Expected side effects of adjuvant radiotherapy after prostatectomy?

This is very informative and I appreciate all the comments and words of wisdom. My husband starts hormone TX this week and then adjuvant Volumetric Modulated Arc Therapy (VMAT) with daily Cone-Beam Computed Tomography (CBCT) and inverse planning next month (3.5mo post RALF).

He has had minimal to no bladder leakage right now but this is a big concern going into radiation tx. At 58 yrs he really wants quality and of course quantity but mostly quality. This has been a scary road but this chat line has really helped us both. Looking back I am shocked that his primary care doctor did not suggest he see a urologist for his PSA of 4.6 over the past few years. Either way, he is getting treatment now and hoping the oncology team can eliminate the cancer.

Thank you all for the feedback and I wish everyone well.

@heavyphil
At the ancan.org meeting @soli attended Tuesday one guy made @soli case choice seem mild.

The guy at the meeting has a case of prostate cancer he wants to overwhelm. He’s had a prostatectomy, Followed by radiation and now plans on having chemotherapy. His point of view is that he wants to go all out to destroy the cancer and not have to worry about it ever coming back. That may be a folly but compared to what @soli is doing it’s way extreme.

@jeffmarc

I agree with you Jeff. I was suprised at the volume ot treatment the man already had and plans to have to overwhelm the cancer without taking into account the toxicity and side effects of the various treatment modes and possible impact on the quality of life.,

@jeffmarc oh boy…while I can get where he’s coming from -I believe in being pro-active - he is putting himself at risk with chemo. I doubt that he can find an oncologist who would comply (or an insurance co who’d approve it!) with his wishes but one never knows…
Phil

@jeffmarc

Yes , but you said that your RO was never present during radiation sessions, so perhaps one has to look for an excellent "radiation technician" ??? 🧐

JC had his RO being present though, but most had him present for a split of second or not at all. 🤷‍♀️

I would suggest Soli to look into proton option, if he has means and is in LA area. I know we would 😊. It is just too far from us, unfortunately...

@surftohealth88
The thing is, there’s nothing for the radiation oncologist to do once you come in to have the radiation done. Maybe in this MRI situation there’s An exception because they watch what’s going on in a real time basis.

For almost all radiation done with IMRT or SBRT the technicians are given the exact instructions for what to do. I suspect the machines are preloaded with all of the technical information that the RO has decided on. This is something that computers are designed for. An RO would set up the plan in the computer and technicians would have it load into the radiation machine, when the patient was ready to be radiated. Not much room for screw ups, they follow exactly what the RO has programmed. They even know whether or not there’s enough liquid in your bladder Because they do a CT scan just before they do the radiation. I bet the machine even tells them If the quantity of liquid is not correct. All this has to be automated. As a result, the RO has nothing to do. When I had SBRT on my spine The RO didn’t talk to me until the end of the last session. He definitely was not in the room. Same when I have 40+ IMRT sessions, Though I didn’t hear from the RO until days later, after the last session was done.

@surftohealth88

That is a great idea and I had been looking into that since proton therapy is supposed to cause minimal damage to surrounding tissues.. The challenge is there are very few medical institutions with proton equipment due to its huge cost. In our area, I only know of Loma Linda, and a little further : UC San Diego. But for something as important as this, distance shouldn’t be a shop stopper, so I will continue to explore proton therapy for potential adjuvant or salvage radiation therapy. I will also look into UCLA’s acclaimed (non-proton) radiation therapy program under renowned Dr. Amar Kishan.

A lot to investigate….

@soli
An article link that was posted here today outlines some of the risks of salvage radiation or adjunct radiation.

In general, toxicities after postprostatectomy radiation using photon-based techniques have been tolerable, although the rates of late grade 2 and gastrointestinal (GI) and genitourinary (GU) toxicities range from 10% to 20% [10–14] with image-guided intensity-modulated radiation therapy (IMRT).

What this means. “ late grade 2 and gastrointestinal (GI) and genitourinary (GU) toxicities”
Above describes moderate symptoms of damage to the bowel and bladder, requiring minimal intervention but impacting daily activities, and occurring after salvage radiotherapy for a recurrence or persistent cancer after initial treatment. Gastrointestinal (GI) symptoms can include moderate diarrhea or bleeding, while genitourinary (GU) symptoms might involve increased urinary frequency, pain, or intermittent bleeding.

Article the information came from
https://pmc.ncbi.nlm.nih.gov/articles/PMC8019576/