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Thread: If he has prostate cancer, can he have radiation again?

  1. #1

    If he has prostate cancer, can he have radiation again?

    I know I might be jumping ahead a little but am concerned about my husband's latest PSA level of 15. He is to be retested tomorrow but the levels have been going up over the past few months at am alarming rate. He will have a biopsy if the levels are indeed high. My first thought was that if he has pc, then surgery would be the best way to go, but now I am reading that high numbers suggest it might have spread and that radiation is more effective. My concern about this is that he had rectal cancer 6 1/2 years ago and had radiation at that time too. As the prostate and rectum are not that far apart, it is possible for him to get more radiotherapy in that area? He is still affected by the treatment for the rectal cancer.

    10 years ago, he had a biopsy when his PSA was 12 and the result was that he had BPH, but he has since had a turp to reduce the size of the prostate, so I feel it is unlikely to be BPH again. He is 71 years old.

    Any input would be much appreciated.
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  2. #2

    psa

    Even if BPH isn't likely, PSA might still be elevated from prostatitis.

    As for treatments, that's a big question, and there is no one single answer.

    Radiation can indeed treat more than just the prostate itself, if local spread is suspected. It can also be done after surgery, on an adjuvant or salvage basis.

    I don't know the answer about whether his previous radiation would rule out prostate radiation. That would be a good question for a radiation oncologist, and should your husband be diagnosed, I would definitely consult one in addition to the urologist and a medical oncologist.

    If he has a biopsy, and if it is positive for cancer, it will provide valuable information that will help the physician(s) estimate clinical stage and recommend appropriate treatment. Be sure to read the sticky post at the top of this forum by az4peaks for the newly diagnosed.

    And I recommend "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" (2007 ed.)

    Best wishes.
    Replicant

    Dx Feb 2006, PSA 9 @age 43
    RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
    PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
    Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
    PSA 6/07 0.1, 9/07 (and thereafter) <0.1
    http://pcabefore50.blogspot.com

  3. #3
    Senior User
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    Hi alihamilton, - The prostate sits immediately in front of the colon and any residual problems relating to the previous Radiation Therapy (RT) for his rectal Cancer, would likely be exacerbated by further radiation, even though RT is more precise today than ever.

    But, at this point, you don't know that he has Prostate Cancer (PCa) and therefore it may not be necessary. It is true that a high PSA is often a sign of PCa, but it is also a sign of BPH (Benign Prostate Hyperplasia) and Prostatitis, both of which are NOT Cancer, but benign conditions. BPH, you are already familiar with and Prostatitis, which is inflammation, often caused by infection.

    Bacterial infections are often transient in nature and an anti-bacterial medication like Cipro is usually very effective in resolving the problem, if prescribed for 4-6 weeks. But not ALL Prostatitis is bacterial in origin. Chronic Prostatitis often is NOT and is therefore usually much more difficult to cure, or even adequately control.

    Since symptoms of all three diseases are very similar, it often becomes a matter of elimination to determine which is the main culprit. Many times, more than one may be, at least temporarily, contributing to the elevated PSA readings. IN GENERAL, if the PSA trend has been STEADILY upward, it is more likely a result of PCa or BPH, while PSA readings from Prostatitis tend to be more erratic.

    The fact that his PSA has only risen 3 points in the 10 years from 61 to 71 y/o, would normally be a very encouraging sign, and may still be, but the TURP surely would have altered his readings because of the de-bulking it entails, somewhat distorting it's true significance. The TURP relieves the symptoms of BPH, but does nothing to control its future growth so, depending on when it was done, BPH may well be a factor again.

    I would suggest that if he has not already put his PSA results in chronological order on paper, that he does so and preferably chart it on graph paper, where PSA trends can be easily spotted. They are more informative than any single reading.

