Re: Radiation therapy 2 years after RRP

[Guest guest]

Hi Dan,

I was diagnosed in Feb this year and had a RRP in

April. First PSA after that (in mid-May) was 0.5, so

my oncologist/surgeon strongly recommended a

combination of ADT and radiation as soon as possible.

I'm 47 and in good health, so he wanted to throw

everything at it as soon as possible.

I had a 4-month shot of Lupron on May 24, and started

July 25 on a 7-week course of external beam radiation.

25 of the radiation treatments were general in the

pelvic area (targeting any lymph nodes as well as the

prostate bed) and the last 13 treatments are focused

on the prostate bed where the post-surgery pathology

report indicated that the tumors were at the surgical

margins.

My radiation oncologist gave me a published report of

increased effectiveness in adding ADT to the

radiation. (This may be the same thing you read, a

report by King et al. from 2002) There's

not a lot of published literature to back it up yet,

but both my oncologists agree that outcomes are

improved by adding ADT and radiation rather than a

simple course of radiation. The way they describe it,

the Lupron weakens the cancer cells so that radiation

is even more likely to be effective.

My gleason score is 4+5, so they're both aware that

metastasis could easily happen, but they felt that

this is a useful treatment plan and probably my best

option at this point. The only other option is to go

straight to ADT, which I'm not interested in at this

point. I started radiation about 2 months after the

Lupron started (I don't know why you'd wait for 3

months), and just for the record, 4 weeks after

getting the Lupron shot my PSA was undetectable (the

first good news in a long time...)

My evaluation of the treatments: Lupron is not good.

I've been very depressed and somewhat more fatigued

than usual, but I've kept on a regular exercise

schedule which has helped somewhat. The radiation has

not been difficult, I've been more fatigued after

about 4 weeks and had a little bowel and bladder

discomfort, but no pain to speak of. I'll be done with

that on Sept 17, then wait a month for a PSA test to

see what's next.

My surgical oncologist does recommend intermittent ADT

if it looks like I will need it. And he agrees with

starting treatment early (PSA about 0.5) rather than

letting it go a bit higher. The radiation oncologist

said it's well documented that Radiation is more

effective when the PSA is still low. I have to say

that I'm not sure I ever want to go through Lupron

again, but I guess if the PSA starts rising it might

be better than going to a quicker metastasis. At least

for now I know that I'll get some relief from the

Lupron side effects, and hopefully won't have to do it

again.

That might be more than you asked for, but I hope it

helps.

Dan M

--- Dan wrote:

> My PSA has increase to 0.2 and 0.3 in the last 3

> months. My urologist

> wants to wait till PSA is 0.5 and start hormone

> therapy.

> I went to a radiation oncologist and he wants to

> start radiation IMRT

> in about 2 weeks. Has anyone had this scenario and

> what did you

> decide. I have also read where 3 months of hormone

> therapy prior to

> radiation has much better results. I have also read

> that beginning

> radiation before PSA reaches 0.5 yields better

> results.

> Thanks very much for any comments.

> Dan

>

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