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Treatment without HT

User
Posted 26 Jul 2020 at 13:24

I asked a consultant urological radiologist why a prostate doesn't work after RT, if the X-rays only kill the cancer cells.

The answer was that the non-cancerous prostate glandular cells would still work. However, the repeated exposure of the prostate muscle to daily X-rays results in the generation of lots of fibrous material in the muscle as it heals, and it can't contract to expel the fluid. Also, many of the small ducts may be blocked by fibrosis. A prostate is typically around 5% effective after RT, but this can vary from nothing in some people, to very significant recovery for others.

Someone I know has recovered over half his ejaculate having finished RT and HT. It's worth noting that over half of the semen comes from the seminal vesicles, and the prostate contributes a smaller proportion. If someone had their prostate but not seminal vesicles irradiated, they may still ejaculate something looking like semen, but missing the prostate contribution (which is a clear fluid, so not obviously missing). If that applies to you, I think you could try an experiment to confirm if the prostate contribution is missing. A substantial part of the contribution from the prostate is PSA. PSA's job is to liquify the semen so the sperm can swim out, and this normally happens within a few minutes of ejaculation - semen will go runny and clearer. If yours doesn't, you are probably missing the prostate's contribution to it.

If you had spread in/near the seminal vesicles or were a high risk patient (PSA => 20, or Gleason >= 8, or T3 or N1), you will normally have your seminal vesicles included in the RT target area too, in which case they are likely to be very ineffective afterwards too. Even if they are working, they might not still have functioning ejaculatory ducts through the irradiated prostate, but if you get white coloured semen, then your seminal vesicles are working to some extent, and managing to get their contribution through the prostate.

User
Posted 28 Aug 2020 at 09:11

Originally Posted by: Online Community Member
Well, we got through lockdown ok and now all 21 active cases are in quarantine and all new arrivals are put into isolation and tested. No community transition. I went to see a Dr about hemorrhoids (sp?) and he felt the prostate while he was there. First time since rt and too good an opportunity to miss perhaps. He commented that it was quite small and couldn't feel any lumps. Question. What happens to the prostate after rt? Does it shrink as the cancerous cells are dying off and do the normal cells regenerate if they are killed as well?Not the cancerous ones hopefully! Will the gland now be a completely different shape? My Dr said not to do any dre's after rt but my specialist said a year after rt. I'm now 18 months after rt and starting to worry about the next PSA in September. A six month wait. Dr said 3 months, specialist said 6 so I chose 6. Of course.
Keep safe everyone!

There has been another outbreak in the community, so over 100 new cases. Not sure of the exact number but 5 to 10 daily. Some restrictions again, L 3 or 2 depending on where you live. Maybe easing soon. PSA in 3 weeks but not stressed. Yet. We shall see. 

User
Posted 15 Sep 2020 at 02:43

Originally Posted by: Online Community Member
The RT may carry on working for a couple of years but you would generally be looking for nadir at 18 months. The RT damage to cells might still have some effect but the PSA may start to rise again as healthy prostate cells replicate so my priority would be the August blood test. If getting a PSA test in June is instead of August then fine but I would be reluctant to have a June test and then get pushed back to November / December

Yesterday's result was 1.5! Almost didn't believe it so rang back today and it still was. A gap of 6 months and a week and 20 months after rt. Next March is a long way away. Happy.,

User
Posted 15 Sep 2020 at 08:35

Great result. Quite right to be happy.

Ido4

User
Posted 19 Sep 2020 at 21:39

Originally Posted by: Online Community Member
Yes, the nadir is simply the lowest reading that you get. In the case of RT, a man typically reaches his nadir around 18 months after the RT finished because the RT is still doing its damage for that amount of time.

You are aware that you are in an unusual position in that not only have you not had HT to support the RT but your testosterone levels are actually being supplemented so there is little point traumatising yourself with the online articles. You still have a few months to go and it may drop further. If it doesn't go down to 2 or below, your onco might be a little disappointed but the fact that you are still seeing a steady fall is a good sign.

1.5 now, 14 September, 20 months or so after rt. 

User
Posted 27 Sep 2020 at 08:07

Brilliant result.

Could I ask why you didn't have hormone therapy?

I know hormone therapy is less often used in the US, particularly with low and intermediate Gleason diagnosis, but the hormone therapy drugs costing 25x as much in the US is a factor too.

User
Posted 27 Sep 2020 at 19:56

Originally Posted by: Online Community Member

Brilliant result.

Could I ask why you didn't have hormone therapy?

I know hormone therapy is less often used in the US, particularly with low and intermediate Gleason diagnosis, but the hormone therapy drugs costing 25x as much in the US is a factor too.

I am Intermediate Favourable and was told that they treat men with normal testosterone levels now at that level. In fact, I have monthly injections to get me up to normal levels! This article is on another site.

 

Adding ADT to external beam radiation only benefits unfavorable risk patients

 
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