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Radio Therapy Pro's Con's

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User

Posted 21 Jun 2025 at 18:26

I am 74 years of age and was diagnosed with Prostate Cancer Nov 24 following Doctor visit in Oct with urinary issues, following examination and PSA test (result 10.9). Following this in Dec24-Jan25 I had MRI Scan, CT Scan, Biopsy and Full Body Bone Scan. Results ( Gleeson Score 10, Grade Group 5, nT2, N1, M0 ) and diagnosed with Locally Advanced Prostate Cancer.

In Feb25 I started HT ( Zoladex ) and at the MDT meeting I was recommended for Radiotherapy, My initial response was that I would prefer Surgery to remove the cancer. My consultant advised that he would require PSMA PET Scan to determine if this was viable. Results indicated surgery would be very difficult and I was again pointed in the direction of Radiotherapy.

In May25 I had my second HT injection ( Zoladex ) I was experiencing the usual side effects of Hot Flushes and Fatigue, but coping reasonably well. My PSA Blood test came in at ( result 1.6 ).

In June25 I missed my Radiotherapy Planning Scan due to my wives health issues, but a PSA Blood Test was carried out and came in at ( Result 0.4 ).

My question now is should I go ahead with Radiotherapy with its possible side effects, ( Pro's and Con's ) ???

User

Posted 22 Jun 2025 at 00:29

Hi Paul,

So sorry you find yourself here. One of the things you’ll find is although so many on here are diagnosed with PCA very few of us are the same. And due to this many of us have very different treatments.

I like you have a high Gleason (9), and am t3a and as such the worry was more of the potential to spread. This was also weighed up with potential side effects and surgery was all but ruled out unless I wanted to overule the multi disciplinary team. So I elected for radiotherapy. I had brachytherapy to treat the primary and EBRT to treat everything around. Ht for 2 Years to starve any micro spread.

Tbh the radiotherapy wasn’t too bad although I feel I’ve been one of the more fortunate ones. Some fatigue, and bowel and urinary irritation but nothing too bad. Pros no surgery, atm no ED, treatment to a larger area around the prostate. Cons, pain getting in for treatment each day, some urinary and bowel irritation but not incontenance so far. I’ve had delayed fatigue but am getting over that. My personal experience is the RT wasn’t that bad. The hormone therapy for me is much worse which you are all ready on.

As I said at the start everyone is different and everyone has different reactions. I hope whatever you choose to do I hope you are one of the luckier ones when it comes to side effects. I really wish you all the best.

Stuart

User

Posted 22 Jun 2025 at 01:33

Originally Posted by: Online Community Member

In June25 I missed my Radiotherapy Planning Scan due to my wives health issues, but a PSA Blood Test was carried out and came in at ( Result 0.4 ).

I'm not sure if you're taking this psa reduction as an indication that things are ok and you might not need to go ahead with your treatment plan but the answer to your final question is a definite yes.

I suggest you take the advice of your consultant and go ahead with RT/HT. If he's intimated that surgery would be difficult, he's also saying that there could be serious and possibly lifelong consequences like nerve damage and incontinence. Normally, with a fully contained T2 surgery is an option but in this case you've been advised away from it.

Locally advanced cancer with a G10 but still contained within the prostate is unusual but the N1 rating indicates spread to lymph nodes. Did you get any detailed information about the number and location of the lymph nodes?

Jules

User

Posted 22 Jun 2025 at 02:10

Don't be swayed by PSA fall. It most usually drops dramatically after HT but this constrains cells and weakens them to work with RT rather than kill them sufficiently. Adopting your Consultants advice for RT seems sensible in circumstances. Suggest you read the 'Tool Kit' re treatments and more about PCa. https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Edited by member 22 Jun 2025 at 02:10 | Reason: to highlight link

Barry

User

Posted 22 Jun 2025 at 14:09

Hi, All

Thanks for your rapid response to my query, I do have an appointment with my oncology consultant next Tuesday.

My PC diagnosis is Gleeson Score 10, Grade Group 5, T2, N1, M0 Locally Advanced with a number Lymph nodes showing an interest ( as described by urology consultant ).

I am 74 years of age and in good general health, no symptoms other than manageable urinary issues. I am carer for my wife who has a number of health issues, so my main concern with radiotherapy is the possible side effect of incontinence issues.

The reason surgery was ruled out was that some lymph nodes close to the rectum wall were involved obviously radiotherapy in this area increases risks.

I realise everyone is different but using (Predict Prostate Tool) on average radiotherapy could increase Life expectancy by 1-2 years over conservative management. Is it worth the risk???

Edited by member 22 Jun 2025 at 14:14 | Reason: Not specified

User

Posted 22 Jun 2025 at 17:12

The predict prostate tool states that it is not accurate for high risk disease. Yours is very high risk. At some point HT will stop working, on average it is a little under five years, but by changing medication you might get it to seven years (for some it has worked for decades). As you are 75 and in good health you would easily make 87 without prostate cancer, with cancer and minimal treatment 80 is a reasonable guess. Because your disease is so high risk, you probably only have a 50% chance of cure (it would be 70% for medium risk), if you aren't cured it will still knock the disease back by 2 or 3 years. If the RT doesn't work you are probably talking 82 life expectancy, if it all works well then you are back up to 87. The side effects of HT are worse than the side effects of RT. If I were in your position I would be having the RT treatment.

Edited by member 23 Jun 2025 at 00:35 | Reason: Not specified

Dave

User

Posted 23 Jun 2025 at 07:24

Originally Posted by: Online Community Member

so my main concern with radiotherapy is the possible side effect of incontinence issues.

If you're thinking in comparison with surgery, the RT is less likely to cause problems. I had RT and HT at age 75 with slight problems with frequency of urination but certainly nothing that would prevent a normal day's activity.

With your cancer the key question will probably be how they manage treatment of the "number of lymph nodes" infected. Spaceoar could be an option for you. It's not always useful but the idea is that it creates a barrier that can protect the rectum from radiation. The number of lymph nodes that oncologists are willing to treat has increased. I had 3 treated and the people who did mine were going up to 5 but it varies from place to place.

Jules

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