Surgery or Radiotherapy? Decision made!

I'm having a senior moment. Why am I calling you David when I know you are our WARRIOR. Sorry about that

LOL  !!

I have had very little problems, initially bowels 3/4 times a day but now regular, once after breakfast. Get up once a night for a pee , no change. Hot flushes have been a bit worse, still only at night. Now have my follow meeting booked for 15/4. Any questions I should ask

Hi 10UP,

My consultation is on 8 Apr, so we’re still (almost) in step with each other.  I will be asking about my CBC (complete blood counts) as the radiotherapy reduces white blood cell count (leading to leukopenia) including reduced neutrophil count (neutropenia) and low lymphocytes count (lymphopenia).  Basically, this means lower immunity.  I want to have regular CBC checks to see if I need any medication to help these levels recover.  I feel fine, but it’s a conversation worth having.  Another question will be how long will I need to stay on decapeptyl hormone therapy. My notes currently say 12 months, and I’m happy with that as I’m tolerating it well.  But I need to discuss if there is any benefit to going to 18 months, or any risk with coming off it after only 7 months (I’ve had one 1 month jab and two 3 month jabs so far).

Apart from those questions, I would like to see any scans (before / after) as I was scanned each time before delivery. I’m intrigued by the science! 
AW

Hi AW

I know that chemotherapy destroys white and red blood cells, but why would radiotherapy do that?  If anything I would have thought that RT causing tissue destruction would lead to an increase in white cells in order to clean up the area.

With regard to more or less HT, it is not directly related but the latest 5 fraction RT as originally researched by the Royal Marsden and being introduced throughout the NHS, is without HT.  There seems to be some balance between the dose of Gy and the facility to omit HT.

The science of the latter interests me, because I am opting out of HT and having 7 of ultrahypofractionated RT at a higher Gy than the standard.

The length of time to be on HT seems to be an art rather than a science!  Approaching ( hopefully) the end of HT there is a real fear for us of recurrence on the one hand and absolute hope that the PSA will not rise! It’s almost like letting go of a safety net but, at the same time looking forward to my husband coming through the door in a 25 year old’s body ( exaggerating a bit - I wouldn’t be able to keep up with that:) )

it seems very much that the decision to finish the HT is a matter of weighing up patient tolerance and consideration of side effects such as diabetes etc  more than statistical evidence?

Yes - and, of course, HT can reduce bone density leading to osteoporosis, so need to pay heed to that as well.   AW

Not sure of the mechanism between radiotherapy and WBC (white blood cell count), but my baseline WBC & lymphocytes counts (pre HT and RT) were 3.8 & 1.6.  Now they are both below the low limits.  They are 2.6 & 0.5.   The lymphocytes count is particularly low - due to my whole pelvis ( including all lymph nodes) was treated with radiotherapy.   AW

Hi AW.

Do you really want to know. Please take care as it looks as if it could take up to 3 months for your immune system to recover.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283969/

I suppose the clue is in whole pelvis radiation' and thus the wider RT field taking in the bones of the pelvis.  The blood cell producing bone marrow is obviously affected.

All very interesting, and something I hadn't considered.

The question is over how significantly immunity etc can be affected and what precautions should be taken over the time it takes for the WBCs to replenish.

D