First of all it will be external beam radiation. I don’t know if Proton beam is used for this purpose or not; it would not be seeds because you have to have a prostate there to put them in. My understanding is that the radiation is given specifically to the bed of the where the prostate was and then a larger window including the distribution of the pelvic lymph nodes. Now several things:
- With the prostate out, there is no prostatic urethra to irritate so from a urinary standpoint radiation is much better tolerated.
- You still can have radiation changes to the bladder (radiation cystitis) which usually manifests early as an irritation to void and then later (years) as bleeding.
- Small increase in bladder and colo rectal cancers as a result of radiation.
- Worsening of your erectile function. If you were lucky enough to have erections after the prostatectomy, the radiation will be a negative influence. To what degree is unknown until you have it and your baseline function before the XRT.
- You can start radiation anytime you like but most radiation therapists feel the sooner the better, usually when it is for certain that the PSA is going up and it is felt secondary to residual disease.
- Mild GI symptoms which usually are short lasting like diarrhea.
- Usually the same amount of radiation as if you never had the prostate removed, i.e. 42 treatments excluding weekends.
- If the residual disease is local, the PSA will go down. If by chance the prostate cancer has spread to bone, even if the bone scan was negative, then radiation to the pelvis will not result in the PSA going down. This is an unfortunate situation, and means that hormonal therapy will have a role soon.
- There is no definitive evidence (to my knowledge) that doing radiation after a prostatectomy and the PSA going up, improves survival. It does make sense to me however to pursue it. A lot depends on the nature of the cancer, i.e. Gleason’s.
- Salvage Radiotherapy after Prostatectomy
- Radiation after prostatectomy normogram and study
- The lower the PSA and the more favorable the disease the better radiation will work.
- I have had patients that had absolutely no symptoms after radiation after the prostate removed
- I have had patients that have had such inflammation that they significant bowel problems….
So, is it reasonable to do radiation if after the prostate is removed and the PSA goes up? Yes.
What will it be like if I have radiation? You won’t know until you do it. If you are lucky….you will hardly know you had it. If you are not lucky…well…you may have some of the consequences of radiation going through your skin, through the bowels, through the bladder. hitting the nerves that affect erections and all those structures will feel it. The deal is this…sometimes you don’t have a choice.
The way I thought about it..” If my cancer comes back one day and progresses….did I do all that I could do to eradicate it?” In my mind that was the priority way of thinking about things.
I had my prostate removed. If my PSA begins to rise, I may for a while try mild anti-hormones like Avodart. However, if that fails…I will do radiation. Like I say in my book about Admiral Farragut, ” Damn the torpedoes. Full speed ahead!”