different trades work together and manage to deliver better diagnosis (and satisfactory answers).

Radiation may have caused IBM or you had already ulcerative colitis without knowing, which would have been proibitive for IMRT treatment. IBS symptoms can be aliviated with a change in diet, but it takes time to get down the results. 
Have you discussed with your doctor about the above or have considered to get the opinion of a nutritionist ?

 

Can you share info on the progress of your PCa case?

 Best wishes.

VGama 

 

Vasco,

I think you've summed it up well - the difference between having the sigmoidoscopy at all

vs having one with a biopsy in the rectal area.

I did call radiation place and a dr looked at my records and said not to have biopsy within 20 cm

of where rectum starts; I read that rectum area usually up to 18-20 cm so don't know if he

was just covering whole area to be safe or if the imrt might have touched the full area. I'll

discuss this with gi dr. 

I guess if gi dr does feel a need to do biopsy within rectal area, then it can be discussed with

rad dr and i guess would be a potentially serious situation - since gi dr knows why not to take

biopsy in rectal area,  it would be a real serious thing if he felt one was needed.

But still want to make sure its ok to have it at all as to just the scope going in itself in case there

might be some areas that are problematic that might be affected just by scope going in and doing exploration;

and since even if no signs of rectal problems from imrt, things could have happened/be happening there,

and will keep thinking about this whole topic.

as to controlling the ibs I have been controlling food for a long time; some of those mental medications for it have too many side

effects, but its mostly that since 9 mos post imrt the ibs had gotten so much more frequent and severe than in the past when was able to more or less manage it though tough even then; that increase in severityis what is leading to this possible sigmoidoscopy, though really in 2yrs am due to colonoscopy again and do need to do that to monitor about colon cancer, etc in any case.

Thanks again for your comments.

VascodaGama said:

Hope for the best

Hopeful,

Probably the gastroenterologist wants to perform the sigmoidoscopy with a rigid apparatus. This tool is enough to check the end portion of colon at the sigmoid. To go further inside he will need a flexible endoscope. The procedure would not affect any cancer (if it exists) at the area or at the gland.  You shouldn’t be so concerned.
You may experience some discomfort or pain if you got any open wound like an ulcerative colitis. In any case, without checking the colon your doctor cannot diagnose the origin of your problem.

The biopsy should be avoided as per your radiologist so that the matter should be further discussed at a latter occasion, if the gastro finds (this time) something suspicious. He can always identify the spot at another sigmoidoscopy and perform the biopsy under the guidance of your radiologist.

IBS is commonly reported by Pca patients of radiotherapy. In my case, RT has weakened my colon walls causing me a partial loss of sensation when passing stool. Fortunately, I am continent but I do “puff” more often after RT then before. In my last colonoscopy the doctor found diverticulosis (outpocketings along the colon) that fill up with detritus and cause occasional intestinal gazes. Diverticulosis causes rectum bleeding too but it seems to be a natural way of our system to clean up/empty those pocketings.

Surely your best shot is that the gastroenterologist calls the radiologist. If he doesn’t want to call him then change doctors. You would be the one to surfer the consequences arising from the procedure, not your gastro.

I hope they find nothing in your rectum and that you fully recover from the condition.

Wishing you peace of mind.

VGama

I'm the original poster and wanted to give an update on what was discussed in this thread so far.

1. 6 weeks ago I had the sigmoidoscopy.

2. The Dr did a digital rectal exam first and said the prostate felt flat which he said was a good sign.

3. Biopsy's taken to see if IBD were negative and he did not report and problems with the rectum as to

effects seen from imrt though I realize those problems can manifest later (its been 2 1/3 years since imrt).

4. I was due to have psa and asked how long it could be good to wait to avoid artificial rise in psa

due to dre and sigmoidoscopy - he suggested one week.

5. one week later i had the psa and it was 0.2, which was different than the 0.1  I'd had for a year or so

(and before that at least 9 months of mostly <0.1, which is as low as the psa test I take goes.)

6. I thought the 0.2 might still be related to the dre and sigmoidoscopy effects on prostate so asked

if I could take psa again after one month.

7. HOWEVER, it is 0.2 again, which is what is troubling, being that it was 6 weeks after the sigmoidoscopy

that I took it.

===> Question - could it be that the sigmoidoscopy and dre might have stimulated or otherwise affected

prostate to become more active as to the remaining cancer cells -- and that is why its again 0.2

(after having been 0.1 for such a long time, and < 0.1 for a long time before that)  ?

OR could it be that its still just the effects of the DRE and sigmoidoscopy itself causing

an artificial increase of the psa, even though it was 6 weeks after the sigmoidoscopy/dre

that the recent lab was done ?

Thanks again for comments or suggestions.