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Radiotherapy following chemo

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User
Posted 18 Jun 2022 at 21:05

My other half was recently diagnosed with adv PCa. Has had a round of chemo  and is on HT, and is now going straight into some radiotherapy. Id expected some tests other than PSA ( which has dropped massively!) before another treatment was started. Is this usual? Does it signify anything?


I just want to understand!


 

User
Posted 19 Jun 2022 at 02:03
We don't really have much info to go on, PSA prior to Treatment, MRI and Biopsy assessment with full staging and whether RT was going to be given with curative intent to pelvic area or to address areas of cancer in bone to reduce pain for example. Was a treatment plan not explained and accepted by your OH? HT very quickly reduces PSA and does this if it is continued until cancer cells learn to get round testosterone so this is usual. We don't know that it wasn't always part of the treatment plan to with follow up If a full diagnosis and treatment plan is unknown or not been explained. It might well have been. I suggest OH confers with his GP who should have been made aware of full diagnosis and proposed treatment. Alternatively, contact the clinical nurse dedicated to his case, who should be able to provide this information to help answer your question. The latter may be quicker as there are sometimes delays in Consultants communicating withGPs.
Barry
User
Posted 19 Jun 2022 at 18:34

Radiotherapy to the prostate in the case of advanced prostate cancer is offered to some patients with a low number of metastases, as it's been shown to slow down the development of metastases, which at this point appear to rely to some extent on the primary tumor in the prostate. This extends life and is a relatively new treatment in this case.

Edited by member 19 Jun 2022 at 18:36  | Reason: Not specified

User
Posted 19 Jun 2022 at 18:43

HI fergy...I know this is a very  distressing time for you both and phone calls are not always the best line of communication. Perhaps you could ask re the possibility of a  face to face consultation. Guess it depends  on your health trust. We had been offered a phone consultation for our first oncology appt  but  I asked for a face to face instead and was accommodated no problem.


Regards Ann


 

User
Posted 21 Jun 2022 at 06:17

Hi Fergy


I’m in a similar situation… OH diagnosed with Stage 3 N1 Gleason 4+5. Spread locally and to lymph nodes but not bones. PSA down from 91 to 0.2 with hormone treatment, side effects not great but so far tolerable. Now being recommended 4 weeks of heavy radiotherapy. My question to others further down the line: how to weigh the nastiness of RT (consultant said high dose because he’s basically strong and healthy) and likely long term scarring against reduced chances of cancer waking up again? Consultant assumed we would want to go ahead, was very rushed, OH went along with it but I felt he’d been bounced into signing discharge.


There’s a bowel complication to be dealt with first so we have a bit of time.


Is there someone out there who’s had/researched radiotherapy and can help us understand better what it all means?

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User
Posted 19 Jun 2022 at 01:39

There is no reason for the consultant to arrange more tests -the treatment plan was presumably set when they finished the diagnostic stage and a programme of HT, chemo then RT is fairly normal for advanced prostate cancer if they believe the RT might help - the thinking is either that zapping the prostate will weaken the cancer clusters wherever they have spread OR the RT is being given to just a couple of specific sites to reduce side effects. 


Some men with advanced PCa aren't offered RT at all so your OH is getting good care.


It doesn't signify anything except that at your hospital, men are offered RT.

Edited by member 19 Jun 2022 at 01:41  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Jun 2022 at 02:03
We don't really have much info to go on, PSA prior to Treatment, MRI and Biopsy assessment with full staging and whether RT was going to be given with curative intent to pelvic area or to address areas of cancer in bone to reduce pain for example. Was a treatment plan not explained and accepted by your OH? HT very quickly reduces PSA and does this if it is continued until cancer cells learn to get round testosterone so this is usual. We don't know that it wasn't always part of the treatment plan to with follow up If a full diagnosis and treatment plan is unknown or not been explained. It might well have been. I suggest OH confers with his GP who should have been made aware of full diagnosis and proposed treatment. Alternatively, contact the clinical nurse dedicated to his case, who should be able to provide this information to help answer your question. The latter may be quicker as there are sometimes delays in Consultants communicating withGPs.
Barry
User
Posted 19 Jun 2022 at 10:43

Thank you... It just wasn't explained at the beginning that both would be done and what I've read didn't seem to show using both immediately as standard treatment.


It's all rather disconcerting and worrying! Very glad this forum is here!!

User
Posted 19 Jun 2022 at 14:51

Sorry.. Its all a bit vague.


Gleason 9. 


Told it's advanced PCa, but only by a booklet being sent for that . Theres a lymph node in the shoulder showing in a PET scan, so it fits.


Consent form says radiotherapy is to extend life, and will be directed at the prostate. Chemo was down as palliative on that consent form.


