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1 Year Post CK Possible Side Effects/Bladder
Hoping4TheBest
Posted: Wednesday, November 04, 2009 11:40 AM
Joined: 11/4/2009
Posts: 4


Hello:

 

I am now 14 months post CyberKnife treatment for prostate cancer. I am glad to say that my last two recent PSA test levels were 1.3 & 1.0. Since my CyberKnife treatment urination has not been restrictive, however slightly more frequent (2 - 3 times a night) accompanied by random bouts of diarrhea.

 

Approximately 30 days ago I began having pain during urination, more specially towards the tip of my penis and between my pelvic bone (bladder location). This pain over a week's time increased and visible discoloration (blood) in my urine was present. Increased urination urgency and restrictive flow escalated. I visited my General Physician who placed me on Bactrim for 7 days thinking it was a bladder infection. Upon the completion of this treatment my symptoms grew steadily worse. I was referred to an Urologist who performed a urine test which found blood, but there was no evidence of an infection.

 

The Urologist diagnosis was Prostatitis. He placed me on 3 more weeks of Bactrim. After 14 days of this treatment my symptoms diminished greatly and I had very little visible discoloration in my urine. Then with great vengeance the pain and symptoms returned. Large Gross Hematuria flakes (Coagulated Blood) were present in my urine. I went to the hospital on 11/02/09 for CT Scan without and with contrast on my abdomen and pelvis. CT SCAN Final Report stated: “The urinary bladder appears abnormal being thick-walled and irregular particularly at bladder base. It is possible that this is a post radiation change. Clinical correlation is necessary. Cystoscopy might also be considered. The wall of the bladder at the bladder base appears trabeculated and thickened. The prostate appears mildly enlarged. There are some metallic clips noted within the pelvis.”

 

On 11/03/09 I had a Flexible Cystoscopy done by my Urologist. He diagnosed that severe inflammation was present from the 11:00 to 2:00 position in my bladder and was definitely the source of the Gross Hematuria. The inflammation was of unknown origin. He presented it could be from CyberKnife post radiation scarring or possibly malignant cancer. HOWEVER, it did not resemble any cancer he had seen during his career. He recommended to scrape the internal lining of the bladder then cauterization. He then would do a pathology on the inflammation.. I am now on Macrobid for the next 3 days because of the cystoscopy being done yesterday (11-3-09).

 

Prior to this type the surgery I would like to direct the following questions to the CyberKnife doctors.

 

#1         Could CyberKnife treatments be associated to the inflammation in my bladder?

 

#2         Have you had any reports CK post treatment that resemble my current situation?

 

#3         Do you have any treatment options/recommendations?

 

#4         Has any other CK patients experienced this problem if so how did you treat them?

 

 


radsrus
Posted: Wednesday, November 04, 2009 2:10 PM
Joined: 10/10/2008
Posts: 4148


1. Yes, this could be from CK treatment.
2. Not exactly, but this is certainly the sort of thing that could happen, although it usually does not.
3. They may want to try Trental and vitamin E and Elmiron. If it continues, we would consider hyperbaric oxygen
4. WE have not seen this exact set of events


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Hoping4TheBest
Posted: Thursday, November 05, 2009 8:09 AM
Joined: 11/4/2009
Posts: 4


Very nice article about Medicare Expanding CyberKnife Treatment Options for Prostate Cancer

http://www.glgroup.com/News/Expanding-Treatment-Options-for-Prostate-Cancer-44054.html

 


Donald B. Fuller, M.D.
Posted: Thursday, November 05, 2009 9:20 AM
Joined: 10/10/2008
Posts: 370


#1         Could CyberKnife treatments be associated to the inflammation in my bladder?

 

Yes

 

#2         Have you had any reports CK post treatment that resemble my current situation?

 

We have seen a small number of cases of bleeding from the bladder neck post-CK, however, to date, all have been minor and self limited - We have not seen a case of the severity you describe but such a thing is possible in my opinion - If we do see a severe reaction from radiation we prefer conservative management, using meds such as outlined by Dr. Medbery +/- hyperbaric oxygen, with surgery of any form held as an absolute last resort - We did have a case of severe urethral inflammation post-CK that did respond well to hyperbaric oxygen after all meds had failed

 

#3         Do you have any treatment options/recommendations?

