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Radiation for Prostate Cancer with Ulcerative Colitis

Posted by sparky54 @sparky54, Sep 13, 2020

Has anyone with ulcerative colitis had pelvic radiation, specifically of the prostate bed after surgical prostatectomy? After 13 cancer-free years, doctors are concerned my prostate cancer is trying to return, with a PSA score of .33 after more than a decade of undetectable readings. Numerous scans of various types have not produced a single image of a cancerous mass. Radiation of the prostate bed would normally be a first line of attack, as the assumption is that's where the cells are hiding. However, I also have ulcerative colitis, which is a non-issue for me health wise, but apparently radiation can produce life-changing inflammation of the colitis (ergo, the rectum). Many radiation oncologists won't even attempt prostate radiation with active colitis present, and those who will try are very clear about the risks. Any first-hand knowledge or recent studies would be helpful. Thanks.

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Moderator
Colleen Young, Connect Director | @colleenyoung | Sep 13, 2020

Hi @sparky54, and welcome to Mayo Clinic Connect. I'm tagging @dandl48 and @ken82 in this discussion as they also have digestive tract issues and prostate cancer.

Here are a couple of studies that may have some relevancy for the decision you are facing.
- Implications of prostate cancer treatment in men with inflammatory bowel disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520802/
- Long term clinical toxicity of radiation therapy in prostate cancer patients with Inflammatory Bowel Disease https://www.sciencedirect.com/science/article/pii/S1507136716301481

Sparky, could the rise in PSA be caused by something other than cancer? Is PSA the only indicator that the cancer may have returned?

REPLY
sparky54 | @sparky54 | Sep 14, 2020

Hello Colleen,
Thanks much for providing these two studies. I will read them later today. As for your question about PSA rising for reasons other than cancer, I don't know. If you have any information on what could cause it to rise in the absence of a prostate gland I would be eager to see that.

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dandl48 Dave | @dandl48 | Sep 15, 2020

@sparky54 I see that Colleen mentioned me in a post. I have Barrett's Esophagus, not a lower GI problem like you. Yesterday I had a scoping of my Esophagus done At Mayo Rochester awaiting the results of the biopsy's. Thursday, I start SBRT treatment for my Prostate, that's 5 treatments over the course of 10 days. Good luck to you Sparky

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1 reply
sparky54 | @sparky54 | Sep 16, 2020
In reply to @dandl48 "@sparky54 I see that Colleen mentioned me in a post. I have Barrett's Esophagus, not a..." + (show)
@dandl48

@sparky54 I see that Colleen mentioned me in a post. I have Barrett's Esophagus, not a lower GI problem like you. Yesterday I had a scoping of my Esophagus done At Mayo Rochester awaiting the results of the biopsy's. Thursday, I start SBRT treatment for my Prostate, that's 5 treatments over the course of 10 days. Good luck to you Sparky

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Thanks Dan, and best of luck to you too.

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semeon | @semeon | Sep 25, 2020

I know in my case in terms of treatment I always opted for quality of life and weighed the risks that way. We are all different so it it’s hard to get get reassurance on a treatment method. To me a PSA of .33 is very low so what I would do is take my PSA every month for about 6 months and observe the velocity of change if it’s high you likely need to do something. If it has not changed then maybe you just continue to watch your PSA but don’t do anything.

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1 reply
sparky54 | @sparky54 | Sep 25, 2020
In reply to @semeon "I know in my case in terms of treatment I always opted for quality of life..." + (show)
@semeon

I know in my case in terms of treatment I always opted for quality of life and weighed the risks that way. We are all different so it it’s hard to get get reassurance on a treatment method. To me a PSA of .33 is very low so what I would do is take my PSA every month for about 6 months and observe the velocity of change if it’s high you likely need to do something. If it has not changed then maybe you just continue to watch your PSA but don’t do anything.

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Thanks for your thoughtful comments Semeon. That’s exactly what we decided to do. PSA test every 3 months and take it from there.

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