It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 04-04-2009, 07:48 AM   #1
Senior Member
(male)
 
Join Date: Oct 2008
Location: Welland, Ontario, Canada
Posts: 114
flyfisher37 HB Userflyfisher37 HB Userflyfisher37 HB User
Radiation finished, side effects diminishing.

Hi Folks,

I finished my radiation therapy for recurring prostate cancer three weeks ago and my side effects which were bladder and bowel irritation have pretty much gone away. Just some bowel irritation, but the bladder irritation has gone.

I still don't know if any long term side effects will show up and that's the purpose of this posting. Has anyone out there gone through the same thing (36 treatments of photon radiation ) and experienced anything different than what I've experienced so far? From what I've read, it would seem that just about everyone has some bladder and bowel irritation after the radiation, but what about long term term side effects? Has anyone had something unusual show up maybe months later that presented a problem?

I go back in May to see my oncologist and at that point, assuming that everything has settled down, he will order a psa test for me and then I"ll know if this was all in vain or not ( hopefully not! ).

Take care....Lionel

 
The Following User Says Thank You to flyfisher37 For This Useful Post:
vickyg (10-28-2011)
Old 04-04-2009, 05:01 PM   #2
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Radiation finished, side effects diminishing.

Quote:
Originally Posted by flyfisher37 View Post
Hi Folks,

I finished my radiation therapy for recurring prostate cancer three weeks ago and my side effects which were bladder and bowel irritation have pretty much gone away. Just some bowel irritation, but the bladder irritation has gone.

I still don't know if any long term side effects will show up and that's the purpose of this posting. ... but what about long term term side effects? Has anyone had something unusual show up maybe months later that presented a problem?

I go back in May to see my oncologist and at that point, assuming that everything has settled down, he will order a psa test for me and then I"ll know if this was all in vain or not ( hopefully not! ).

Take care....Lionel
Hi Lionel,

I'm glad things are improving for you.

You might want to check what Dr. Dr. Charles "Snuffy" Myers has said about radiation and its side effects. He went the extra mile to research this for us, adding to his understanding from published research and his clinical prostate cancer practice by going through radiation treatment and recovery himself. He had a challenging case that involved metastases, and he worked with Dr. Michael Dattoli to plan an aggressive course of seed and IMRT radiation. (He was also on triple hormonal blockade therapy for nineteen months, and he had some surgery at Johns Hopkins, not on the prostate, but to remove some cancerous lymph nodes. I guess he just wanted to touch all these bases so he could tell us about it. ) His side effects were so burdensome that he suspended his medical practice for the better part of a year.

Fortunately for the rest of prostate cancer survivors who have had radiation, he wrote about what he learned in his Prostate Forum newsletter, and back copies are available. There's nothing like going through something yourself, and some of his tips have a very first person flavor. He returns to radiation from time to time, but the older copies have a lot of great information. Here are some issues you might want to find:

Vol. 3 #4 The Problem of Impotence 1. Radiation for Recurrent Prostate Cancer [I believe these are two separate topics.]

(In Vol. 4 #4, he addressed his own prostate cancer, I believe for the first time in the newsletter: "The Physician Becomes The Patient"; from time to time he updates his experience. He is currently doing great.)

Vol. 4 #5 Radiation Therapy Part I
Vol. 4 #7 Radiation Therapy Part II
Vol. 5 #9 Radiation Therapy
Vol. 5 #12 Diet and Radiation Proctitis (published June 2001)
Vol. 7 #4 Radiation I
Vol. 7 #5 Radiation II
Vol. 10 #6 Radiation Therapy & High Risk Prostate Cancer

Some of his tips have to do with minimizing or eliminating scar tissue, as well as avoiding some problems that tend to develop slowly.

As he usually does, he provides references to published medical studies that provide the evidence for many of his points. That enables us to go to [url]www.pubmed.gov[/url] (the site we can use on the board because it is sponsored by the US Government) and get more information if we so wish.

I hope you have a smooth course from here on out.

