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Radiotherapy after a hip replacement and with historic urinary issues

User
Posted 27 May 2025 at 20:30

I am 71 and recently diagnosed with prostate cancer.  My Gleason score was 3+4 and I’m Prognostic Grade Group 2 , possibly T stage 3A.   The surgeon suggested that radiotherapy might not be a good option as I have a metal hip and also a history of urinary/bladder problems (e.g. frequent urinating, leaking a little before and after, not emptying my bladder fully sometimes).  The oncologist thought that the hip replacement was not a concern, it would only be if I’d had both hips done. He didn’t see any additional risks to other organs around the prostate.  But he did think there is a risk of radiotherapy making my continence problems worse.  However no one has been able to say how likely that is to be say a little worse, much worse or very significantly worse.  And so no one is able to say what I would have to do if things were a little, much and very significantly worse.  No one has been able to say how likely these three scenarios are.  I currently wear pads and that’s no problem for me.  I’ve also been unable to find any studies looking at this issue.  I think this is likely to be the crucial issue in my choice of treatment, but I’m struggling to make an informed decision.  I’d appreciate any thoughts or experiences. 

User
Posted 27 May 2025 at 22:19

I am not medically qualified. 

RT beams are very small about 1cm diameter and are fired from many angles. I would think it would be very easy to plan not to have to fire one through your hip joint. I believe any metal can reduce the quality of a MRI image, maybe the surgeon is thinking that is a problem. I would definitely trust the oncologists opinion on that.

RT and urinary issues, not usually a problem, but it definitely can be. I think ColwickChris who posts on here has had the worst of these problems. 

I would say from the stories I have read on here that surgery is more likely to cause continence issues or make existing ones worse than radiotherapy is.

 

Dave

User
Posted 27 May 2025 at 22:29
Thanks Dave. That's helpful, especially the comment about surgery being more likely to cause continence issues. Again, many thanks.
User
Posted 28 May 2025 at 11:15

External beam radiotherapy can be done with replacement hips. The treatment is planned slightly differently so that the beam is switched off as it would otherwise have passed through the replacement hip, and the dose for the rest of the sweep is adjusted to compensate.

(You can't have proton beam with replacement hips, as it's only delivered through the hips.)

User
Posted 28 May 2025 at 11:25
Thanks for this Andy. I think my decision is now going to be based on the impact on my urinary function. I'm hoping to get more on that soon from this site and MacMillan. Again, many thanks. George
User
Posted 28 May 2025 at 12:54
As with other things with PCa and it's treatment, men can respond to varying degrees so I don't think you will get a reliable idea of how severely you would be impacted by RT even without the additional problems you have in respect of incontinence. At its worse I was for a time getting up 8 times a night due to RT but this gradually reduced to my pre RT level of once or twice a night and I was continent prior to RT. With EBRT there is some beam scatter along the path of the beam anyway. They already shape the bean to minimise dose that the rectum receives for instance. In your position I would want to get an opinion from a Radiooncologist who is given full details of your PCa and particularly your scans. To be frank, I don't think anybody here or at MacMillan unfamiliar with your individual case is going to be in a position to provide information that will be of great significance.
Barry
User
Posted 28 May 2025 at 14:11

Many thanks Barry, especially the suggestion to see a radioncologist. I've been surprised by the absence of studies given hiw many men come to a diagnosis after experiencing urinary problems. Again many thanks. George 

 
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