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Monday, May 20, 2013
Alternatives to Radiation Therapy
I am a 61 years old male. After having been diagnosed with prostate cancer, I was diagnosed with lung cancer a week later, lower right lobe removed. I`ve been recovering from the thoracotomy and urologist is injecting Lupron until he decides what to recommend as treatment for the prostate cancer. In 1999 I had a seminoma, and preventive radiation was given to me after removal. The new oncologist I have says that due to the old fashion radiation I was given 1999 I cannot be given radiation again for my actual prostate cancer nor can I have it removed. He is going to discuss the issue with the urologist. My questions: Can I have seeds implanted? Can I have removal via "Da Vinci"? How safe is to continue Lupron for life? PSA is 3.5. Thank you. (as you can see I`ve had a rough time!!!)
You have not mentioned the stage of your prostate cancer. I assume it is clinically localized since you are considering different local options for this tumor. Previous radition does make surgical removal of the prostate difficult. It would depend though on how much of the pelvis was included in your radiation for the seminoma. If the area of the prostate was spared then surgery could be considered, though possibly difficult. Repeat radiation is an issue in the region of the pelvis, though brachytherapy is something that you could discuss with your radiation oncologist. He/she would review the previous radiation protocol, dose and your clinical situation in relation to tumor stage, volume and then discuss the pros/cons of this option.
Another option you could discuss with your urologist is cryotherapy (freezing) for the prostate. This is a relatively newer modality (though has been around for a while). The advantage would be that your previous radiation would not impact this treatment since it is done tranperineally (similar technique as seeds), is minimally invasive, and is not related in any way to radiation. It can be repeated again if there is localized recurrence of the disease. The limitation is that long term data is not available as of now, though the approx 7 year follow up data available at present looks reasonably comparable to other modalities. All this information though, would need to be tailored to your specific clinical scenario and stage of the disease. You can discuss all this in detail with your urologist regarding the pros/cons/risks/complications of this modality.
Hormone therapy is reasonably well tolerated by most patients though some of the potential side effects of decreased testosterone are osteoporosis, decreased muscle mass, fatigue, hot flashes, decreased sexual desire, erectile dysfunction, fatigue, etc. Hormone therapy is usually used for advanced disease or in combination with radiation therapy. I hope the information I have provided answers some of your questions. As I mentioned earlier, all this information has to be considered in relation to your clinical situation.
Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati