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flyfisher37 11-23-2008 09:50 AM

Salvage radiation after Hormone Therapy?
Hi Folks,

I had a radical prostatectomy three years ago in October. There has been undetectable psa on every six month checkup until the last one this past October. It was 0.1. I had a Gleason 8 cancer, and apparently it might have returned after almost 3 years.

My urologist, of course, said we will do another psa test at the end of this month to see what's happening. He mentioned that if it went up, I would be a candidate for salvage radiation of the pelvic area.

However, after my RP, he said that everything was clear. The margins of my prostate gland were clear and all the peripheries were clear as well. But since I had a Gleason 8 cancer, it would seem that perhaps some cancer cells escaped in my blood system. I guess this would mean that they could be anywhere in my body. Because of this possibility, I personlly think that hormone blockade therapy would be the only viable answer.

I have read about some of the side effects of radiation, and I don't like what I read. Urinary and bowel problems seem to be the main issues after radiation. I've already had my share of urinary problems after my RP. I developed bladder neck scar tissue and I had to self catheratize myself for almost a year to keep the scar tissue at bay. The scar tissue finally matured and now I don't have to use a catheter. But if I developed even more scar tissue after radiation, there is the possibility that I will have to use a catheter for the rest of my life. So this is why I'm not too crazy about having radiation .

And what happens if after radiation, it is discovered that I still have a psa reading which means that there are still cancer cells somewhere. At that point, hormone therapy would be my only choice. Plus I would have to live with the other problems caused by radiation.

So my thinking is, why not just start hormone therapy and see what happens. If it ever gets to the point where I need radiation in the pelvis area or somewhere else, would having the hormone therapy first, affect the effectiveness of the radiation?

I'm sure that there must be someone out there that has gone through this same scenario and perhaps they will share their experience with me.

Thanks so much......Flyfisher37

Dickiedo 11-23-2008 05:48 PM

Re: Salvage radiation after Hormone Therapy?
Hi Flyfisher: I went through the same procedure. I had surgery then 39 EBR treatments now I am on hormone therapy. If you Oncologist thinks your cancer is in the bed where the prostate was then I think I would opt for the radiation. By chance if it is still there you could be cured. Hormone therapy isn't a cure it just keeps the cancer from growing by cutting off its food supply. Yes there are some side effects but it really depends on the Dr. and the equipment that they are using. All of the treatments have some sort of side effects, we just learn to live with them.

daff 11-24-2008 07:31 AM

Re: Salvage radiation after Hormone Therapy?
[QUOTE=Dickiedo;3802630]Flyfisher:... If your Oncologist thinks your cancer is in the bed where the prostate was then I think I would opt for the radiation. By chance if it is still there you could be cured. ...[/QUOTE]

As you've probably read from my many prior posts, I had proton beam radiation at University of Florida Proton Therapy Institute in Jacksonville, and have been an advocate of that form of radiation. That's due to the fact that it's highly targeted, doing less damage than other forms of radiation, and has no exit dose of radiation after its energy is discharged. I don't know to what extent that's used in cases like yours, but it might be at least worthwhile checking it out, just to get another opinion. There are five centers in the U.S. now, and none would be particularly convenient, location-wise, but it still might be something to look at.

flyfisher37 11-24-2008 08:25 AM

Re: Salvage radiation after Hormone Therapy?
Hi Rich,
Thanks for responding to my post. I have a couple of questions for you: was your EBR x-ray or proton beam or something else and did you have any severe side effects , such as bladder neck scar tissue, from the radiation?

Have a great day......Lionel

flyfisher37 11-24-2008 08:32 AM

Re: Salvage radiation after Hormone Therapy?
Hi Daff,

Proton beam radiation sounds like the way to go, rather than concentrated x-rays. However, I don't know if that is available in my area, but I will be finding out in the near future.