 

Conservative management and wait it out if possible

 

#4         Has any other CK patients experienced this problem if so how did you treat them?

 

We have sent two of our worst cases for hyperbaric oxygen (out of 140 or so) and both responded well - 98% of the time we have not had to consider that



Donald B. Fuller, M.D.

Radiation Oncologist

CyberKnife Centers of San Diego

477 N El Camino Real, Ste D101

Encinitas, CA 92024

(760) 230-6706

dfuller@rmgmed.com


Hoping4TheBest
Posted: Thursday, November 05, 2009 3:31 PM
Joined: 11/4/2009
Posts: 4


Initally, I would like to say Thank you to all the Doctors and Staff that have assisted me during my pre and post CyberKnife treatments. You have always been attentive and offered timely responses. Those are qualities that offer comfort during stressful life challenges such as my prostate cancer. A rare find in today's hurried society.

I have obtained the medications referenced above and I will commence taking them this evening. I will post future updates.

Again, Thank you.....

 


Hoping4TheBest
Posted: Tuesday, November 17, 2009 12:52 PM
Joined: 11/4/2009
Posts: 4


As an update, most severe pain I have been experiencing has subsided since starting the above recommended medications, however, blood is still present during urination. Sometimes in gross hematuria magnitude. As of the date of this writing, I no longer experience severe coagulated blood voiding in my urine.

I have found this article regarding radiation cystitis very informing and very much worth reading.

.

http://emedicine.medscape.com/article/442319-overview

.

If any doctors can make further recommendations as to treatment options, it would be greatly appreciated.

 

Thank you.

 

 

 


viperfred
Posted: Tuesday, November 17, 2009 6:38 PM
Joined: 10/10/2008
Posts: 788


Hi Hoping4TheBest, Thanks for sharing medscape link. Glad you are improving. Very interesting information. I am glad the CyberKnife was used to treat my PCa. Fred
radsrus
Posted: Wednesday, November 18, 2009 5:22 AM
Joined: 10/10/2008
Posts: 4148


You might want to talk with the doctors up there and see if they can set you up with HBO. It is better to use it early than late. But if not, you are getting better and can see what hapens.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Donald B. Fuller, M.D.
Posted: Wednesday, November 18, 2009 8:39 AM
Joined: 10/10/2008
Posts: 370


I concur - This seems like a case that may benefit from hyperbaric oxygen

 

Get a couple of good books . . .

 

(30 - 50 sessions that take an hour plus . . .)



Donald B. Fuller, M.D.

Radiation Oncologist

CyberKnife Centers of San Diego

477 N El Camino Real, Ste D101

Encinitas, CA 92024

(760) 230-6706

dfuller@rmgmed.com


Jak29672
Posted: Tuesday, June 25, 2013 8:01 AM
Joined: 6/25/2013
Posts: 12


I came across this post from a few years back. It caught my attention because I have some different but similar side effects. No pain but dramatic increase in urination frequency. Prior to ck, had normal frequency, 6-8 times per day and may be once at night. Post ck, I am going 15 times a day and 3-4 times a night. Nights are especially difficult. Takes 15 mins to void. Taking .8 mg tamsulosin. Works good through out the day but nights are tough. Not sure where to go. My ck was about 9 months ago and this issue seems to continue to get worse.. Any thoughts?

Jak29672
Allen_E.
Posted: Tuesday, June 25, 2013 12:44 PM
Joined: 8/8/2010
Posts: 539


For me, one Rapaflo worked much better than 2 flomax. Taken at night. I think Aleve helped too. It resolved eventually.
- Allen (not an MD)
Jak29672
Posted: Tuesday, June 25, 2013 7:32 PM
Joined: 6/25/2013
Posts: 12


Allen, thank you for your quick post. What does the Aleve do to relieve the symptoms? I thought all all alpha-blockers were similar in their results, what makes Rapafllo different from tamsulosin? Again, I appreciate you insights.
Jak29672
Allen_E.
Posted: Tuesday, June 25, 2013 11:05 PM
Joined: 8/8/2010
Posts: 539


Aleve is an anti-inflammatory that might reduce inflamed tissue. All alpha-blockers are slightly different - find the one that works best for you.