Jim

 
Sponsors Lightbulb
   
Old 04-06-2009, 11:53 AM   #3
Senior Member
(male)
 
Join Date: Oct 2008
Location: Welland, Ontario, Canada
Posts: 114
flyfisher37 HB Userflyfisher37 HB Userflyfisher37 HB User
Re: Radiation finished, side effects diminishing.

Hi Jim,

Always nice to hear from you.

I was reading about a study that was published in the JAMA and had to do with salvage radiation. One of the doctors in the study was Alan Partin. Is he the one that originated the Partin tables?

You might find this interesting as would anyone who has had or is undergoing salvage radiation for recurrence after radical prostatectomy. Of course this is not the entire article.

"Results With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy. Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer–specific survival relative to those who received no salvage treatment (hazard ratio [HR], 0.32 [95% confidence interval {CI}, 0.19-0.54]; P<.001). Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer–specific survival (HR, 0.34 [95% CI, 0.17-0.69]; P = .003). The increase in prostate cancer–specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors. Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer–specific survival. Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer–specific survival. Salvage radiotherapy also was associated with a significant increase in overall survival.

Conclusions Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer–specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial. "

Maybe there is some hope after all?

Take care....Lionel

 
Old 04-06-2009, 03:45 PM   #4
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Radiation finished, side effects diminishing.

Quote:
Originally Posted by flyfisher37 View Post
Hi Jim,

Always nice to hear from you.

Hi Lionel,

It's always nice to hear from you too and to learn how you are doing and what you are thinking about. Thanks for pointing out this recent study. It's very encouraging, but I actually am convinced patients will do even better than suggested in this study and am giving some of the reasons below, inserted in the abstract that you quoted. Based on your tip I just took a look at the abstract myself on [url]www.pubmed.gov[/url], and I'm going to give the abstract the color orange and put my comments in green. Jim


I was reading about a study that was published in the JAMA and had to do with salvage radiation. One of the doctors in the study was Alan Partin. Is he the one that originated the Partin tables?

Yes, he's the one, and quite a surgeon himself. You may also notice that Dr. Patrick Walsh is the senior (last) author in this Johns Hopkins research.

You might find this interesting as would anyone who has had or is undergoing salvage radiation for recurrence after radical prostatectomy. Of course this is not the entire article.

"Results With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy. Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer–specific survival relative to those who received no salvage treatment (hazard ratio [HR], 0.32 [95% confidence interval {CI}, 0.19-0.54]; P<.001).

That's striking! Really impressive! I'm not sure why they are calling it a 3-fold improvement rather than a 2-fold improvement (22% vs. 11%), but there is probably a good reason. That "P<.001" is also impressive, meaning there is an extremely small likelihood that the result is due to chance rather than to a real difference in treatment results. It means the study group was large enough to lend huge confidence to the results, with the true outcome falling somewhere between 19% and 54% death for the salvage group compared to 100% for the no-salvage group. (That may be confusing to those unfamiliar with statistics; if the study were immensely large, say 1,000 patients for this kind of study, that range of 19% to 54% would get much smaller - zeroing in on the true value.)

Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer–specific survival (HR, 0.34 [95% CI, 0.17-0.69]; P = .003).

This is where patients and many doctors may be mislead if they do not understand the context. To me, it suggests that hormonal therapy actually, in all likelihood, made quite a worthwhile contribution , even though at first glance it looks like patients had a higher death rate of 12% if they added radiation to hormonal therapy instead of the 11% death rate with radiation alone. There are at least several reasons.

First, it is almost a certainty that patients getting the combination of radiation and hormonal therapy had much more serious cases and evidence of much more challenging recurrences, such as a shorter PSA doubling time, perhaps bone scans showing metastases, etc. The complete paper for the study probably provides enough information to see if that was the case, but you cannot tell from just the abstract. Maybe someone on the board could somehow access the paper and report back. In part I believe that because in the years when many of the patients were treated (spanning 1982 - a long time ago, to 2004), hormonal therapy was often reserved until patients had symptoms of advanced disease.

Second, reserving hormonal therapy was especially common at Johns Hopkins. In other words, it is likely that patients did not get a hormonal boost to the radiation until they had clear evidence of metaststic disease. Unfortunately, while hormonal therapy helps quite a bit with metastatic disease, it appears to be much more effective when used earlier.