I may seem like I'm asking a lot of questions at this point in time, when I haven't yet had my second psa test to see if in fact my cancer is returning. It's just that I know that being in the category of 8-10 Gleason is not a nice place to be and these cancers can be very aggressive and persistent. Time will tell.........Lionel

Dickiedo 11-24-2008 09:25 AM

Re: Salvage radiation after Hormone Therapy?
Hi Lionel: I had my radiation back in the spring of 2001. At that time there wasn't any Proton Beam. If you could get that treatment that is the way to go. I really didn't have any side effects until I started on the Hormone therapy a year and half ago. Now I have some incontinence. It comes a goes, some days I wear a pad but most of the time I can control it. I am sure it is the residual remains of the radiation and not the hormone treatment. All of these treatments are nasty but without trying were would we be.
I have been fighting this since 1995 and will continue to do so, so hang in there and think positive. Rich

Mart16 11-24-2008 02:11 PM

Re: Salvage radiation after Hormone Therapy?
Hi there all-
I thought I'd join in and let you know of my husband's experience which is similar to yours.
He had the DaVinci surgery with PSA 9.6 and Gleason 4+3. All margins clear but did have extra capsular extension. His first PSA came in at .1 which is the lowest our lab reports. At his 6 month PSA it was .3 so we redid after a couple of weeks to make sure it wasn't a lab error and it was still .3. Waited another 3 months to see the trend and it was .7 at his 6 month checkup. Not good. Met with radiation oncologist and set up for treatments over the next 7 weeks but before we started the procedure he did have a prostascint. This did show a particular hot spot so this was an area targeted along with the prostate bed. PSA before radiation started had gone up to .9. With this doubling time we felt we needed to act quickly. I believe I've read where if salvage radiation starts within two years and PSA is below 1. you have a better chance of a cure. And that is what we were striving for - a cure. The dr gave us a 60% chance of cure at that time.
My husband was never fully continent after surgery. Also wore pads but manageable. After radiation it has set back his incontinence but we are still hoping he will get back to at least preradiation level. He also has on occassion some fecal incontinence which is most upsetting to him. But it is not often. Other than that he feels well and never had burning or nausea. Maybe a little more tired but not bothersome.
His first PSA after radiaiton came back at .2 which is very good. In the next two weeks he'll have another so time will tell if we got lucky.
I hope your next PSA results prove nothing to worry about and you continue feeling well.


flyfisher37 11-27-2008 09:15 AM

Re: Salvage radiation after Hormone Therapy?
Hi Martha,

Thanks for your input. I certainly hope that everything turns out well for your husband.
The problems you describe after radiation, is what scares me. I had problems after RP, as you read, and I certainly don 't want to have them again, or even worse! I guess I was really lucky after my surgery, because I only had to wear a pad for about 2 weeks and then I was okay after that. The scar tissue thing scares the hell out of me, because I had to make 2 trips to the emergency room after my RP because I couldn't urinate! Most uncomfortable and scary! The problem took about 6 weeks to show up after surgery.

I wouldn't hesitate to have the radiation, if it wasn't for the complications. I might still go that route, but I haven't decided yet. I see my urologist next month and depending on the results, I will have to decide on something.

Have a great day.....Lionel

flyfisher37 11-27-2008 09:21 AM

Re: Salvage radiation after Hormone Therapy?
Hi Dickiedo,

I'm assuming that the radiation you had was the primary treatment and not salvage radiation. I also am assuming that because you are on hormone therapy, the radiation didn't eliminated the cancer. Too bad. Have you had any severe side-effects from the hormone therapy? And how do you feel otherwise?

Take care.....Lionel

Dickiedo 11-28-2008 04:29 PM

Re: Salvage radiation after Hormone Therapy?
Hi Lionel: I had surgery in 1995 and 5 year's later my PSA started to rise. My Uro that did the surgery retired and the Dr that took his place said that we would wait till the PSA got to 10 then he would start hormone treatments. I went to a different Dr right away because I didn't like that idea. The next Uro sent me to a Oncologist and I started EBR treatments in May of 2001. That worked until the spring of last year when the PSA started to rise again, that is when he started me on the Zoladex.My PSA has been 0.01 for the last 4 test so he took me off the hormone treatment for the next 6 months. My health is good otherwise, I try and stay active and do a little exercise. I guess time will tell. Good Luck to you. Rich