    A Pathologist directly viewing Biopsy obtained tissue under the microscope, is the ONLY widely accepted method of diagnosing PCa so eventually, that will probably be necessary. I will be happy to try and answer any specific questions you may proffer. Good Luck! - John@newPCa.org (aka) az4peaks

  4. #4
    Many thanks for both replies....they are so helpful. I do realize I am preempting the results and must wait until we know for sure. I will post again when I know more and meanwhile will take your information and advice.
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  5. #5
    My husband has now had his biopsy and ultrasound and will get results in about 2 weeks. Apparently, he has some calcifications. I will post the results when we get them.
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  6. #6

    Results

    We have not long come from the urologist's office...it is prostate cancer, stage 11 Gleason 9. Trying to come to terms with the third cancer between the two of us and to decide which treatment to take. Radiation is available here, seed implantation is not, so we would have to travel to the US for that. Hifu is another option here. Now ,we just have to decide which course to take.

    Need some encouragement, please!
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  7. #7

    hi again

    Ali, sorry to hear it's prostate cancer.

    Can you clarify the stage? It's usually T2a, T2b, T3a, and so forth. I'm guessing you meant stage T2 something. There is a description of the various stages here: http://www.phoenix5.org/Infolink/ClinicalStaging.html and on other sites.

    I recommend getting a copy of the biopsy pathology report. It will have plenty of valuable information that you can use in conjunction with John (az4peak)'s sticky message at the top of this forum "What every newly diagnosed PCa patient MUST know"

    You mentioned HIFU. My impression of HIFU is that it is showing promise in low to intermediate risk cancer. In my layperson's view, that does not include Gleason 9, PSA 15 cancer. I base this view, that HIFU is not appropriate in high risk cases, from my reading of several study abstracts, including two separate Italian studies: http://www.ncbi.nlm.nih.gov/pubmed/19260381 and
    http://www.ncbi.nlm.nih.gov/pubmed/19081465 ; a Japanese study of 517 men : http://www.ncbi.nlm.nih.gov/pubmed/19863624 , a French study of 119 men: http://www.springerlink.com/content/2885g36408825j26/ , from a HIFU manufacturer, Edap: http://www.edap-tms.com/uploads/pdf/..._robertson.pdf , and multiple other sources.

    That's not to say you should not investigate HIFU on your own, or substitute my thoughts on the matter for qualified medical advice.

    I would consult specialists in each treatment modality available to you. A medical oncologist who specializes in prostate cancer, if you can find one close to you, could be a valuable asset.

    If you can post the specifics of your husband's biopsy report, there are others here who can provide more targeted assistance. You could also take the information from the report and plug it into the calcultor at the Memorial Sloan Kettering site, http://nomograms.org , to get various probabilities.

    Best wishes.
    Replicant

    Dx Feb 2006, PSA 9 @age 43
    RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
    PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
    Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
    PSA 6/07 0.1, 9/07 (and thereafter) <0.1
    http://pcabefore50.blogspot.com

  8. #8
    Thanks for the response. We live in a small country, on an even smaller island and there are only four oncologists in total, so none specialize in any particular cancer. The same oncologist who treated my husband's rectal cancer, treated my lymphoma. The urologist is the one who deals with prostate cancer here and has given us the options. External radiation can be done here, but the seed implantation would have to be done in the US.

    We are not sure what the actual Stage is because of the previous turp surgery which removed a good bit of the prostate. The urologist feels it is most likely a 2, rather than 1. The cancer has shown up in three areas, all with a gleason score of 5+4. The percentage of the left apex is 90% and in the left base and left periphery 1, 60%. That is all I get from the pathology report.
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  9. #9
    I see what you mean from those links to reports which I have skimmed through but I also see someone on this forum with a similar Gleason Score but not such a high PSA having had the Hifu treatment. It is so interesting to see people coming here to the Bahamas for treatment when it is usually the other way round!

    Our problem is that I am concerned about more radiation to that area when he already was radiated for rectal cancer over 6 years ago and there is definitely damage to the rectum. We are presently waiting for the treatment plans and summaries from the UK where he received the radiation last time to see if more radiation is a viable option.

    So we might just be left with brachytherapy as that appears less damaging to the surrounding organs. From what I have read briefly, that would entail a short stay in hospital or outpatient treatment? I wonder how soon we could travel back home here after the procedure?

    Of course, he would also be receiving hormone therapy.

