Tuesday, 18 September 2012
Monday, 17 September 2012
If your PSA starts to rise after you’ve undergone prostatectomy, so-called "salvage" radiation therapy might be a good option to explore. With this approach, external beam radiation is delivered to the area immediately surrounding where the prostate was, in the hopes of eradicating any remaining prostate cells that have been left behind. Radiation is more commonly being given after surgery for men with high risk disease (positive margins, seminal vesicle invasion, positive capsular extension), even in the absence of a PSA rise. If you did not get radiation immediately, doing so later based on a rising PSA is often reasonable. (Brachytherapy is not an option because there is no prostate tissue in which to embed the radioactive seeds.)
But the procedure is not for everyone. If there are obvious sites of disease outside of the immediate local area, if any tumor cells have been found in your lymph nodes, or if your Gleason score was 8-10, post-surgery radiation therapy may not be right for you. In this high risk situation, additional therapy may be warranted such as hormonal therapies or clinical trials. Also, in men who are considered good candidates for this therapy, it can be very effective, but five-year disease-free rates tend to be considerably higher in men whose pre-therapy PSA levels are lower than 0.2 ng/mL compared with those whose pre-therapy PSA levels are greater than 0.2 ng/mL. Therefore, if you and your doctors are considering post-surgery radiation, ideally you should start before your PSA goes above 0.2-0.4 ng/mL. Side effects from the radiation therapy can be moderately severe, and are additive to those previously received with surgery. These include rectal bleeding, incontinence (urinary leakage), strictures and difficulty urinating, diarrhea, and fatigue. Be sure to discuss with your doctors what you can reasonably expect before deciding on a course of therapy. In some cases, hormone therapy might be added for a short period before radiation to allow your urinary function to heal, or during the radiation treatment, which can also add to the side effects that you might experience.
Because the anatomy looks different and the tumor is often not visible on imaging or felt on DRE, the radiation oncologist has to carefully balance between delivering sufficient radiation to destroy the prostate cells while not damaging the healthy tissue. Once again, practitioner skill can make an important difference in outcomes.
In some cases, particularly if the tumor was considered high-grade and therefore at greater risk of spreading to the surrounding areas, your doctor might decide to initiate radiation therapy right after you’ve healed from your surgery. This approach, known as adjuvant therapy, typically starts about six weeks after surgery, and is unrelated to "salvage" radiation therapy that is administered if the PSA begins to rise.
Saturday, 8 September 2012
Before I was diagnosed, over 2 years ago now, I suffered from severe back aches. The pain was so bad at times that I could barely walk, and if I needed to sneeze I would hold onto a lamp post or kneel down! This had been with me for several years and specialists said that it was simply disc degeneration, all part of the ageing process!
After surgery, as if by some miracle, this pain dissapeared. I was able to run again, it just wasn't there anymore and I even started playing badminton. I joked at the time that had I realised the back pain would go, they could have had my prostate gland years ago!
Last week, very suddenly and for no apparent reason, the pain came back. It was the same pain, like an evil old friend returning, just as bad and it won't go away. I often thought that during the surgery, because my body was elevated and the pressure on my spine relieved for over 6 hours, that something had just clicked back into place. Surely it wasn't the cancer causing this pain because my bone scan was clear?
Funny thing is, by hanging from the balcony and allowing my spine to stretch out with the weight of my body, the pain goes away instantly and doesn't return for hours. I warn Beverley before I do this, after all, finding your partner 'hanging' around the house can give cause for concern! It doesn't hurt at all during the night, but getting up in the morning is fairly hellish.
I'm not due a PSA test until December, but just to be on the safe side I am asking for one next week. If it's clear then great, I know that I have a back problem to deal with again. If it's not, then at least I won't be giving anything another 3 months to develop.
Anyone else had similar back trouble before or after surgery?