All consults have been by phone and OH doesn't ask many questions, so the move to RT came as a surprise.... it  wasn't mentioned in the call to say chemo was needed after scans and biopsy.


If its a standard pathway then it's just that communication hasn't been great, rather than something for me to be concerned about.


Thanks for trying to put me straight.


 


 


 

User
Posted 19 Jun 2022 at 15:47
Sometimes things are not explained well or a patient is rather bemused by the unfamilier information being provided by a Consultant whoes time is rather limited due to work load. We do suggest that where possible a patient is accompanied by somebody else at appointments, perhaps with a notebook or seeks permission to record what is said. That way it can be more fully absorbed afterwards. It's also an idea to prepare a list of questions in advance so answers may be obtained. Certainly some things will be pretty standard but patients may be at different stages when diagnosed, have different types of PCa or need to be treated differently for a number of reasons so an individual needs to know his particular situation and how it is planned to deal with it which may then change depending on how he responds.
Barry
User
Posted 19 Jun 2022 at 18:17

I understand what you're saying . But OH is an ex nurse..... So not readily bemused by language etc 


Phone calls are not helping...  No other person can accompany in the same way and they come at unexpected times.. Once in the shopping arcade!


It's just  difficult.


Anyway .... He's getting treatment, so maybe I'll just work on being grateful for that!


Thank you.


 

User
Posted 19 Jun 2022 at 18:34

Radiotherapy to the prostate in the case of advanced prostate cancer is offered to some patients with a low number of metastases, as it's been shown to slow down the development of metastases, which at this point appear to rely to some extent on the primary tumor in the prostate. This extends life and is a relatively new treatment in this case.

Edited by member 19 Jun 2022 at 18:36  | Reason: Not specified

User
Posted 19 Jun 2022 at 18:38

That's brilliant news!! And it fits this case.


Thank you so much for sharing. I'll sleep better tonight!!

User
Posted 19 Jun 2022 at 18:43

HI fergy...I know this is a very  distressing time for you both and phone calls are not always the best line of communication. Perhaps you could ask re the possibility of a  face to face consultation. Guess it depends  on your health trust. We had been offered a phone consultation for our first oncology appt  but  I asked for a face to face instead and was accommodated no problem.


Regards Ann


 

User
Posted 19 Jun 2022 at 18:49

Thank you Ann, 


I would ask, but OH won't make a fuss. We're all different... And it's him this is happening to.


So I have to work round it as best I can.


Take care.


 


 


 

User
Posted 21 Jun 2022 at 06:17

Hi Fergy


I’m in a similar situation… OH diagnosed with Stage 3 N1 Gleason 4+5. Spread locally and to lymph nodes but not bones. PSA down from 91 to 0.2 with hormone treatment, side effects not great but so far tolerable. Now being recommended 4 weeks of heavy radiotherapy. My question to others further down the line: how to weigh the nastiness of RT (consultant said high dose because he’s basically strong and healthy) and likely long term scarring against reduced chances of cancer waking up again? Consultant assumed we would want to go ahead, was very rushed, OH went along with it but I felt he’d been bounced into signing discharge.


There’s a bowel complication to be dealt with first so we have a bit of time.


Is there someone out there who’s had/researched radiotherapy and can help us understand better what it all means?

User
Posted 21 Jun 2022 at 06:39
Hi Minnie,
This x reads to me as if the only treatment your OH has been given so far is the hormones....
My understanding, and I'm no expert, is that in time all men with find their PCa will become castrate resistant, at which point the hormones no longer work. RT should stop it throwing out mets as well as knocking the primary tumor.
I hope that helps a bit.
Lots of tough decisions.
Take care


User
Posted 21 Jun 2022 at 11:11
Thanks! A bit… but I’d be more reassured if I knew how this would help his chances of a normal life and/or how long for. The long term side effects we were warned about are potentially quite life changing. He’s already been warned the hormone therapy is for life.
User
Posted 21 Jun 2022 at 14:13
Most people manage the side effects of RT well - my husband had none at all apart from a bit of mucus in the weeks afterwards.

Your OH doesn't have to have the RT but if he doesn't, he potentially reduces his lifespan significantly. On average, HT on its own can work for anything from a few months to a few years - if the prostate and local lymph nodes are zapped, that can extend his life and also stops the risk of the cancer advancing into his bladder, bowel, kidneys ... mets in those places have a significant impact on quality of life and longevity
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 Jun 2022 at 14:39
That's good to hear, thanks Lyn. It's already in the seminal vesicles - I guess they'll map and zap as much as they can safely but the consultant says there are too many nodes in too many other places to be able to reach. Definitely want to keep him around... so I guess we'll go with the flow. For all the sophisticated machines they use, RT seems awfully primitive still.
 
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