The next "Step" after robotic prostatectomy

The proposed treatment is Standard of Care, AFAIK.

The radiation sessions are very short, but there's a pretty strict protocol about having a full bladder prior to each radiation session. I personally wouldn't worry about things that may (or may not) happen way down the road. In that context, Eric gave you good advice (see the post above).

Carpe Diem!

Hello NDFarmboy,

Your situation is very similar to mine. My first PSA test a few months after surgery in 2015 was 0.53 and my next was 0.75. I began radiation shortly after, 33 sessions, but did not have hormone therapy with it. My Gleason was 3+4. My urological surgeon, before handing me over to a radio-oncologist, described post-surgery radiation as a mop-up procedure. Pretty good description, I think, and standard practice.

I wasn't completely continent before I started radiation, but I was well on the way. I was told that whatever level of continence I was at, it would never improve beyond that, and that's true, I never became completely dry, but until a couple of years ago I was down to just one flimsy shield a day and I was dry overnight. I'm much worse now but I can't and won't blame that on the radiation itself; it was too long ago. I also had a certain level of ED before surgery and radiation did not worsen it.

The reason that they say to front up with a full bladder is that it pushes your bowel out of the way a little bit, preventing some irritation to it and reducing the severity of loose motions which persist for a few months after. Or so I was told.

If anything has 'fallen apart' for me, and it is now 7 years after my radiation, is that I have what's known as a biochemical recurrence; my PSA is now 0.51 after reaching its nadir of 0.04 five years ago. Happens to 30% of those after surgery, apparently.

It is common to have a course of androgen deprivation therapy (in this case Orgovyx) prior to radiation therapy. There is synergy between the two:

Adjuvant androgen deprivation therapy for prostate cancer treated with radiation therapy - PMC (nih.gov)

Usually it's prescribed the other way around; Casodex first then Lupron (to prevent Lupron flare).

NDFarmboy,

I hesitate to post this because it sounds a bit dire, but my radiation after RP included 45 Gy in 25 fractions to the entire pelvis, including lymph nodes followed by a 25.2 Gy in 14 fractions boost. Hormone therapy before, during, and after. Few complications during treatment but It was soon made clear that I suffered radiation cystitis to the bladder wall resulting in urine leakage, burning, blood in urine, and clotting. Prostate bed pain developed two months after treatment and lasted for about 6-8 weeks. Almost four years later, scar tissue blocked flow through the urethra and had to be cut away. This scar tissue was from the burning caused by the radiation. This left a hole in the urethra and complete incontinence to prevail.

Another 3 years later and I am struggling with peripheral neuropathy and loss of balance due to tiggling and numbness in the feet and lower legs. Suspect scar tissue impinging on nerve bundles or actual nerve damage from the radiation.

My post RP PSA stubbornly sat at about 1.5 which resulted in radiation/hormone therapy recommendations. And while my current PSA remains at <0.01, knowing what I know now, I might have waited a little longer before making the decision to have the radiation accomplished.

It's a tough choice to make. I would be interested to know how much radiation to the pelvis is too much radiation...

Brevp