- Allen (not an MD)
flyguy909
Posted: Tuesday, July 02, 2013 11:23 AM
Joined: 2/10/2012
Posts: 25


Wanted to chime in and say that I also have been experiencing similar side effects 12-13 months post CK. On and off I had a little blood or bits of coagulated stuff for about 8 weeks or so. Checked for bladder infection, then did Cipro for the last month. The bleeding appears to be gone now, but like Jak said, days are ok but nighttimes can be tough. Started taking vitamin E. Symptoms appear to vary somewhat week to week - burning intensity and restrictiveness. Seems sex temporarily makes it a little worse. Sidenote - tried Rapiflo instead of .8 Flomax. Seemed to not work as well. Back on Flomax.
alan katz md
Posted: Wednesday, July 03, 2013 4:01 PM
Joined: 10/10/2008
Posts: 463


If you give 35 GY, I have seen about 5% of men get these symptoms, higher for 36.25 Gy. The good news is that the symptoms usuallt subside on their own over a few months time

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


Jak29672
Posted: Wednesday, July 24, 2013 7:19 AM
Joined: 6/25/2013
Posts: 12


Allen (not an MD) - Just an update. Rapaflo did not work as well as Tamsulosin for me. The Aleve is great. Not sure why there is still inflammation after 9 months but all I can say is that it helps. Have had these side effects for about 6 months. Began right after the 4th month pst CK. Not sure what is meant by "subside...over a few months time".

Jak29672
Allen_E.
Posted: Wednesday, July 24, 2013 9:42 PM
Joined: 8/8/2010
Posts: 539


Jak- I wish I could give you a formula to put your mind at ease, but everyone is a little different. They call these "late term effects" and they're fairly common. Mine started after about a year and lasted a few months. What Dr. Katz means, and he has probably treated more men with SBRT than anyone, is that the symptoms you're experiencing will almost certainly disappear on their own even if you do nothing about them. If Rapaflo and Flomax didn't help, there's Hytrin, Uroxatral and a few others. Some guys get bladder spasms that can be relieved with Vesicare, Enablex, Elmiron, etc. My friend who just had HDR said Pyridium, a urinary tract analgesic, was very soothing, but it stains urine - and tidy whities - bright orange and one can only take it for a short time. There are lots of medications, but you will have to sit down with your urologist to work out what makes sense for you. There are prescription strength versions of Aleve that you can ask your doctor about too. I hope you start feeling better soon.
- Allen (not an MD)
Jak29672
Posted: Thursday, July 25, 2013 8:29 AM
Joined: 6/25/2013
Posts: 12


Allen (not an MD) Thanks for bing part of the message board. Your information helps. I'll stick with the tamsulosin for now. Like I said works fine during the day. Not a frequency thing at night, just takes 15 mins or so to start and finish. Encouraged that this will eventually correct itself.

Jak29672
Jak29672
Posted: Monday, August 19, 2013 1:29 PM
Joined: 6/25/2013
Posts: 12


Allen E, You seem to know a lot about the side effects associated with this procedure. Saw a new urologist and he is suggestion my symptoms this far after the procedure may be related to the formation of scar tissue. Am I being too impatient waiting for the side effects to subside or might it be scar tissue that has developed?
Jak29672
radsrus
Posted: Monday, August 19, 2013 3:00 PM
Joined: 10/10/2008
Posts: 4148


This sort of thing usually goes away, but it can take a while. We frequently use a combination of vitamin E, Elmiron, and Trental. My empiric observation is that it helps, but I don't have a shred of data to back that up.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Allen_E.
Posted: Tuesday, August 20, 2013 1:21 PM
Joined: 8/8/2010
Posts: 539