    Any advice would be appreciated.
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  10. #10
    Senior User
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    Hi Allison, - I am sorry your husband has been diagnosed with Prostate Cancer (PCa) and I am particularly sorry that it APPEARS from the limited information contained in your Post, that he likely has fairly advanced disease, rather than early-stage PCa that is now found in most newly diagnosed men.

    I tell you this, because I am not sure from your latest Posts that you yet, fully comprehend the potential seriousness of his disease, Also, if he is already suffering adverse rectal effects from his previous radiation, any localized treatment has a greater chance of further exacerbating existing problems. For this reason, it is extremely important that every effort is made to answer the question of disease Stage prior to initiating treatment.

    The Gleason Score of (5+4)=9 coupled with the 15 PSA makes it more statistically likely that his PCa may already be systemic, rather than still remaining localized. If PCa is systemic, it is HIGHLY unlikely that radiation in any form, nor any other "local" treatment will be successful in "curing" his disease.

    If the chances of "cure" are determined to be small, or non-existent, because the disease is thought to be systemic, then an effective treatment regimen is pretty much limited to some form of Hormone Therapy (HT), usually starting with Androgen Deprivation Therapy (ADT).
    Such treatments can "control" the disease for WIDELY varying time periods, usually measured in years rather than months

    Of course, at this point you don't know whether his disease is thought to be localized or systemic. But, it is important that it is thoroughly investigated before further treatment decisions are made, so that the most effective and least detrimental in morbidity (side effects) are fully considered.

    Good luck with your further pursuit in trying to clarify his status and dealing with the PCa. - John@newPCa.org (aka) az4peaks

  11. #11
    Well. now I am starting to panic. It is definitely thought to be localized...that was made clear to us by the urologist but I do realize that if it is not contained, that any localized treatment would be a waste of time. He is to start hormone therapy as soon as we have received the info from the UK and have met with the radiation oncologist and spoken to our oncologist, regarding treatment options.
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  12. #12
    An update but not too much progress. My husband's PC has not spread outside the prostate. He has had his first Zoladex injection but treatment has not been determined as yet. The urologist still wants to do Hifu. The radiation oncologist wanted to do external beam radiation with a reduced dose but our medical oncologist says that is definitely not viable, given the previous radiation. A team in Tampa is to discuss the case on Monday. Cyberknife is a possibility, though we understand it is very expensive and may not be covered by insurance. And so we wait. Our medical oncologist certainly feels triple blockade would be better than just the Zoladex. It is very difficult being in the middle of professionals who have differing opinions, but whom we might well need in the future!
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  13. #13
    I see there are no responses but before I close this thread, I am just updating. The team in Tampa feels that brachytherapy with palladium seeds would be the best route to take. We will now look into what that entails in terms of travel, prep and administration of the treatment.
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

  14. #14
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    Alison

    Your husband has a very severe and aggressive variant of prostate cancer with a Gleason 9, and I suspect that as much as those here give amateur medical advice from time to time, the usual patient that they are addressing is a Gleason 6 or Gleason 7, which is a far different game than a Gleason 9. think of a Category 2 hurricane v a Category 4 hurricane.


    If you check the HIFU thread on this site, you will see that excellent surgeons perform HIFU procedures in the Bahamas, but i don't know if the HIFU docs address Gleason 9.

    Radiation, as I understand it, kills the cancer, but slowly over months. In your husband's shoes, I would ask the docs whether a quicker remedy like surgery, or HIFU, might not be better to eliminate the malignancy immediately.

    Good luck.
    age 60
    PSA 7.5
    Gleason 3+4
    HIFU June 10 Bermuda Dr Scionti
    Salvage HIFU April 11 Bermuda

  15. #15
    Thanks...yes, there is some concern that Hifu is not appropriate for Gleason 9. Surgery is out of the question due to his previous surgery for rectal cancer and TURP. We will continue to investigate and all I can do is hope we pick the best treatment plan. There are so many opinions and all our professionals think he or she is correct!!!
    Alison
    Husband dx with Stage 111C rectal cancer July 2003, currently in remission, myself dx indolent follicular lymphoma July 2006, currently in remission. Husband dx February 2010 Stage 2 prostate cancer Gleason Score 9

 
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