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Deciding treatment to Prostate or to include Pelvic lymph nodes

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User
Posted 25 Jul 2024 at 19:00

This is my first post on this forum.

I must say that advice etc i have read so far is most helpful.

I have advanced localised PC . Scans show no spread elsewhere other than towards my seminal vesicles.

I am on HT and awaiting RT.

I saw the Oncologist for the first time today.

He offered two options:

1- RT to prostate and seminal vesicles

2- Above plus including pelvic lymph nodes

He favours option two as he thinks the risk of any worse side effects is so low that it is best to do the pelvic lymph nodes also.

It’s my choice.

Any advice etc would be much appreciated.

User
Posted 26 Jul 2024 at 01:08

I had the same choice. I was concerned about side effects such as lymphodema, but my oncologist said he'd never had a case at the lower prophylactic dose (and it was rare even at full dose). However, I wanted to give it the best chance of a successful outcome first time, so I had pelvic lymph nodes done.

My pelvic lymph nodes were treated at a lower dose than they would have been if there was known cancer in them (23 x 2Gy = 46Gy).

That was exactly 5 years ago, and no known issues due to having them done.

I also extended my HT out to almost 2 years, which was longer than the minimum my onco suggested. This was because I heard another eminent oncologist explaining that hormone therapy for 18 months after the main tumour has been zapped seems to kill off micro-mets (mets too small to show on scans) which are outside the radiation target.

Edited by member 26 Jul 2024 at 08:18  | Reason: Not specified

User
Posted 26 Jul 2024 at 01:29

My experience was similar to Andy's [see my profile]. After a PSMA PET scan, in addition to treating the prostate and seminal vesicles, I had 3 specific cancerous lymph nodes radiated as well a several other "likely" lymph nodes in the chain.

Nearly 4  years have passed and I've had no problems, or recurrence.

Jules

Edited by member 26 Jul 2024 at 04:41  | Reason: Not specified

User
Posted 26 Jul 2024 at 18:48
I was locally advanced with spread to seminals. I had 37 sessions of RT to, obv, prostate and whole pelvis, a lower strength to pelvic area. No lasting issues, RT was end of 2016. I had Zoladex for 3yrs (p!us 2yrs abiraterone and enzalutimide on trial). No regrets with treatment other, of course, apart from fact I needed it!
User
Posted 26 Jul 2024 at 21:30

Hi Cycleman,

I agree with your choice but just a word of caution….I had opted for that course but after the CT Planning Scan, the Onco said there was too much danger of collateral damage to the bowel….I was informed the day before treatment was due to start and it was a real downer for me. I was told my plumbing was just ‘in the wrong place’.

So,  I reverted to 20 sessions targeting the prostate and seminal vesicles only..and it led to a significant delay in the start of treatment as I needed yet another CT Planning scan🤷🏼‍♂️

I hope it works out for you though and you get the optimum treatment🤞🤞🤞

All the best,

Derek

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User
Posted 26 Jul 2024 at 01:08

I had the same choice. I was concerned about side effects such as lymphodema, but my oncologist said he'd never had a case at the lower prophylactic dose (and it was rare even at full dose). However, I wanted to give it the best chance of a successful outcome first time, so I had pelvic lymph nodes done.

My pelvic lymph nodes were treated at a lower dose than they would have been if there was known cancer in them (23 x 2Gy = 46Gy).

That was exactly 5 years ago, and no known issues due to having them done.

I also extended my HT out to almost 2 years, which was longer than the minimum my onco suggested. This was because I heard another eminent oncologist explaining that hormone therapy for 18 months after the main tumour has been zapped seems to kill off micro-mets (mets too small to show on scans) which are outside the radiation target.

Edited by member 26 Jul 2024 at 08:18  | Reason: Not specified

User
Posted 26 Jul 2024 at 01:29

My experience was similar to Andy's [see my profile]. After a PSMA PET scan, in addition to treating the prostate and seminal vesicles, I had 3 specific cancerous lymph nodes radiated as well a several other "likely" lymph nodes in the chain.

Nearly 4  years have passed and I've had no problems, or recurrence.

Jules

Edited by member 26 Jul 2024 at 04:41  | Reason: Not specified

User
Posted 26 Jul 2024 at 18:48
I was locally advanced with spread to seminals. I had 37 sessions of RT to, obv, prostate and whole pelvis, a lower strength to pelvic area. No lasting issues, RT was end of 2016. I had Zoladex for 3yrs (p!us 2yrs abiraterone and enzalutimide on trial). No regrets with treatment other, of course, apart from fact I needed it!
User
Posted 26 Jul 2024 at 19:56

Thanks everyone for your help.

Option 2 it is.

User
Posted 26 Jul 2024 at 21:30

Hi Cycleman,

I agree with your choice but just a word of caution….I had opted for that course but after the CT Planning Scan, the Onco said there was too much danger of collateral damage to the bowel….I was informed the day before treatment was due to start and it was a real downer for me. I was told my plumbing was just ‘in the wrong place’.

So,  I reverted to 20 sessions targeting the prostate and seminal vesicles only..and it led to a significant delay in the start of treatment as I needed yet another CT Planning scan🤷🏼‍♂️

I hope it works out for you though and you get the optimum treatment🤞🤞🤞

All the best,

Derek

 
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