Scar tissue/fibrosis seems to be difficult to reverse. I think Doc Medbery is onto something with the combo of Trental and Vitamin E, but I think their effect, if any, will take a lot of patience. I've been reading about a Vitamin E analog called tocotrienol that may work even better (it's fairly inexpensive and available on the net). The other fibrosis-reversing procedure that seems to work for some people is hyperbaric oxygen therapy. As the Doc said - there's not a lot of high level evidence for any of this, but he sees a lot of cases, so his experience is about as good as you can get. If you try any of this, let us know how well you think it works.
- Allen (not an MD)
gardenz
Posted: Wednesday, August 21, 2013 3:00 AM
Joined: 8/5/2013
Posts: 15


For Allen and the doctors here, why do these "late term effects" start to pop up a year after CyberKnife treatment? The body has taken all that time to mend. Isn't the radiation damage being repaired?
JAV
Posted: Wednesday, August 21, 2013 5:44 AM
Joined: 10/29/2010
Posts: 650


I think the answer is no one really knows exactly why ....... Radiation works to kill cancer cells, it's been used for about a hundred years, but there is still not complete understanding of the details on what is exactly happening especially over time. We will see what the experts have to say about this. The above is only my personal non-educated opinion. All I can tell you for sure is that my PSA was 0,3 a month ago and I'm still waiting for any late-term effects to kick-in. JAV ( not a MD, DO, or PhD )

Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7 PSA at 7-13 , 0.3
Allen_E.
Posted: Wednesday, August 21, 2013 1:01 PM
Joined: 8/8/2010
Posts: 539


I'm not a radiobiologist, but my guess is that healthy cells attempt to repair themselves from the DNA damage caused by the radiation and go into an extended resting phase of the cell mitosis cycle. The ones that can't self-repair in all that time then go into programmed cell death (apoptosis) which involves release of cytokines that may be responsible for the symptoms.
- Allen (not an MD)
ChicoXXX
Posted: Wednesday, August 21, 2013 3:29 PM
Joined: 10/10/2008
Posts: 380


What is considered to be Normal. (normal range or urinations during an eight hour sleeping period for post CK patients Medicare eligible? For dietary reasons, I eat a lot of vegatables for dinner and find myself getting up at least once, if not twice, during the night. I don't remember my schedule pre-ck. Thanks
ChicoXXX
Posted: Wednesday, August 21, 2013 3:29 PM
Joined: 10/10/2008
Posts: 380


What is considered to be Normal. (normal range ) of urinations during an eight hour sleeping period for post CK patients 70 yrs old +\-. For dietary reasons, I eat a lot of vegetables for dinner and find myself getting up at least once, if not twice, during the night. I don't remember my schedule pre-ck. Thanks
radsrus
Posted: Thursday, August 22, 2013 3:22 AM
Joined: 10/10/2008
Posts: 4148


My guess about the late term effects is that small blood vessel changes occur about that time. BUt that is only a guess. We actually don't see a lot of the late term effects. I have not seen any in our patients since we changed to the HDR-like regimen. But the very few you do see are sometimes miserable enough for a while that it SEEMS like you are seeing a lot. It is a very unusual thing though.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


radsrus
Posted: Thursday, August 22, 2013 3:23 AM
Joined: 10/10/2008
Posts: 4148


Nocturia (having to get up to urinate at night) is variable and can occur for a variety of reasons. I have closely questioned patients for a while and I m convinced that a lot of it is that they wake up for other reasons and then get up and go since they are awake, or because once they are awake they feel the urge.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Jak29672
Posted: Thursday, August 22, 2013 3:40 AM
Joined: 6/25/2013
Posts: 12


Allen E, The changes at the cell level are a little beyond me. From what I read it could explain why Aleve and vitamin E work. How long can one take Aleve without concern? Still a little confused about late term side effects. Don't want to seek medical care and have someone do something that might make it worse and on the other hand don't want to ignore symptoms if it is something more serious that needs to be checked out. If it is truly rare, it may be a sign of something else going on. I am going to try the tocotrienol with a little patience and will let you know where it goes.

