Another New Member

FlyFisher

Welcome to the board.

I also think that radiation is a good “shot” for you. Gleason 8 (4+4) is aggressive and the positive DRE may signify that extra capsular extensions exist, even with negative image studies. The hormonal portion (ADT) you have started is palliative but it will increase the success of the radiation. It “sensitizes” the cancerous cells to better “absorb” the radiation and die. In other words, it will “lay down” the cancer for the whole period until the cells’ life cycle completes. The radiation will kill the cancer by “disrupting” its DNA, prohibiting it from recuperating and duplication.
Typically one is on ADT during two to three months before the radiation, and it will continue for additional 6 months or two years, depending on the aggressiveness of the case.

I wonder if the seeds you comment above are the fiducials (markers to guide radiation)?
Seeds could mean brachytherapy, another form of delivering radiation to the prostate, which could be part of the radiation protocol; Brachy plus EBRT.
Can you share more details of your treatment?

A note regarding your worry issue with RT “I am told after radiation, surgery is not recommended if radiation is unsuccessful”; I may say that this is not exactly true. Some surgeons do operate after radiation but there are risks in the healing process because the local tissues are affected and take much longer to recuperate from the “blow” (over 6 months in low grade Gys). Moreover, why doing surgery after failed radiation?
Surgery is a choice to be taken if the cancer is contained within the gland. In extra prostatic extensions cases, it would be used for the purposes of debulking the big bulk of cancer (the whole gland) without any assurances of cure. The cancer could exist in the prostate bed or at the near lymph nodes, requiring additional treatment (typical of Salvage Radiation).
I would say that the worrisome would be for radiation over radiation because of the limits of our body tissues in absorbing radiation. It could cause fistulas.

EBRT done from the begining will cover the whole gland including those near by areas (prostate bed plus lymph nodes). You can discuss with the radiologist on his intended coverage to be sure of what will be done.

Think positively. The radiation will blow away those buggers for good.

Best wishes for a successful outcome.

VGama

FlyFisher said:

VGama,
Tthank you for your

VGama,

Tthank you for your comments.  By "seeds", I do mean brachytherapy.  At this time, I am not sure what isotope will be used, but I expect EBRT for about 4 - 5 weeks, then placement of the seeds.  I should know more in next couple weeks.  Thank you for your positive encouragement.

FF

Thanks for sharing the details. I am aware of this sort of combination radiotherapies however I see more cases using brachy first (as main) followed by EBRT as a boost, to cover surrounding areas such as the seminal vesicles and bed (plus lymph nodes). In your therapy they will use EBRT as main and add brachy as the boost. This type seems more recommended to lower risks cases of Gleason 6 and 7.

The main difference between EBRT done alone to a protocol with a boost is that in a combination therapy the total radiation delivered to the prostate is higher. The initial EBRT delivers less Gy saving the healthy tissues in the path of the rays, standing before and after the prostate. Brachy is a more localized therapy so that it can be used to deliver higher volumes of Grays to close tissues, which added to the EBRT portion will delivered higher levels of Grays capable of affecting seriously the cancerous cells in the prostate. Other areas should be covered by the EBRT alone.

I do not know the reason for choosing such protocol for you, a Gleason 8 case, but I assume that they took into consideration your other issues/problems in the groin area, so that they want to “distribute” the radiation more effectively, with lesser severe side effects to the areas with problems.

In any case, I would recommend you to find out about the field of coverage (isodose planning) so that you know that all is included (lymph nodes, etc) and should discuss about the risks of urinary incontinence, linked to brachytherapies. The field of radiation and the direction of delivery should be studied carefuly to balance the risks but also to eliminate the cancer effectively.

Here are articles about your type of treatment that may interest you;

http://onlinelibrary.wiley.com/doi/10.1002/cncr.26203/pdf

http://www.touchoncology.com/articles/combined-external-beam-radiotherapy-and-brachytherapy-management-prostate-cancer

 Best,

VGama

Fiy Fisher,

I hate to say "Welcome" because this isn't fun, But, glad you are here with all of us. 

As has been mentioned "Hopeful And", MRI's are the best way to look for bone and other problems, related to the cancer..  That was one of the first steps in the process I went through. 

