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radiation questions
artkit posted:
Hi to all. First time poster here with a question about radiation therapy. I was recently diagnosed with prostate cancer (T1C). Gleason score of 3+3=6 and psa 4.5. My cancer is confined to the prostate (so I'm told). I'm considering external beam radiation and my questions, which I haven't gotten from my radiation oncologist, are: Should hormone therapy be given, or is it normally given in conjuction with EB radiation? I've recently read that a study found that radiation AND hormone is the best option for cancer that has not spread beyond the prostate. My radiologist hasn't mentioned hormone at all. Can anyone help? I've also spoken with some men in my community who've had surgery but have found no one who's had radiation. Is radiation either that rare or is it less successful? I know perhaps these questions make me sound uninformed but it seems the more research I do, the more confused I become. Thanks
aus62 responded:
Hormone treatment with radiation is often suggested for more agressive Prostate Cancer, but in any event radiation is believed to be more effective when hormone therapy is also used.

Radiation is often used and is sometimes a better alternative in some situations where surgery might not be a good or safe option for example.

Surgery or radiation can be equally effective treatments and it often comes down to personal preference, and which potential side effects are more acceptable to the individaul.

If you have difficulty, it could pay to consult a medical oncologist expert with Prostate Cancer who can objectively assist you through your decision making process.
stxdave responded:
Hi Artkit,

The article you read is correct, but it is up to the individual radiation oncologist to prescribe the combined therapies. I would talk to him BEFORE starting any treatment. Some therapies use ADT2 which starts Casodex about a week before Lupron and about a month before starting EBRT. There are equivalents to Casodex and Lupron. Casodex is used to suppress the PSA bounce occurring when Lupron is started by itself. Lupron suppresses testosterone from the testicles, whereas Casodex suppresses it from other organs of the body. (The purists must forgive the basic explanation I am giving.) The length of time the patient takes the hormone therapy is again determined by the radiation oncologist, I assume based on PSA and Gleason scores at the beginning of treatment. Hormone therapy has a number of side effects that the radiation oncologist may be trying to save you from. From my point of view, the side effects are temporary and worth the added killing effect.

Sorry you had to join our club,

Dave Dx'd 1999, Age 60, PSA 43, Gleason (4+5=9), T3c, 42-3d-EBRT+ADT2, Intermittent ADT, RRP
frogs1936 responded:
Whether to include hormone therapy with your radiation is a judgement call by your radiation oncologist. In my case (age 71, PSA 4.0, Gleason 3+3 from one lab and 3+4 from another) my radiation guy decided not to give the hormone treatment before my proton radiation. But another fellow in my group with a slightly more advanced PC did get the hormone. By the way, take a look at: before deciding on your course of action
artkit responded:
Thanks to all of you. Still not convinced that radiation would have been right for me, I'm now 99%sure I'll have sugery instead. There were just too many unanswered questions regarding radiation. I also thought that 3D-CRT or IMRT would have been better choices if I were to have radiation because they're somewhat less invasive, but neither are available within driving distance of here. I now have an appointment in April at Dartmouth-Hitchcock Cancer center in NH to discuss robotic laparoscopic surgery.
Hop57284 responded:
Hi yah Artkit, after reading about your delemer, I think you are making the right decision on what to do. Radiation in any form has many side effects which if you don't need them, Why get them. As in my case, I felt get the dam thing out and all the problems should go out with it. Good Luck in April.
MarineMustangPA responded:
I had IMRT w/o hormone. The urologist and radiation oncologist make a decision based on all the information they have, sometimes including the size of the prostate. In my case my doctors told me there was no need to add the extra burden of hormone to the mix, In any event I would not subject myself to any radiation that is not delivered with the latest and best methods, i.e., IMRT. Which is precise and has the ability to deliver very large concentrated doses of radiation.

I had IMRT w/virtually no adverse side effect. Unfortunately, my PSA never reached a nadir of less than the desired 1.0. So, now we are waiting to see where it goes before deciding if I should start hormone.

Good luck on you decision and results.

artkit responded:
A couple of things I found out about radiation that changed my mind (and that doesn't make it wrong for everybody) is that once it's used in the pelvic area for example, it can't be used there again, which because I had bladder cancer twenty years ago, probably wouldn't be good. Radiation could also cause frequency and discomfort in urination, and because, in addition to PC I have an enlaged prostate and have urinary problems already, I wouldn't want to chance an increase in those existing symptoms/problems. And, as I mentioned, there's no place close enough for me to drive to for 6 or so weeks that have the latest technology, although there is a hospital that has at least a more advanced system than most in this part of the state.
bogie11 responded:
I just completed radiation treatment with proton therapy at Shands, Jacksonville, FL. The experience was great - no pain, no incontinence, no decrease in sex life, and no catheter. My only side effect has been an increase in urinary frequency - instead of getting up once a night I usually get up 3 times. My wife and I had a wonderful time, became friendly with several couples who were there for the same reason, and mostly continued our normal activities except for about half an hour a day, five days a week for the treatment. We were actually sorry to leave. The hospital staff was outstanding - proficient and helpful. Incidentally, I'll be 85 next month.
dlvestal responded:
hi artkit. i had surgery for prostate where you have an appointment. you will learn a lot when you talk to the surgeon there. in my case some nerves were left and i did not have what is called "positive margins". i was fine for a year and then my psa went from less than .001 to a .25. as a result i chose external radiation. this treatment is ongoing but my psa has dropped to .13 at just a little over the half way point of treatment (which is 37 consecutive treatments). i would also like to say that i have just about full control of my bladder functions and sexual function as well. don't be afraid to ask questions and write them down before your visit so that you don't forget them. another set of ears can sometimes be a good thing as well. good luck dlv
midatlantic responded:
Bogey11.....I have just been diagnosed and am interested in proton beam therapy at Jacksonville. I hope to visit there next month. Would you mind sharing more about your experience there....especially the quality of the doctors and staff. Any insight as to the use of proton beam with an enlarged prostate? Any issues there? It has been suggested to me that with a gleason of 7 and a PSA of 4, the cancer cells may be beyond the prostate and therefore I should get hormone therapy combined with IMRT, not protons -- becasue the proton beam therapy is so accurate it will not treat the cells beyond the prostate. .Would appreciate any thoughts on any of the above. Thanks.
bogie11 responded:
I highly recommend the proton therapy center at J'ville. I found the doctors and the staff to be not only knowledgeable but very helpful and friendly. My experience was a thoroughly postive and enjoyable treatment. I think that most of the patients who go there have some degree of enlarged prostate, so it is the normal thing. My Gleason before treatment was 3+4 and my PSA was 7+, and hormone therapy was not recommended for me. If you would like to send your e-mail address, I'd be glad to chat with you further and answer any more questions that you might have.
prostatecancerwife responded:
My hubby and I were told that studies show that hormone therapy prior to radiation makes the cancer cells more susceptible to radiation. You might want to go to Pub Med at this link:

There you can search for the studies that have been done about radiation and hormone therapy combined. Then perhaps you can get a better idea if this will be right for you.

Hope this helps!
jkk2007 responded:
I'm 70 yrs. old had a gleason score of #8 , have completed 42 teratments of External Beam Radiation therapy , and also hormone treatments . Have had no problems , would look for someone who does TOMO Therapy. Go to thier web site it shows all , . You can see who has one in your area .

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