Jak29672
Allen_E.
Posted: Thursday, August 22, 2013 5:49 PM
Joined: 8/8/2010
Posts: 539


Jak29672, I'm not a doctor and know nothing of your medical history, so I would refer that question about how long to take Aleve and how much to take to your doctor. What I like about Doc Medbery's combo of Trental & Vitamin E (or tocotrienol) is that they seem to work well together. Trental is said to change the shape of red blood corpuscles, allowing them to bring oxygen into places that have not been well supplied. I'm not sure how Elmiron works, but if he's noticed that it does, it may be worth discussing with your urologist. Where we lack high level clinical evidence, an expert's observations (as from the doctors who are generous enough to freely offer us advice) may be the best any of us can have.

- Allen (not an MD)
Jak29672
Posted: Friday, October 11, 2013 3:24 AM
Joined: 6/25/2013
Posts: 12


Finally got in to se a urologist and told them about use of Trental and Elmiron. Unfortunately, they didn't see the connection. Seem to have develop urine retention and they associate this to a possible stricture. Cysto scheduled.

Jak29672
JAV
Posted: Friday, October 11, 2013 5:38 AM
Joined: 10/29/2010
Posts: 650


IMHO, I wouldn't let them do a cysto until the drugs are tried - the less invasive, more conservative approach.  Sounds like your uro. is into plumbing, eh ?  BTW, Doing a cysto can cause problems.   You can always have the cysto done later.  You are the patient ( decider).  The Dr. / patient relationship isn't a game of "follow the leader".  You input / concern should be respected.

Also, recently I have been using a CPAP machine.  And since I started using it, I am getting up less at night to urinate - like only about once a week vs. three times a week previously.   I mentioned this to the sleep medicine Dr. and he smiled and then said that's common.  He said sleep apnea can cause the production of uric acid to increase and cause nocturia.  Also, he said with sleep apnea patients aren't in deep sleep.  This goes along with Dr. Medberry's theory.

JAV ( not a MD, DO, or PhD )


Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7 PSA at 7-13 , 0.3
flyguy909
Posted: Friday, October 11, 2013 7:56 AM
Joined: 2/10/2012
Posts: 25


Jak, just wanted to let you know that you are not alone.. I have the same issues and it's now been almost 1.5 years since procedure. My RO seems puzzled and my Uro seems not too concerned since I'm tolerating it ok. The last week I've started to get a little dull pain in the tip of my penis that comes and goes during the day. Days are usually ok but sometimes a get more burning and restriction during the day, but not as bad as nighttime. Sometimes this happens (sometimes during the evening if I've drank more than usual fluids) - I get the strong urge to go, then almost can't get a flow going but manage to evacuate some. Then 5 minutes later have to go again and this time the spigots are open, flow much better. I've basically given up drinking more than 1 beer at any one time because of the issues the last 6 months.. and I used to brew beer as a hobby. Life's not fair.
Jak29672
Posted: Saturday, October 12, 2013 3:46 AM
Joined: 6/25/2013
Posts: 12


Thank you flyguy909, symptoms sound very similar. Just had my 1 year anniversary for CK. These symptoms appeared about 6 months after the procedure. I am confused about use of drugs for a stricture. Clarification would help me communicate with my Urologist. Logically, it seems the drugs might help prevent formation of scar tissue but if a stricture has developed, how do they get rid of the scar tissue/stricture?

Jak29672
JAV
Posted: Saturday, October 12, 2013 5:33 AM
Joined: 10/29/2010
Posts: 650


Jak:

Yup, drugs can't treat a stricture.  The issue is wether you have a stricture, or not.  The urologist hasn't determined that yet, that's why he/she wants to do a cystoscope, I believe.  They think you may have a stricture.  But other conditions can cause you symptoms.  So why not try drugs first before a cystoscope to rule out the other possibilities ( besides a stricture) ?

Doing a cystoscope can cause damage and long lasting complications, from what I have read.  It's a diagnostic procedure, not a treatment.

