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Should I have RT?

User
Posted 11 Jan 2022 at 17:42

Im 78 and reasonable healthy, apart from prostate cancer- and partial deafness.  

I am trying to decide whether to have RT. Ive got a low PSA (2.6) but  Gleason of 7 ( 4+3) with some  local invasion identified by a MRI scan, but no wider (bone) transmission seen. Im on HT which seems fine with no side effects apart from hot flushes . Ive been offered RT - 4 weeks of 5 sessions a week.. The side effects seem more serious than HT, and they worry me. So does the 4 weeks of RT and, I'm told, 6 weeks of recovery. Sounds grim.

In theory I suppose I could duck out of RT and just stay on the hormone injections. But I am told you can't do that for ever (2-3 years max?). HT effectiveness decreases with time and the side effects get worse, and the risk of the cancer spreading fully out of the prostate into the rest of the body, although much reduced, is still there and it would grow again as the hormone effect wore off . So, as far as I can see, there's no long term path via delaying RT and actually some short and then long term risks - I will also be older and less able to cope with RT maybe .

Does all that make sense? Do I really have a choice- other than taking a risky bet that HT will see me through for a few years, with other illnesses maybe taking over as my final undoing anyway!? 

 

User
Posted 11 Jan 2022 at 19:07

What is it about RT that worries you? I had a course of 32 sessions of RT three years ago and found it pretty tolerable. A few weeks of increased peeing urgency and a rather longer period of bowel "instability" was as bad as it got. The peeing returned to normal within a few weeks; the bowels took several months but at no stage was it more than a minor inconvenience (I just took Imodium if I went out for the day). Three years later and I'm absolutely fine and the cancer is (touch wood) sorted.

Happy to answer any questions you might have about RT.

Best wishes,

Chris

Edited by member 11 Jan 2022 at 19:39  | Reason: Not specified

User
Posted 11 Jan 2022 at 23:36
Go for it - 78 is quite young and there is so much living for you still to do once we all learn to live alongside this darned Covid.

4 weeks of RT might sound onerous but has anyone explained that the actual Rt last a few minutes and you will usually be at the hospital for 30 - 45 minutes depending on how they approach the task of water drinking? My husband was a lot younger than you but had his RT every morning at 8.30am and was usually on his way to work before 9am.

Some men have some bowel problems (runny, mucous-y perhaps) during the RT but not all by any means and the hospital would probably give you a diet sheet of things to avoid just for the 4 weeks. Some men feel tired in weeks 3 & 4 and for perhaps a couple of weeks after but an afternoon nap isn't a crime.

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

User
Posted 12 Jan 2022 at 00:57
Nothing is certain and the suggestion that you might have 8 years left is probably an average, whereas you might have much longer than this. With a 4+3 Gleason I would have the RT in your shoes. It might well stop spread or at least slow progression of the disease. I had RT in 2008 when on HT and the RT component added slightly more to fatigue for the treatment period, a major increase in urinary frequency which gradually returned to pretreatment level about 8 weeks post RT and mucus in stools on lessening basis up to about 6 months. If you go to a major hospital they may well have the more advanced linacs available now which are quicker and treat in a more refined way. Of course the decision on whether to have RT is yours.
Barry
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User
Posted 11 Jan 2022 at 19:07

What is it about RT that worries you? I had a course of 32 sessions of RT three years ago and found it pretty tolerable. A few weeks of increased peeing urgency and a rather longer period of bowel "instability" was as bad as it got. The peeing returned to normal within a few weeks; the bowels took several months but at no stage was it more than a minor inconvenience (I just took Imodium if I went out for the day). Three years later and I'm absolutely fine and the cancer is (touch wood) sorted.

Happy to answer any questions you might have about RT.

Best wishes,

Chris

Edited by member 11 Jan 2022 at 19:39  | Reason: Not specified

User
Posted 11 Jan 2022 at 19:10

same as Chris I had 37 lots off radiotherapy with no problems found it really tolerable 👍

User
Posted 11 Jan 2022 at 22:13

Statistically you have about 8 years of life ahead of you. I think with HT and Gleason 7 you might make it.

