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Old 10-04-2012, 12:42 AM   #2
Tall Allen Tall Allen is offline
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Re: radiation and hormone therapy after RP

I'm sorry they didn't get it all the first time.

He will probably start the hormone treatments a couple of months before radiation (neoadjuvant) and continuing concurrently. The sexual side effects are unfortunately synergistic -- neoadjuvant hormone therapy + Salvage RT has lower rates of potency preservation than any of those therapies alone. He can ask his doctor if he can take daily Cialis or Viagra concurrent with radiation and continuing afterward as a protective measure. It seems to prevent radiation damage to the vasculature that feeds the penis. In terms of incontinence, the worse they are now, the worse they seem to get after SRT. However, if his continence is good now, it probably will not get worse. Generally, other urinary and rectal symptoms are irritative, temporary and manageable with Rapaflo (urinary) or Mesalamine (rectal) if bothersome.

A couple of weeks ago, the FDA approved a new imaging technique designed to find out exactly where the recurrences are. It is good at finding even small amounts of cancer -- much better than anything thus far approved. It's called C-11 Choline PET/CT and is only available for now at the Mayo Clinic in Rochester, MN. You might want to call Eugene Kwon's office to ask if your husband is a good candidate for it. If they can find and treat any metastases they find with SBRT radiation, it is quite a bit less toxic and possibly more curative than spraying the entire area blindly with radiation. For the met to show up, the PSA must be sufficiently high, so he can't be on hormone therapy before the PET scan.

I would also urge you to look into clinical trials of salvage radiation therapy -- there are many. Some use innovative imaging, some use chemo, some use new types of hormone therapies -- all for the purpose of improving the odds of recurrence-free survival. If you tell your oncologist you are interested, she can help you find the one most appropriate for your husband.

- Allen

Last edited by Tall Allen; 10-04-2012 at 01:00 AM. Reason: added: no HT before PET