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IBS and hormonal treatments

Posted 14 Sep 2020 at 13:49

I live in Sweden but since I am a native English speaker I thought it might be better to post here. I got my diagnosis for low-risk PC in 2017 after a checkup because of my age, then mid 60's, though I had no symptoms. PSA was 5 and I was put on active monitoring (that is what they call it here) and when the PSA continued to rise and jumped suddenly from 8-12 after 3 years, and I had the 3rd biopsy, the urologist said it needed treatment, having gone from low to medium-risk. Because I am on Xarelto since 2016 (a blood thinner) for the rest of my life due to 3 previous DVTs, it was recommended that we exclude an operation. Instead we would do hormonal therapy for 3 months - first Bicalutamide for about a month and then after a few weeks taking that an implant with leuprorelin which would last 3 months and then radiation. After starting on the leuprorelin I started having severe IBS problems and have had them 2/3 of the time for 5 months. The doctor gave me cortisone to help a couple of weeks ago and that seems to have a small effect but not getting rid of the problem. I follow a FODMAP diet and had the IBS under control until before starting the hormones. I was wondering if anybody else has had this problem and how they dealt with it? The oncologist said that the regular external radiation would play havoc on the intestines and wanted me to be okay before doing any radiation so now he is talking about brachytherapy treatment using a spinal block and a 2-3 hr procedure with needles in the prostate so that no radiation is outside of the prostate. I will meet him in 4 days to discuss it. Cheers 

Posted 14 Sep 2020 at 16:03

There isn't a recognised link between IBS and hormone therapy. There's even been some research on it:

Association between ischaemic bowel syndromes and androgen deprivation therapy in patients with prostate cancer: A retrospective cohort study

That's not to say it's definitely not related, but there was no statistically significant link in the data.

What you definitely should consider with IBS is the use of a rectal spacer while having the radiotherapy, such as SpaceOAR. This pushes the prostate and rectum apart, so that achieving max dosing at the prostate edge doesn't also deliver that dose to the rectum. It can be used with either brachytherapy or external beam radiotherapy, and if you came under the UK NHS, you might be able to get it on the NHS as an IBS patient. Not all hospitals have surgeons skilled in doing SpaceOAR though. It's currently not recommended in high risk cases, but you haven't indicated that's the case for you. Brachytherapy will deliver less dose to the bowel than external beam radiotherapy. There are two types of brachytherapy, permanent seed or LDR (low dose rate) where radioactive seeds are placed inside the prostate and generate a dose for around 6 months until they wear out (although they stay there permanently), and temporary or HDR (high dose rate) which uses a single seed which is put inside the prostate and delivers its dose for about 10 minutes before being removed again. The HDR procedure is normally done twice 2 weeks apart, but that's not common in the UK. In the UK, HDR is usually given as a single session, and the other session is replaced with a reduced dose of external beam radiotherapy (called HDR Boost), which would not be so suitable in your case.

Edited by member 14 Sep 2020 at 16:04  | Reason: Not specified

Posted 14 Sep 2020 at 16:28

Thanks very much Andy! I am a medium-risk case. I will show this to my oncologist in Sweden this week. I would prefer the external type since now the standard is a higher dose of radiation and only 7 times over a few weeks. He said that the standard used to be a lower dose and 39 times but that they found this new standard was just as effective! The Swedish NHS covers everything. I guess the oncologist was suggesting the HDR you spoke about, two weeks apart and using a spinal block and a short stay in the hospital with a catheter till they know that urine flow is okay. This is difficult in pandemic times because I would need to travel some hours to a major city to do it. It is not done in my area.


Edited by member 14 Sep 2020 at 16:37  | Reason: Not specified

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