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What to ask the radiation oncologist about prostate cancer?

Posted by surftohealth88 @surftohealth88, May 7, 2025

Tomorrow we have zoom call with radiation oncologist that was recommended to us by prostate surgeon. Our meeting with surgeon was somewhat confusing since we did not expect to be told that my husband's case is not "urgent" and that we should talk to radiologist and as well to a doctor that does focal treatments. We were convinced that RP was the best approach, as we still think that RP is a way to go with cruciform and IDC but since we were told that we should have consultations with radiology, we agreed. I can say with whole honesty that we were like two deer caught in headlight after we were told that there is no rush, and we both failed to react with NEW questions and stared at "old ones" on our paper in confusion. So, in preparation for tomorrow's appointment I am asking for help with possible questions - any suggestion and advise is welcome. Thanks so much in advance < 3

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groundhogy | @groundhogy | May 12, 2025
In reply to @surftohealth88 "Yes, but one has to look at individual presentation to make valid decision. My husband is..." + (show)
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Yes, but one has to look at individual presentation to make valid decision.

My husband is basically none of the "standard" groups used for that diagram. For example, his PSA was 7.6 (now 5.2), he has low tumor burden BUT he is actually "unfavorable intermediate" because he has IDC and cribriform present. IDC and cribriform are the one that put him in high risk so he has to have aggressive approach, regardless of the fact that it is one singe core in the whole prostate with gleason 7.

On the other hand, because he has one single core with that presentation and because his cancer is one singe spot contained inside the gland RP is by both experts deemed as curative in his case. Yes, they both said "curative" for RP. I even asked about "salvage" radiation and RO told me "nah, I do not think he will need that". I was surprised, but hey, was nice to hear it. IDC and cribriform sometimes show resilience to radiation so to choose radiation as the first step would not warrant complete eradication no matter what any diagram shows.

Only time will tell if RP was "curative". One has to choose the step that is "the best at the moment" and at the moment for his particular case RP is the recommended path.

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Yeah, nothing is perfect for every case. Sounds like you did your homework which is the important thing and cane to a reasonable pathway.
Good luck!

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mjp0512 | @mjp0512 | Jul 6, 2025
In reply to @brianjarvis "I’ve accumulated these questions over my time on this forum —> Questions to ask regarding prostate..." + (show)
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I’ve accumulated these questions over my time on this forum —> Questions to ask regarding prostate cancer external radiation treatments

You will want to weigh the risks, benefits, preferences, and outcomes of various treatment options; these can help guide your decision and help you start an open and candid conversation with your oncologist.

> What are the different external radiation treatment options (IMRT, SBRT, Proton) for my condition?
> Which kinds of external radiation therapy would treat my cancer best (IMRT, SBRT, or Proton)?
> Which are available at this facility?
> How many have you done?
> What are the procedures (When/Where/How) for each type of radiation treatment?
> What are the expected side and after-effects and risk factors with (the specific form of) radiation treatment?
> Will I require hormone therapy (Eligard, Lupron, Orgovyx) as part of my treatments?
> What side-effects should I expect from the hormone therapy?
> Is there a way to minimize the side-effects from the hormone therapy?
> What are the chances that I will suffer from complications during or after treatment (from either the radiation or the hormone therapy)?
> What are the chances that I will have GU, GI, ED, incontinence, bowel, rectal, problems during or shortly after, treatment?
> Should I be worried about side effects years after treatment has ended?
> What advanced technologies do you offer at this facility that can help reduce the risk of side effects?
> For (the specific form of) radiation, will I use a rectal spacer? If so, what type (SpaceOAR, Barrigel, or BioProtect)?
> Is there a chance the cancer will come back after treatment?
> What will the preparation for each treatment look like?
> What will the duration of each treatment be?
> Can you describe the entire treatment plan?
> Will there be an impact on my daily routine?
> Will I be able to continue to work?
> What activities will I still be able to do?
> What activities are not recommended during each type of treatment?
> How soon must a decision on treatment be reached?
> Is there anything that I didn’t ask that I should know?

Hope that helps!
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Can't thank you enough for putting this together. My first visit with my RO is tomorrow.

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brianjarvis | @brianjarvis | Jul 6, 2025
In reply to @mjp0512 "Can't thank you enough for putting this together. My first visit with my RO is tomorrow." + (show)
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Can't thank you enough for putting this together. My first visit with my RO is tomorrow.

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Excellent!

My only recommendation would be to not bombard the RO with all those questions at once. Pick a half-dozen or so on one topic (like radiation, for example) for this first visit; then another half-dozen or so on one topic (like hormone therapy) for the second visit; then possible complications; then…….

That way you’ll have good in-depth conversation in each topic area, give you time to review and understand each one, (and won’t bog him down too long).

Good luck!

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capatov | @capatov | Jul 7, 2025

If you have the option of radiation vs. surgery vs. other treatments, just look at the incidence of post treatment long term side effects. It took me five minutes to realize I did not want a week of post procedural catheterization, surgical drains and up to 50% chance of long term incontinence and impotence. So I chose radiation.

I can say the 23 IMRT external beam treatments were painless and quick. The single high dose brachytherapy procedure was far less horrible than I thought. And I have been blessed with virtually no hot flashes or weight gain from six months of hormone therapy. J

I just today got my first PSA post treatments and I've gone from a 7.1 PSA to a 0.04 PSA. So far, the three phased radiation treatments seems to be working well. Here's praying for a long term low PSA score and cure

Obviously, I am a big fan of targeted prostate radiation at a "center of excellence" facility that does lots of it!

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