Radical Radiotherapy

The first doctor we saw was a cancer specialist who was offering a radiotherapy treatment.

He seemed rather nonchalant and confident that he could cure my cancer - something that concerned us at the time, but makes more sense as we have learnt more. There were two course one of 20 treatments (4 weeks of 5 days) using a lower, less focused beam of radiation, and a course of 5 treatments (1 week) using high doses and tighter focused beans. In both cases the patient receives the same amount of radiation. The side effects are similar - there is a long list of likely/possible short term and longer term (possibly permanent) side effects.

The area of the body containing the prostate is pretty congested with the bladder and related structures, the bowels and the nerves and pipe work supporting the penis and reproductive piping. The radiation can affect all of that to a greater or lesser extent. 

A key point is that the prostate, the various plumbing routes and related connections, albeit irradiated in parts, remain in the body as is. The body will still generate PSA, but the levels can be monitored and additional medication prescribed if necessary. This continuing presence of the prostate does leave the risk (albeit a small one) that even if THIS cancer is cured, another prostate cancer could develop in future, but in the grand scheme of things this does not worry me.

For both courses of treatment the medical team would first suppress my natural testosterone, the male hormone, which normally stimulates the prostate for at least a couple of months. By inducing  sort of a male menopause the cancer is stalled and the doctor said much of the cancer woulds be killed, leaving less work for the radiation. This suppression will likely last between 6 months and 2 years depending on how well I respond. There are additional side-effects from the long term use of the suppressant drugs, hence their removal at the earliest sensible point.

The doctor was clear that he recommended the 20 treatment option in my case. Upon questioning it appears that the softer focus. lower intensity of the beams better suits the spread of my cancer and it proximity to the capsule.

We have also learnt that the testosterone suppression once started also removes any immediate urgency for the course of radiotherapy meaning we can schedule it for a period that makes sense amidst the other things that are going on.

Hearing all this I found myself leaning towards radiotherapy, but still had to talk with the surgeon.