JAV ( not a MD, DO, or PhD )


Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7 PSA at 7-13 , 0.3
ecrane
Posted: Saturday, October 12, 2013 9:33 AM
Joined: 4/27/2009
Posts: 27


I also have had similar symptoms and issues.  For an overview read my post regarding "late effects four years out?" which is a few posts down from this one.  I began to have difficulty around Labor Day as described in the post.  I've followed this forum for many years, even before my treatment, and it's been very helpful.  I also though I may have had some radiation cystitis based on my symptoms and what I read here.  It never got better and, in fact, got worse.  I was seen by my Cyberknife doctor who didn't believe it was caused by my treatment given it was four years out and I hadn't had problems before.
I had been seeing a local urologist who ended up doing a cystoscopy which  my Cyberknife doctor recommended doing to assist in getting to a diagnosis.  He found I have a "high bladder neck" and "kissing lobes" from my prostate, basically BPH.  Of note he didn't see any signs of cystitis which is what I "assumed" the problem was.
At present, I'm self cathing 3x daily to keep down the amount of urine carried by my bladder, as I can still void some but leave post void residuals of around 500-530 mls.  This evidently is too much. Rapaflo and Flomax have not been helpful.
I also saw the urologist associated with my Cyberknife team and he had floroscopic 
urodynamics done which showed a functioning bladder that is quite obstructed.
So now I'm left with a choice of having a limited TUIP/TURP done on radiated tissue to have a chance of getting normal function back or I can continue to self cath.  Nice choice huh?
My point, if any, is don't assume what your diagnosis is, you may be wrong.  By the way my PSA is 0.5.  However, this isn't quite the cure I was expecting.
Ironically, if I had had the prostatectomy I didn't want because I felt Cyberknife was a superior treatment, and had done well, ( a big if) I wouldn't be typing this.  It seems a treatment that was quite succesful in treating my cancer puts me in a position where other treatments are made more difficult.

alan katz md
Posted: Saturday, October 12, 2013 1:27 PM
Joined: 10/10/2008
Posts: 463


I think that doing a cysto to see what is going on is not a problem. If it is a stricture, it can be dilated. I have seen pts get a limited TURP with laser after CK without becoming incontinent. It just has to be done correctly. Too muc resection can lead to incontinent.

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


Jak29672
Posted: Monday, October 14, 2013 5:32 AM
Joined: 6/25/2013
Posts: 12


One of the things I appreciate about this site is the exchange of good information. It is otherwise hard to come by. ecrane, thank you for your "story". It does help. Right now going through several studies. Did a bladder scan and found I was retaining some urine (300cc) , not as much as yours. Doing a voiding diary right now and a uroflometry soon. Then a cyst (if necessary). Trying some Baclofen and possibly Finasteride. If these drugs don't help I think the cysto is next. Out of curiosity, did you have a large prostate going into CK? Does prostate continue to enlarge even after CK? Are strictures common after radiation (CK, brachytherapy, or other external beam radiation)? Can HoLEP (Holmium Laser Enucleation for the Prostate) be preformed after CK?

Jak29672
ecrane
Posted: Monday, October 14, 2013 6:22 AM
Joined: 4/27/2009
Posts: 27


Jak29672
Regarding prostate size, I've been told by various providers I've seen over time that I have a "small gland".  I don't know it's volume aside from that comment.  I've been told the total size of the prostate may not correspond with how much it compresses the diameter of the urethra.  I was given the analogy of a donut hole, it can be large or it can be small.  It appears I've got a small one.
I don't know if the prostate continues to enlarge after CK the doctors would have to answer that question.  I was told this probably would have happened even if I hadn't had radiation tx.  It's the history of radiation tx that makes, as it appears, a fairly basic urological procedure more complicated.  I saw a quote somewhere "radiation never forgets"...
That rest of your questions will need to be answered  medical providers,as I don't know.  What reading I've done seems to indicate that urinary problems seem to be a little more common with brachytherapy.

JAV
Posted: Monday, October 14, 2013 4:26 PM
Joined: 10/29/2010
Posts: 650


I doubt if the prostate enlarges after CK.  My R.O. has done two DRE's post-toastie on me and he has said both times,  it feels " smooth and flat".  He also said he believes it is all "scar tissue" at this point.   If that's true, I can't see how it can enlarge post CK.

I'm interested in hearing the Docs opinion/experience on this question.

