Expected side effects of adjuvant radiotherapy after prostatectomy?

@soli I had bladder cancer and my URO was concerned that the radiation would reactivate it and send it to a more aggressive state.
I decided not to worry about things I couldn’t control and to focus on what I could. So far so good but if the bladder cancer comes back, I’ll have to deal with it. What else is new?
Phil

Thanks Jeff for the clarification.

@heavyphil

That is very true: whatever decision you make, there are tradeoffs: there is no free lunch when dealing with the nasty disease of cancer.

@heavyphil

Yes, but you needed salvage dear Phil 😌, Soli was asking about adjuvant.

Adjuvant is done when your PSA is undetectable and that is a tough call indeed. We have a member here who consulted, I forgot was it 4 or 5 top notch institutions, about doing adjuvant and all but one told him not to do it. Even top doctors are not sure IF and WHEN is it wise to do it, so it is kind of being a "pioneer" in the unknown land of PC, unfortunately. That member did need salavage at the end, but those months gave him time to heal.

As for any medical study, one can find some that show benefit and some that don't.

As we can see as of lately, all of the sudden there is a trend to do shorter courses of ADT, or even none in some cases; now we also have "ADT holidays", what is next - nobody needed to be on ADT for 2 years ??? All of the sudden everybody will be on estrogen instead ? 😳 Well, it is wonderful that new and new things are invented and discovered, thanks heavens for that, but at some point one starts to wonder and one starts to rethink the whole approach 🤷‍♀️.

Would you jump into adjuvant at 74 ? Lets say, your PSA is 0.015 and you are just 8 weeks post op, still recovering. You might or might not have BCR in the next 5 years., and results are better in 25% cases OF 8 % cases of total number ??? And that is in ONE study, the other shows no advantage ?

It is a very tough call. One can do it and be possibly done with "maybe" needed clean-up for many years ahead or one can wait either a year or up to 5 or even more and than do salvage ? It is maddening even if there were zero side effects 😣, and there are never 0. Some are acute and some come later , not all are extremely bad, but ... We can go in circle till the *ell freezes over ... 😵‍💫 It is TOUGH choice.

@surftohealth88
Yes, getting on estrogen instead of ADT does sound attractive, But there are a few issues.

If you have BRCA, you can’t do it, Estrogen is going to cause nothing but problems and accelerate prostate cancer issues.. If you do take estrogen, you need to get your chest x-rayed ahead of time, or very early to prevent gynecomastia. At the ancan.org Meeting Tuesday one of the guys said he even had a mastectomy because his breast were getting too big. Estrogen sounds like a great deal, but it has its drawbacks.

Adjunct radiation was discussed at the Ancan.Org meeting on Tuesday, when @soli showed up and discussed his desire to do adjunct radiation. @soli is pT3b and has a decipher score of .75 (already discussed in another message on this forum), so he does fit the criteria Dr. Efstathiou recommended.

Dr. Efstathiou concluded as follows:
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6

We then had a discussion About side effects for those that had prostatectomy following by salvage radiation. A number of side effects were experienced by people in the meeting. Most of them happened years after the initial radiation. Like my experience with incontinence five years after salvage radiation. The radiation does harden the urethra and that’s probably why incontinence occurs. @soli is aware Of all of these possible side effects. It could be getting a really good radiation oncologist can prevent many of them. Some people had rectal bleeding, But the rectum isn’t in the prostate bed, so maybe getting a really good radiation oncologist can eliminate that kind of issue. Other people had bladder issues, But the bladder isn’t in the prostate bed so better radiation techniques should eliminate it.

Yes, adjunct radiation could be chancy, but having it done by a real good doctor and team, could avoid most side effects.

If my surgeon recommends when we meet in November that I consider adjunct radiation within a year , given my high risk factors, I will definitely try to work with the top radiation oncologist in our area. As he promised on the ancan zoom call yesterday, , Dr. John Antonucci emailed me a name: Dr Amar U Kishan of UCLA. I checked out his resume and accomplishments, and I am very much impressed.
@surftohealth88 also recommended an excellent genomic test called PROVOST to determine my sensitivity to radiation. The test can determine one’s susceptibility to side effects of either or both of SBRT CFRT. If I am going to consider adjunct radiation as a treatment option , I will definitely take this test even if I have to pay for it since it is not yet FDA approved.
Should I wait for PSA to rise consecutively indicating a relapse 3 or 5 or whatever years from now, or should I do a preemptive strike within a year after I heal, to delay the relapse of cancer by many more years? Should I subject myself to possible side effects of radiation years sooner than I need to, to delay the recurrence time line? What is the nature, magnitude and duration of the side effects I will experience? No easy decision here since there are many unknowns and difficult trade offs.

@surftohealth88 The mechanics of adjuvant vs salvage are exactly the same. This is why it is so important that he heal completely before treatment.
@soli has also informed us that his genetic testing profile shows he has a more aggressive cancer.
Since he describes himself as being in good health he could conceivably live many more years.
So once again it comes down to a choice of which poison you’d prefer: possible side effects from radiation vs effects from long term ADT/-lutamides/PARP inhibitors…A tough choice indeed.
Hey @soli, don’t mean to talk about you as if you’re not there 🫣, but you started it….
BTW, what exactly is your current PSA? That will probably help a great deal in making a decision.
Best,
Phil

Hi @heavyphil : My prostate surgery was done on September 2nd. So my first, post-surgery PSA test will be conducted during the first week of November to allow residual PSA enough time for sufficient numbers of half lives. But even if my PSA is undetectible at that time, I believe the question of getting adjuvant radiation within a year (of course, after I have sufficiently healed from the surgery) will still be on the table given the very high risk biology of my disease (pT3-b, Decipher score of .75 etc).

@soli Oh, so REALLY early days for you…you have plenty of time to decide what to do.
At the worst, IF - and it’s a huge if - your PSA comes back higher than anticipated (or rises constantly in 3 month intervals) you can go on Orgovyx to really put the brakes on any growth or spread.
You can always do radiation afterward no matter how you classify it - adjuvant, salvage or whatever…Best of luck on your treatment,
Phil

Good advice.

Thank you @heavyphil