Hello Jaderawr, If you read my profile you will see that I had a radical prostatectomy July 2015, histology showed the cancer had breached the capsule and there was evidence of intraductal cancer in addition to the "normal adenocarcinoma.
I started HT last December and had salvage radiotherapy March/April this year.
My PSA went from undetectable to 0.7 from 1/6/16 to 30/11/16.
You are correct in saying your dad shouldn't have a PSA reading as he has no prostate to produce it so any rise in PSA will be down to cancer.
Key questions are:
1. What is his PSA now?
2. What is his PSA doubling time?
3. What was his lowest PSA figure after surgery?
4. Will any salvage radiotherapy be aimed at the prostate bed only or further afield?
5. Will the oncologist conduct any scans prior to radiotherapy to better target it? (I had a Gadolinium enhanced pelvic MRI and then a Choline F18 PET scan).
6. Will the radiotherapy be a curative attempt and if so whet are the chances of success? I was quoted 40% success maximum)
7. What are the likely side effects from radiotherapy?
How much radiation will be delivered? (I had 55 Grays over 20 sessions)
Sorry there are a lot of questions there but they are important before making final informed decisions.
Best wishes, Ian.
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Hi there
Although retired now as an ex LGV and PCV driver I immediately felt an affinity with Dad's position. I had surgery in 2015 but never achieved an undetectable PSA answer in 2016 had salvage RT because the PSA kept rising. It was explained to me that some cells were floating around somewhere in my body but they were unable to determine where. Because the PSA was rising relatively slowly they believed the cells were in the prostate bed and so could focus the RT in that area. This didn't work for me so in 2017 I started HT as this is more of a scatter gun approach and should work on the cells wherever they are. The good news is that 3 months after starting HT I had my first undetectable PSA reading.
Some onco's use HT and RT in close proximity as a belt and braces approach but mine had a good chat about it and we decided to try one at a time so that I only had one lot of side effects to deal with at a time. It might be worth discussing this.
The RT was not a major problem and I was happily able to drive the 94 mile round trip but went equipped with emergency supplies of pads, trousers, pants and wipes just in case as I had read that RT could cause bowel problems during treatment. I am pleased to say that I didn't need any of it and the radiology team were so helpful.
towards the end of the 33 sessions I was aware that I was getting a bit tired and I wasn't working full time so Dad needs to be mindful of this as in his job there is a lot of concentration required.
I had my LGV medical 3 weeks ago and have just had my licence back for another year as I still do casual driving on trucks and buses so all good.
The HT hasn't been a major problem but the hot flushes take a bit of getting used to.
Hope this helps a bit.
All the best
Kevan
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I meant to also say that it s better to start the salvage radiotherapy when the PSA is low. Ideally below 0.5 but certainly before it reaches 2.
Evidence suggests that the treatment is effective for longer when started at lower PSA levels.
It might also be worth asking whether chemo would appropriate at this stage too.
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I think if they have told you that dad will never be in remission, they will assume that you understood that his cancer is incurable. On that basis, I would ask the onco what the purpose is of the radiotherapy? Either the RT is being targeted at some spread to reduce the side effects or reduce the tumour size a bit OR there has been a bit of misunderstanding and there is still a chance of cure. You need to understand which so that the family does not have false hope or feel unnecessarily hopeless (depending on the answer the onco gives you)
Having no PSA because he has no prostate would only apply if he was in the curable camp - obviously since he is incurable, the cancer cells wherever they have spread will be producing PSA.
What happens next and how serious your dad's situation is is rather influenced by whether or not he is taking hormones already? If not, you could ask the onco whether hormone treatment is to be given with the radiotherapy.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Before starting a salvage radiotherapy it is better to clarify if the psa increase is caused by a local recurrence (e.g. in the bladder or urethra) or by a metastasis. If the psa is still low (below 1.0) and the doubling time is long, it is more likely a local recurrence.
In case of local recurrence high dosage of radiotherapy is required (at least 74 Gy/ 2Gy per fraction) in order to control it for long term.
Main side effects are frequent urination and defecation due to irritation of urethra/bladder/rectum.
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Hi Jade, I have just finished Radiotherapy, 20 sessions totalling 60 Gy.
Worst bits were travelling to and from treatment. You have to keep hydrated before arriving, emptying bladder, then drinking 3 cups 1/2 hr before session to get fill bladder to the right amount.
You will be well briefed at the planning session
Your bowels needs to be empty, gas free, not always possible, but the radiologists are very understanding.
Radiotherapy has no feeling, just lie there keeping still, listening to the machine rotate around you bleeping,
RT can cause diarrhoea but speak to the nurses to gets some meds.
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Thank you, this was all very helpful. My dad is awaiting an appointment for this month to get his 3rd result since I posted this. So soon as o have the results I am sure i will be on here to talk to you all again.
Thank you ever so much.