Stage 4 Radiation challenge: How to avoid risk to bladder?

Posted by zmarkv @zmarkv, May 21 2:55am

Hello, I’m stage 4 post Radical, post comprehensive radiation, coming off ADT, waiting for Testosterone to return, looking at next steps. When they did the radiation, they said there was a small area near the bladder that could cause complications if they treated it. Still sensitive but wanted to know if there was a way to go after that area without having bladder risks. PSMA scans didn’t find anything else last time. Suggestions? Thanks in advance.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Even in surgery cancer can be found in Apex If taken out either way there is a operation to plug the blabber qaqnd allow for normal urination without lifetime folly

Keep on Zolodax to stop testosterone look at apalutimide or other

Keep googling and praying


Thanks, I guess my question was: is there a a radiation procedure that is exceptionally precise that could handle this? Intermittent ADT gets my vote. Allows for imaging plus some studies show it to be more effective.

I’m fine regardless, just doing due diligence. My faith is not in medicine or doctors.


zmarkv: you might want to ask your radiation oncologist about the Mridian Linac, its 2 mm margins (vs 3-5 mm for most other radiation treatments) and real time built in MRI and 5 hypo fractional treatments. I had it for my prostate cancer with minimal urinary side effects. I have heard that it has been used for bladder cancer (and other types of cancer) and as a layman, real time MRI, adaptive planning and auto shutoff may give you an extra edge in treating the bladder area.


72 years old. Healthy and fit by all appearances. So much for appearances...

Presented with PSA 15.1 and inability to empty bladder. (Became symptomatic late October 2023)

MRI showed wide spread prostate lesions with extra prostatic activity to include seminal vessels.
Prostate biopsy 4+3, 4+4, 4+5. Cystoscopy showed no lesions in the bladder.
PSMA showed metastasis to left iliac and right femur, and ALSO both lungs as confirmed by pulmonary biopsies.

i opted for orchiectomy with reconstruction. 95% of my testosterone production permanently stopped in 90 minutes (including securing implants and closing incissions). Radical detectable testosterone drop occurred 12 to 48 hrs after surgery.
Bonus! 3 days after surgery my urine flow improved a bunch and 5 weeks post surgery almost back to normal.

i start chemo tomorrow!

This is my triple therapy:
ADT (orchiectomy performed 4-17-2024)
PSA rose from 15.1 prior to biopsy to 26.6 two weeks after biopsy.

Chemo- Docetaxel (start 5-21-2024) 6 treatments. Once every 3 weeks for 18 weeks.
PSA down to 4.4 (5-16-2024).

ASI- Abiraterone/prednisone starting soon. (coming from Rochester, Mn.)
i asked to have my testosterone checked again before starting Abi.

Love these answered prayers and love the entire Mayo staff!!!

You are all in my daily prayers as is your medical team.


Takes 15-18 months for testosterone to return. Your bladder situation requires Dr. KWON from Mayo Clinic to analyze- you have a difficult question to respond to/ I m not that smart maybe a cystoscopy to start with.

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