But I think with RT you will definitely make it and the side effects will be minor (they were for me). With surgery you might be cancer free for 20 years, but the side effects would be much worse, and you only need 8 years cancer free.

 

Dave

User
Posted 11 Jan 2022 at 23:36
Go for it - 78 is quite young and there is so much living for you still to do once we all learn to live alongside this darned Covid.

4 weeks of RT might sound onerous but has anyone explained that the actual Rt last a few minutes and you will usually be at the hospital for 30 - 45 minutes depending on how they approach the task of water drinking? My husband was a lot younger than you but had his RT every morning at 8.30am and was usually on his way to work before 9am.

Some men have some bowel problems (runny, mucous-y perhaps) during the RT but not all by any means and the hospital would probably give you a diet sheet of things to avoid just for the 4 weeks. Some men feel tired in weeks 3 & 4 and for perhaps a couple of weeks after but an afternoon nap isn't a crime.

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

User
Posted 12 Jan 2022 at 00:57
Nothing is certain and the suggestion that you might have 8 years left is probably an average, whereas you might have much longer than this. With a 4+3 Gleason I would have the RT in your shoes. It might well stop spread or at least slow progression of the disease. I had RT in 2008 when on HT and the RT component added slightly more to fatigue for the treatment period, a major increase in urinary frequency which gradually returned to pretreatment level about 8 weeks post RT and mucus in stools on lessening basis up to about 6 months. If you go to a major hospital they may well have the more advanced linacs available now which are quicker and treat in a more refined way. Of course the decision on whether to have RT is yours.
Barry
User
Posted 17 Jan 2022 at 13:40

Thanks everyone for your positive messages. I will go for RT. 

Though Ive just spotted that I got my Gleason score wrong . It 3+4 not 4+ 3.  Does that alter any of this advice?

 

Edited by member 17 Jan 2022 at 15:42  | Reason: PS

User
Posted 17 Jan 2022 at 18:28

Your cancer is slightly less aggressive than we thought but not enough to change the advice. If it had been 3+3 I would have been inclined to say "that Cancer is probably not going to be serious for another 10 years" so possibly go for active surveillance. With a bit of 4 in there though it might progress far enough in five years that you will need to be concerned.

Dave

User
Posted 17 Jan 2022 at 22:33

I would investigate the option of IRE- see my post . The side effects significantly lower 

The treatment also allows optionality that you can have further treatments which are not possible with RP or radiation.

User
Posted 18 Jan 2022 at 01:39

Originally Posted by: Online Community Member

I would investigate the option of IRE- see my post . The side effects significantly lower 

The treatment also allows optionality that you can have further treatments which are not possible with RP or radiation.

Your second sentence is incorrect Paul.  You can have other focal treatment after RT, I am a case in point having had HIFU twice after RT.  Also, you can have RT after HIFU, probably RT for failed IRE too, but I have not checked the latter.

Barry
User
Posted 18 Jan 2022 at 08:00
I am just finishing my 20 fractions of RT and so far all i have experienced is some increases in urine frequency and tiredness by the end of each week of treatment. So I would say definitely go for it

Keith

User
Posted 26 Jan 2022 at 20:04

Thanks. What about impotence, ED etc?

Dave

 

User
Posted 26 Jan 2022 at 22:13

Dave, I had RT (half external beam, half HDR Brachytherpy) 2½ years ago, finished hormone therapy just over a year ago, and testosterone came back quite suddenly 2-3 months ago. No impotence/ED - all still working fine. The HT does give you temporary ED, which you do need to work on with a pump, if you want things to continue working properly afterwards. At your age, you can probably get away with a shorter period of hormone therapy, or even none at all, as you're probably not looking for 20 years remission.

There is a chance of ED with radiotherapy, around 30% I believe. If it's going to happen, I'm told it starts within 2 years of the radiotherapy, slowly getting worse.

 
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