Third, the hormonal therapy available in the 80s and 90s was no where near as effective, we are highly confident, as the versions of hormonal therapy now available. For instance, there is increasingly convincing evidence that single-drug hormonal therapy - most typically with Lupron or Zoladex injections - is substantially less effective than combined therapy involving an antiandrogen drug (typically these days Casodex, but also flutamide and others). Additionally, adding finasteride (generic version of Proscar) or Avodart as the third class of drug appears to help a lot. Also, in the early years of the study, probably into this decade, the importance of supportive bisphosphonate therapy (Fosamax, Boniva, Zometa, etc., with calcium and vitamin D supplementation) was not appreciated. That therapy not only goes a long way toward preventing or minimizing bone loss as a side effect of hormonal therapy, but it also helps prevent, stabilize or reverse bone metastases from prostate cancer, especially if Zometa is used. Certain cardiovascular risks can also increase due to hormonal therapy, and we now have statins and other drugs that can minimize or eliminate those risks. At the times most patients were under treatment in the study, it is likely that the cardiovascular risks of hormonal therapy were not understood, so countermeasures, even if available, would have been less likely to have been employed.

Finally, all this means that, even with almost surely inferior hormonal treatment, results were achieved (12% death, 88% survival) that were nearly equal to those of patients with almost surely much less serious cases who got just radiation (11% death, 89% survival). (I hope that the researchers brought out some of these subtle but vital points in the discussion section of the paper.)

Does that make sense to? It looks clear to me. However, I expect we will see presentations and hear doctors quote the simple version that hormonal therapy did not help. That to me would be a sign that the doctor is outside of the range of his expertise and is quoting the conventional, not-so-smart wisdom.



The increase in prostate cancer–specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors.

In other words, the superior outcomes in this study - where salvage radiation made a difference - were among those men with more aggressive cancer recurrences. I suspect this means that for those with less aggressive recurrences, adding radiation was not necessary for most - they would do pretty well on their own. Some of the same researchers as on this team have been involved in the Freedland study that has been such a huge help in separating serious recurrences from mild ones, many of the latter requiring no follow-up therapy.

Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer–specific survival.

In other words, delaying salvage radiation for more than two years eliminated a benefit. We now know that it is wise to have salvage radiation fairly early, probably shortly after the patient has recovered from the surgery and a recurrence is clear would be best, but hopefully before the PSA reached 1.0. That know-how (or "know-when" here) may have not been available when many of the patients in this study were treated.

Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer–specific survival.

These would be men with more serious prostate cancer. Considering that many would have been treated in the 80s and 90s, it's likely that PSA tests used to monitor recurrence were only sensitive down to .2 or .1, a far cry from today's ultrasensitive tests that are reliably a hundred times more sensitive. That means that these men were only able to achieve a lowest PSA after surgery that we consider rather high and unfortunate by today's standards. I think it's likely that many would have had cancer that had spread beyond the prostate, probably well beyond the prostate - distant spread, at the time of surgery. This would be tougher for radiation to cure.

Also, radiation technology available then was much less effective than the technology we have today. For one thing, we now know that higher dosing levels are needed, and, in contrast to the past, they can be delivered fairly safely, avoiding substantial long-term side effects.


Salvage radiotherapy also was associated with a significant increase in overall survival.

That's always very important to know. It's not enough to just cure the cancer; it's important that the treatment does not reduce overall survival due to its complications and side effects.

Conclusions Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer–specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial. "

Maybe there is some hope after all?

Definitely! This study certainly supports optimism, but the hope is not based just on this study. Several other threads also apply: "If lymph nodes are positive after RP; hormonal therapy as a sound tactic" (started 2/4/2008; and "Gleason 8 (and higher) cancer: not good, but not always the end of the world," started 2/6/2008.

Take care....Lionel
How does this look to you?

Take care and hang in there,

Jim

Last edited by IADT3since2000; 04-06-2009 at 03:54 PM. Reason: Added one sentence shortly after posting.