Patricio3333 11-29-2008 06:09 AM

Re: Salvage radiation after Hormone Therapy?
Hi all - I had prostate surgery in 1999 - PSA 6.4, Gleason 7. In 2003 it rose to 0.1. It moved slowly for the next 4 years but in 2007 it was at 0.7 and my doctor believing that residual cancer was in the bed of the prostate recommended radiation. I opted for this rather than homonal therapy. I went to City of Hope in California and had 36 treatments with Tomo Therapy. It has been about a year and 5 months since the procedure and I am at <0.1. The side effects of Tomo therapy are very minimal and would recommend this procedure to anyone.

flyfisher37 11-29-2008 08:50 AM

Re: Salvage radiation after Hormone Therapy?
Hi Patricio,

That Tomo Therapy you mentioned sounds like a great way to go! I wouldn't hesitate to have that done, but I have no idea if that is available in this area. I will find out though next month, when I go back to see my urologist.

I checked it out on the internet and was very impressed with the precision that this therapy offers. It is truly amazing how technology can improve on something if given enough time. This technology would eliminate all the concerns I have about receiving salvage radiation, if it gets down to that.

Thanks for your post. It was very enlightening.


flyfisher37 11-29-2008 09:09 AM

Re: Salvage radiation after Hormone Therapy?
Hi Dickiedo,

It must have been discouraging for you to see your cancer return after 5 years from surgery. And then to see it return again after 6 years from having the radiation. I was really upset to find out that my cancer has returned after 3 years from surgery. I can't say for certain that it has returned, but I will know for sure next month. With having had a Gleason 8 cancer, and from what I've read about aggressive cancers of this grade, chances are that it will return. I read that up to 40% of prostate cancer patients will see their cancer return. What a bummer!!

I will probably follow a course of treatment similar to your own in the future. The only nagging question in my mind is where the cancer is. If I knew for sure it was only in the pelvic area, I would opt for the radiation, even if it isn't the latest technololgy. But If the cancer has spread, and there is a good possibilty it has because of the parameters ( negative margins, clear peripheries, no capsular penetration, Gleason 8 ), then ADT would be all thats left for me.

It's only been three weeks since I found out that it might be returning and since I started posting on this board, I gotten a ton of useful information that I will take back to my urologist. It's nice to have some idea of what's going to happen rather than walk into his office totally ignorant.

I'm sure I will have more questions to post as I think of them. I hope that the regulars on this board don't get tired of seeing me.


IADT3since2000 11-29-2008 09:18 AM

Re: Salvage radiation after Hormone Therapy?
[QUOTE=flyfisher37;3807487]Hi Patricio,

That Tomo Therapy you mentioned sounds like a great way to go! I wouldn't hesitate to have that done, but I have no idea if that is available in this area. I will find out though next month, when I go back to see my urologist.

... Lionel[/QUOTE]


My recollection is that TOMO therapy was developed by a doctor at the U. of Wisconsin, which geographically would not be that far from you. (I haven't had time to confirm the location.) Would your Canadian health system cover treatment across the border?

I too have seen information on TOMO therapy as our well regarded community hospital is one of the relatively few that offers this therapy. I took a tour and was impressed.

I want to make some other comments when I have more time.

Take care,


flyfisher37 11-29-2008 09:47 AM

Re: Salvage radiation after Hormone Therapy?
Hi Jim,
Always nice to hear from you.

Unfortunately, my health care system in Canada does not cover any treatment out of country. Apparently, it is possible, with a ton of paperwork and a doctor working on your side, to get the government to make an exception and give permission to get treatment out of country and have it covered under OHIP ( our health care system ). The big drawback is finding a doctor who wants to go through this long and laborious task and also, the time frame involved is a long one. A person could be expired before permission was ever given.

I did go across the border just south of Buffalo NY to a cancer center in Orchard Park to get a bone scan when I first learned I had a Gleason 8 cancer. My own urologist wanted me to have a bone scan, but would have taken a couple of months to get it under our system. Naturally, I wanted to have one right away so I had a better idea of where I stood. I called over there on a Monday and was there the following Thursday getting my scan. It cast me $ 1,000 but if was worth it to find out. It was negative.

Our health care system is free, but very slow. I think part of the reason for that is the fact that so many people take uncessary advantage of the system and simply bog everything down.

Have a great day. Lionel

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