Chemo now or leave to later in life.

User

Posted 31 Jul 2022 at 13:54

I am a 73 year old male never had an illness in my life non smoker enjoys a pint.

Since last October I have had all the tests you can imagine on my prostate including CT scans/Cystoscopy negative/biopsy/Full body bone scan.. negative. I have now been diagnosed with Locally advance prostate cancer T2cN1MO 4+5 PSA 75 just finished 28 days of bicalutamide and started on my first Prostap injections so far no side effects.

However the consultant is worried about a 17 mm lymph mode just on the edge of my prostate....He says I will have to have 3 month injections for the rest of my life. and to start me on radiotherapy

But this is the question I want to ask:

He has given me the option to have chemo along with the radiotherapy and has left it for me to decide and come back in 3 weeks. He advises its best to get it done now rather than leave it to later life if it should be needed. seems to be the new way of treatment. But of course the after effects of chemo worries me so I dont know what to. Also I meant to ask him would the radiotherapy zap the lymph mode

Any suggestions

Thanks

Edited by member 31 Jul 2022 at 18:22 | Reason: Not specified

User

Posted 01 Aug 2022 at 11:02

Hello, it's not obvious to me why your Staging wouldn't suggest a curative treatment, including the pelvic lymph nodes in the radiotherapy target, and time limited (typically 3 years for N1 and G4+5) hormone therapy. It does have to be said that there is a high risk of recurrence, but you could go back on to hormone therapy if/when that happened, and it might not.

If you were going to have this, you would have chemo up-front (typically a month after starting the injections), and then radiotherapy after the chemo, since chemo is always used for curative treatments when there's any lymph node involvement. If you didn't have the chemo up-front, then you would be being treated as a Stage 4 patient from the outset, which probably would be life-long hormone therapy. Yes, there are risks with chemo - it is a bit of a gamble for subsequent Quality of Life.

User

Posted 01 Aug 2022 at 17:30

I'm not an expert nor have any experience on this but from what I've read and heard from doctors on line the chemo used for Prostate Cancer isn't as harsh as chemo for other cancers, it's called Taxatere I seem to recall. If you're a fit 73 year old it's probably a better time to do it than as an older person who's perhaps reaching another stage.

Also from what I've seen Radiotherapy can be targeted beyond the prostate and at the prostate simultaneously or I've read of people having RT on their prostate and following up later on their lymph nodes. One on-line doctor says the accuracy of modern RT enables lymph nodes to be treated without threat to other organs, although he was talking about near the intestines. There are limits on how much RT you can have and I'm not too aware of what they are.

Also the number of RT treatments and Gy will show what the consultant has in mind. You might try to insist you're up for a max strength curative intent treatment and not a semi-strength non-curative intent treatment.

It might be unlikely but if you have a large lesion in your lymph nodes I wonder why surgery to remve it isn't an option as getting rid of bigger lesions is said to be helpful.

Just some thoughts.

User

Posted 01 Aug 2022 at 18:49

My husband was the same age as you when he was diagnosed last year. PSA 8, Gleason 4+3, T3a N1 M1b. He was offered chemo or enzalutimide. he was reluctant to have chemo but as Peter says it doesn’t always seem to be as debilitating as some chemos for other cancers.

We got a second opinion though and after a PSMA pet scan he was downgraded from advanced to locally advanced (no bone met) still in one lymph node. He ended up having surgery and they removed his prostate and 14 lymph nodes. Post op histology changed things to Gleason 4+5, T2 N1. Not sure if the downgrade on tumour was related to him having 4 months of HT?

His 3 post op PSA tests have been <0.025, he has another one this week so a constant waiting game to see if he will need SRT.

I would definitely assume that your RT will target lymph nodes so as Andy has said you would think this will be a curative treatment.

Good luck with your decision and wishing you all the best

User

Posted 13 Aug 2022 at 19:09

Well I have decided to go for Chemo before the RT....T2c N 1 Mo

Had full body bone scan and bladder Cystopscoy all clear....

Just got to get my head around having Chemo.....At the moment I am fit and heathy just worried how its going to effect me I have 6 sessions....any advise or should I not worry unduly

But the best thing so far in July my PSA was 70 after taking 28 days of Bicalutamide its down to 4.3

Thanks

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