 
Old 04-07-2009, 08:23 AM   #5
Senior Member
(male)
 
Join Date: Oct 2008
Location: Welland, Ontario, Canada
Posts: 114
flyfisher37 HB Userflyfisher37 HB Userflyfisher37 HB User
Re: Radiation finished, side effects diminishing.

Hi Jim,

Yes, I liked the sound of that study, especially the part where it would appear that salvage radiation is even more effective on the cancer with a rapid psa doubling time. With the apparent psa doubling time of my own recurring cancer, then I should be getting maximum effect from the radiation. I don't know what the psa count would have been after six months, since the radiation was started only three months after the recurrence. But even in that length of time, my psa had gone from 0.1 to 0.17.

My big concern now is whether the cancer had remained in the prostate area or whether it had gone somewhere else in my body. I guess I won't know that for several months from now, when they do a psa test. I would have felt a lot more confident about this issue if my Gleason score had been a 6 or 7, instead of an 8!

However it is what it is and I'll just have to wait to see what happens.

Take care and thanks for the support....Lionel

 
Old 04-26-2009, 03:25 PM   #6
Junior Member
(male)
 
Join Date: Feb 2009
Location: Birregurra,Australia
Posts: 14
graton HB User
Re: Radiation finished, side effects diminishing.

Quote:
Originally Posted by flyfisher37 View Post
Hi Jim,

Yes, I liked the sound of that study, especially the part where it would appear that salvage radiation is even more effective on the cancer with a rapid psa doubling time. With the apparent psa doubling time of my own recurring cancer, then I should be getting maximum effect from the radiation. I don't know what the psa count would have been after six months, since the radiation was started only three months after the recurrence. But even in that length of time, my psa had gone from 0.1 to 0.17.

My big concern now is whether the cancer had remained in the prostate area or whether it had gone somewhere else in my body. I guess I won't know that for several months from now, when they do a psa test. I would have felt a lot more confident about this issue if my Gleason score had been a 6 or 7, instead of an 8!

However it is what it is and I'll just have to wait to see what happens.

Take care and thanks for the support....Lionel
Hi Lionel

All the best for the upcoming PSA.

I'll be having my PSA checked in July.

Regards
Graeme

 
Old 04-30-2011, 06:13 PM   #7
Junior Member
(female)
 
Join Date: Apr 2011
Location: seattle,wa king
Posts: 14
wilmao HB User
Re: Radiation finished, side effects diminishing.

awesome informations guys!!! thank you! I enjoy snuffy, he's super! -tia

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Difficulty locating proton radiation statistics stever5731 Cancer: Prostate 10 07-19-2010 12:05 PM
Complications from Radiation - Mouth/throat/feeding tube RoseEm Cancer 3 10-16-2009 11:22 AM
Update: Anyone experience adverse effects from pelvic radiation? Cat Az Cancer: Colon 23 09-19-2009 01:45 PM
Prostate Cancer Radiation - HELP! Linda070770 Cancer: Prostate 11 08-17-2009 03:18 PM
Need radiation advice CS53 Cancer: Prostate 25 07-19-2009 04:35 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added




Top 10 Drugs Discussed on this Board.
(Go to DrugTalk.com for complete list)
Casodex
Cialis
Cipro
Flomax
Levaquin
  Levitra
Morphine
Proscar
Tylenol
Viagra




TOP THANKED CONTRIBUTORS



Tall Allen (174), IADT3since2000 (148), Baptista (97), Gleason9 (28), harpman (27), Johnt1 (22), honda50 (9), tumbleweed (6), flyfisher37 (6), GUAMJOHN (5)

Site Wide Totals

teteri66 (1180), MSJayhawk (1005), Apollo123 (906), Titchou (850), janewhite1 (823), Gabriel (759), ladybud (755), midwest1 (669), sammy64 (668), BlueSkies14 (607)



All times are GMT -7. The time now is 05:44 PM.



Site owned and operated by HealthBoards.com™
Terms of Use © 1998-2014 HealthBoards.com™ All rights reserved.
Do not copy or redistribute in any form!