Sounds like you have been really studying all the treatments and I hope you continue to do so.  Be aware of everything you will be faced with.  My Urologist / Oncologist also sent me to a Radiation Oncologist first, before I made the decision to have Robotic Assisted Surgery.  I also had a small hernia, and was told I would probably have a bigger hernia after the surgery.  And I do.  However it is open enough and will not get strangulated and thus we are not doing hernia surgey at this time.   If the hernia "comes out", I lay down and it goes right back in.  When diagnosed, My PSA was 69 with the Gleason of 7.  At first I wanted the surgery ASAP.  I wanted to do "the Seeds" after talking to the Radiation Oncologist.  Then finally decided I wanted "The Cancer Gone".  So, I went back to my first plans.  Had Surgery in Dec 2013. Turned out that because of a birth defect, "The Seeds" wouldn't have worked.  My prostste was adhered to my bladder and they couldn't have gotten the seeds in place where they were needed.   Two months later PSA down to <0.010 where it still remains.  Was on Lupron for two years and had 8 weeks of radiation post surgery. I have been off the Lupron for three months at this point, and will have blood work done in two weeks to check Testosterone and PSA levels as well and kidney function and a bunch of other things they have been checking every 6 months.  I still see my Urologist every three months at this poiunt and will continue to do that until we are sure I am in "Remission". That's the word I'm hearing , with great delight, every time I go to either my Urologist, Radiation Oncologist and Chemo Oncologist.  Time will tell.  However, my doctors don't let me forget that I was dealing and am dealing with a very agressive cancer.  They keep it real and I appreciate that. 

I hope and pray to God almighty you will be hearing the word "Remission" soon.

This is a Hard Fight.  But please don't lose hope.  Fight hard, and try to keep yourself in as good of physical condition as you can.

Best Wishes

Peace and God Bless

Will

The fatigue is part of the low testosterone syndrome as well as a side effect of medicine.  Remember that any cancer will drain the body of nutrients and energy as well.  Combine this with the effects of aging, and you can see that energy levels must drop.  As a body builder, I was a user of steroids unit age 81 when I had to stop due to bone very extensive bone cancer over 75% of my body.  Even with that cancer, I was doing 50% hack squats with 450 and strict one are curls with 100 lb dumbells.  I truly believe that this heavy lifting kept my bones strong even with the cancer and also is the reason I am alive today.  

  I wanted to do roids again.  I asked the doc here about TRT and he said I would be committing suicide, probably a right diagnosis.  I asked my really good doc in Singapore about TRT and he said he only gave that to his patients that were truly suffering from fatigue, and that was not the case with me and my bodybuilding program, and therefore would not recommend TRT for me.  TRT is apropriate for some.  You might look at your diet for help.  I use a product called Tegreen which I think helps.  I would also suggest a daily meditation program with breathing.  A one hour daily meditation program is a MUST DO for everyone, cancer or not.  

You are doing a lot of correct things, congratulations.  I assume your diet is also on track.  I also had to get up to pee every one hour or one hour and a half.  Now, with my PSA at 1.17, down from 300, I now often only pee once or twice a night.  I am also wondering if I even still have the cancer.  I seem to be able to add muscle at 84.  I cannot overemphasize the importance of love and positivity and NEVER ALLOWING YOURSELF TO HAVE EVEN ONE NEGATIVE OR UNLOVING THOUGHT.  Always be available for miracles and oportunity that are your birthright as a spiritual being.  One negative thought will block the miracle from coming to you because you are not available to receive.  No matter what the outcome, you cannot be a loser if you are celebrating everything that comes into your life, but do not take celebration for granted.  You have to do it, it is not a given, just as love is your portential, but also not an automitic given.

I always enjoy your posts.  Love, Swami Rakendra

FlyFisher said:

FlyFisher Update

Hi Guys,

Not much change, but things are getting more defined; I met with the radiation oncologist again.  The waiting periods between biopsy/start of medicines until treatment can start is annoying, but necessary I guess.  I have been on CasoDex for 2 weeks and on Monday, 5/2/16, I will get first shot of Lupron.  That starts the clock for when I can get first radiation treatment in early July 2016.  I will have a 3t MRI on 5/18/16, which is 2 months after my biopsy.  I have concern about a sore tailbone; urologist thought maybe it was bruised during biopsy, but after 5 weeks I thought it would heal.  Oncologist is not sure.  Sometimes the soreness goes away and returns.   Has anyone else had a sore tailbone?  In July 2016, I will get radiation treatment for 4-5 weeks and then have brachytherapy done.

RonJT, I have experienced no significant side effects from CasoDex; we will see what happens with Lupron starting next week.  As for supplements, I only take what I have used before: garlic pill, multi-vitamin, Krill oil, CoQ10, probiotics.  None of which were specifically suggested by doctors.  I have changed the diet substantially; no red meats, increased fruit and veggies, additonal juices(pomegranate, tomato, red wine  etc.).  My exercise is mainly walking 2 to 3 miles a day.  I used to run 10 miles/day, but knees cannot handle running now.  I am an avid fly fisherman and try to spend 1 day/week walking/wading trout streams for 4-6 hours, which is a good workout and takes your mind off the problem.

Guys, thanks for all your help.  I am anxious to get on with the treatment, but at least I have some time in May to do some fishing.

Take care,

FF

Hi Flyfisher

Found this article the other day that may have relevance for your treatment plan.

https://ro-journal.biomedcentral.com/articles/10.1186/s13014-016-0585-y