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Recurrence?

User
Posted 19 Jun 2023 at 22:59

Originally Posted by: Online Community Member

If the radiotherapy did its job, he shouldn't have a prostate. He would have had (in the words of one expert) 'mush', long since largely reabsorbed, the space occupied by the gentle shifting of other organs.

Radiotherapy sure ain't surgery, but if done right, the effects are much the same.

(I certainly hope so, having had it myself!)

That's not quite right - healthy cells left behind after RT can regenerate and will produce some PSA which is why biochemical recurrence is defined as 2.0 + nadir 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 19 Jun 2023 at 23:24

A small number of cells, but that does not a prostate make. The 'ideal' post Radiotherapy PSA approaches zero.

As I said, if it's done its job: it isn't perfect, but it generally does a pretty good job.

User
Posted 20 Jun 2023 at 01:24

Originally Posted by: Online Community Member
This was a tough decision. I declined the offer!

Yes, in the same position I'd go the same way and try to avoid HT. Old Barry's suggested path in its pursuit of further treatment obviously requires some persistence with the medical system and he's set a good example of fighting on. Sometimes I think doctors take the easy option with older patients when life expectancy rears its head as a factor.

Jules

User
Posted 20 Jun 2023 at 05:52

Originally Posted by: Online Community Member

A small number of cells, but that does not a prostate make. The 'ideal' post Radiotherapy PSA approaches zero.

As I said, if it's done its job: it isn't perfect, but it generally does a pretty good job.

After Prostatectomy you have no actual Prostate whereas after radiation to the Prostate you do, even if it's a bit sticky with scar tissue, so quite different after the two procedures.  Have seen many scans post RT (including my own), some with no cancer and some with and biopsy can still be done.  Some seven years after RT, I had a very extensive multi core  template biopsy which showed only one core to have cancer.  This they were able to see and reach with HIFU. 

Incidentally, some cancer cells can be radio resistant and with a Prostate, even a radiated one, there is the potential for a new tumour to start, as well as normal cells to regenerate.. 

Barry
User
Posted 20 Jun 2023 at 08:23

Originally Posted by: Online Community Member
If the radiotherapy did its job, he shouldn't have a prostate. He would have had (in the words of one expert) 'mush', long since largely reabsorbed, the space occupied by the gentle shifting of other organs.

Radiotherapy doesn't work that way.

Radiotherapy exploits a property of cancer cells that makes them much more vulnerable to radiotherapy damage than healthy cells are. The radiotherapy deliberately damages cells' DNA. Healthy cells can repair their DNA when it gets corrupted (which happens regularly in normal life), whereas a cancer cell became a cancer cell because it lost its ability to repair DNA corruptions, and picked up a set of DNA corruptions which made it malignant (dividing and multiplying uncontrollably). Radiotherapy generates enough additional DNA corruption to stop the cancer cells being able to divide and multiply, while the healthy cells can repair the DNA corruptions induced by radiotherapy. There is collateral damage to healthy cells too, and that is what generates side effects. The radiation dose is set at a level where the collateral damage doesn't risk killing the organ, because a necrotic organ the size and position of the prostate would be fatal. (I vaguely recall this is around 10% collateral damage, but I might be wrong here.) The organ must remain viable such that it can maintain itself, fight infections, etc. So after the radiotherapy, the cancer cells are no longer malignant and will simply die of old age over the next 18-36 months, plus a small percentage of healthy cells are similarly destroyed. The prostate is capable of regenerating tissue, and as the impacted cells die off, it may form new replacement tissue. A second effect of the repeated damage and healing cycles of radiotherapy is that fibrous tissue forms during the healing. The prostate is a muscular organ, and this stops it from being able to contract and expel its contents as it normally would.

On average, prostates are about 5% effective after radiotherapy, but this is heavily skewed to most not working at all, and a small number still up to 50% effective. This can depend on the extent of the cancer in the prostate at treatment time.

Radiotherapy doesn't make the organ vanish.

 
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