Just past halfway through salvage IMRT – status report

Today I finished #20 of 38 IMRT sessions for a local recurrence of PCa. I thought it might be worth sharing what I’ve experienced so far.

Quick background: Currently 73. Diagnosed with PCa in 2014 (max PSA of 5.2) and underwent a RARP in spring of 2015. Post-surgical pathology showed maximum Gleason score 7 (3+4) and positive margin on the right apex of the prostate. Prolaris score estimated a 53% chance of BCR in ten years. Had urethral sling surgery in 2023 that completely resolved stress incontinence. For ten years, my PSA was undetectable (< 0.1), then this past June it rose to 0.11 and a DRE detected a small, palpable nodule in the prostatic fossa. Nodule lit up on a PSMA PET scan with SUVmax of 13.4, and a pelvic MRI further confirmed the local recurrence. No scanning evidence of distant metastasis, nor pelvic lymph node involvement. After consultations with three oncologists, I agreed to IMRT of the local recurrence and pelvic lymph nodes (prophylactically). No ADT. IMRT started on Sept 2. PSA at initiation of IMRT was still 0.11 (three months after initial rise).

So far, the only side effect of note has been some fatigue that seems to get worse towards the end of the week. Rest on weekends seems to be a reset. Fatigue hasn’t been extreme, but I find myself sleeping longer at night and occasionally taking afternoon catnaps.

No bladder, nor rectal irritation, nor difficulty urinating or defecating. A couple instances of diarrhea, but nothing persistent. I had a couple instances of urinary leakage while sleeping, and now wear a pad a night as a precaution. Urinary continence has been good otherwise.

Early on I had some mild GI upset and an “icy/hot” sensation in my pelvic area, but that all seems to have passed.

The biggest challenge and stressor, as I have previously posted about, is presenting for treatment with an empty rectum (both gas and stool). This seems to be a common experience. So far, I got kicked off the table only once because of too much gas (my second session). I quickly made some dietary adjustments and all has gone passably well since then. However, some days it feels kind of touch and go. Bowel functioning is foremost on my mind every day. A strict regimen of diet, exercise and sleep seems the best assurance for achieving empty rectum status every day before treatment (11:00am). Occasional use of Gas X has helped too. Imodium is on standby, if ever needed.

I have a good, open relationship with the RT team, which eases the situation and also keeps me informed on the status of my bladder and rectum. I really appreciate this aspect of the daily grind.

So, all in all, treatment is moving along well. With that said, I will be glad when it is done and I don’t have to obsess constantly over bowel movements. Fingers crossed that side effects remain minimal and manageable.

Best to you all.

M