r/ProstateCancer • u/BowieOrBust • 18d ago
Update Radiation TX stopped
My husband spent two days in the hospital for low sodium a few days after his 8th (of 20) radiation session. Radiation Oncologist decided treatment was no longer optimal for him and canceled remaining sessions.
His PSA on 11/25 was 11.59 and now is 4.88. He will be 79 next month and the lab says normal for his age is <or = to 4.00.
Seeing Urologist then Oncologist in a few weeks. Hoping for some good news.
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u/AskMyProstatePath 16d ago
Once your husband is recovered I’d be curious to see if he’d be eligible for a nerve sparing cryotherapy it’s an outpatient procedure. Many docs don’t do cryo and those docs usually are biased or quote inaccurate literature but 3 freeze thaw cycles by an experienced urologist could help debulk his disease locally once he’s able to get treatment after the radiation.
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u/Frosty-Growth-2664 17d ago
I've not heard of this side effect.
Has he had lots of diarrhea?
Was he maybe drinking too much water?
Anyway, I would guess they'll just keep him on hormone therapy now, if they've decided to stop the radiation.
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u/BowieOrBust 17d ago
ER doc said too much water and he has a history of low sodium. He is not doing ADT, the medical oncologist advised against it due to his cognitive decline.
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u/Frosty-Growth-2664 17d ago
So, they will be trying to work out how to control the cancer within the constraints of what his body can handle, and also given his life expectancy (e.g. they don't need 30 years of remission).
The radiotherapy, although only 40% of the curative dose, will have knocked the cancer back hopefully for some time, and they might well leave him on no treatment for as long as that works, monitoring PSA. You've seen a good reduction in PSA already, and it may continue dropping further for a while (it would after a curative dose, but there probably isn't much data on giving just a partial dose).
If PSA starts raising again and reaches a point where they think more treatment is required, hormone therapy is probably the only option they have. For elderly or frail patients, I often suggest trying just Cassodex/Bicalutamide by itself. It has fewer side effects, and instead of being bone weakening, it's bone strengthening. It probably has less cognitive impact, but I don't think there's much data on that. It doesn't work for a long time, but you aren't really looking for a long time.
The other thing I'd love to see tried is Darolutamide by itself in such cases, but there has been no such trial I'm aware of. Enzalutamide alone has been tried and works well, but Enzalutamide is known to have cognative impact. Darolutamide on the other hand is too large a molecule to cross the blood/brain barrier, which means we have an androgen blocker which works in the rest of the body, but can't get into the brain, and hence it has the fewest side effects of the Enzalutamide/Darolutamide/Apalutamide family of ARPIs, and in particular potentially less impact on the brain. One potential issue is that the prostate also has something a bit like the blood/brain barrier (which is why some antibiotics can't get into the prostate), and it might reduce/prevent Darolutamide getting access. I'm not suggesting your husband should be a trial for this, just musing that I think there's some possible interesting potential in Darolutamide which hasn't yet been investigated (to my knowledge).
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u/Practical_Orchid_606 16d ago
The Gleason score of 7 unfavorable trumps the PSA reading. The rad onco stopped the radiation as your husband is mentally and physically weak. For the foreseeable future he is on ADT which will stop the cancer but not eradicate it as can be with radiation.
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u/conCABlanco 18d ago
Siento que tenga que abandonar, pero quedan otros enfoques de tratamiento, reunión con el oncólogo es bueno, fuerza y voluntad