JAV ( not a MD, DO, or PhD )


Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7 PSA at 7-13 , 0.3
alan katz md
Posted: Tuesday, October 15, 2013 5:14 AM
Joined: 10/10/2008
Posts: 463


Overall, the gland shrinks a lot over the first few years after SBRT. However, obstructive symptoms can still occur. Actual strictures are not common. I have seen a few percent with 36.25 Gy and less than one percent with 35 Gy.

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


Jak29672
Posted: Thursday, January 16, 2014 1:35 PM
Joined: 6/25/2013
Posts: 12


Finally went ahead with a cyst to see what was/is happening. No strictures but prostate appears large and inflamed. Uro seem to feel this is what it causing the difficulties with voiding. Tamsulosin and Finasteride aren't enough. He is suggesting something called Revolix Laser to reduce the size of the prostate. Seem to have a retention problem since voiding has been difficult. I have heard procedures to reduce the size of the prostate are complicated by the fact that I had radiation. Is that true? As mention above, will the prostate eventually shrink on its own?

Jak29672
alan katz md
Posted: Friday, January 17, 2014 4:50 AM
Joined: 10/10/2008
Posts: 463


I would try to avoid any surgical procedure. I would try an anti inflammatory,like Aleve, for a while. Eventually, this will reverse and the gland will shrink.

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


MF
Posted: Sunday, April 06, 2014 9:35 AM
Joined: 4/6/2014
Posts: 1


3.5 years post Cyber knife treatment. Last 4 months having issue with large blood clotting causing bladder blockage, catheter is necessary to void and catheter gets block as well. My prostrate is small and PSA.01, No infections in unary track, kidney test are good. Meds tacking for hip replacement pain are 5o mg. tramadol, 10/325 oxycodone, 4o Lay sic, 25o potassium Is the blood clotting a result of the 5 gold targets still in prostrate? If clotting is a result of cyber knife why would it take 3.5 year post procedure?
JAV
Posted: Sunday, April 06, 2014 1:47 PM
Joined: 10/29/2010
Posts: 650


So, is there any way to determine the source of the clots ?   Seems to me if they are coming from the bladder,  there may be another reason besides CK as the cause after 3.5 years.   Maybe the Docs. can tell us if this has been a common occurance with IMRT and/or CK ( any CaP radiation treatment ).  What does your Uro. have to say ? 

JAV ( not a MD, DO, or PhD )


Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7
 PSA at 7-13 , 0.3
 PSA at 11-13 , 0.3

alan katz md
Posted: Sunday, April 06, 2014 2:34 PM
Joined: 10/10/2008
Posts: 463


I have seen  very little of this. Did you have a cystoscopy to see where the blood is coming from?. Are you on anticoagulation therapy?

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


radsrus
Posted: Monday, April 07, 2014 2:31 AM
Joined: 10/10/2008
Posts: 4148


Late radiation cystitis is a possibility, and yes, it can occur after this amount of time. It sometimes responds to a combination of vit E (400 IU three times a day), Elmiron three times a day, and Trental 400 mg three times a day. Ask your doctor. Stop any anticoagulants including aspirin and NSAID's if you are medically able to dose. Again, consult your doctor. This may take many months to heal up. I have not seen this in years, but saw 1-2 cases in our early patients and saw a few patients who were treated elsewhere and came to me for a second opinion. Drink lots of fluids to keep urine flowing.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Rotorhead
Posted: Monday, July 28, 2014 7:30 PM
Joined: 7/28/2014
Posts: 2


I just registered but have been following this discussion for almost a year. I have similar problems that started 3 to 4 months after my Cyberknife treatment in April 2013. My doctor wanted me to wait and see which I did. The situation never got better and I developed additional problems. My Urologist put me on tamsulosin and we took voiding measurements which varied from 50ml to 200ml at different times throughout the day and night. I voided more at night than day. Now I have issues with bowl movements. In addition to being up 3-4 times per night to urinate plus frequent urination doing the day and when I feel I must urgently go, I also have a bowl movement. This happens quite frequently throughout the day but not at night. The doctor also added Vesicare to the medication but then I had uncontrollable bowl movements and discontinued Vesicare. Besides these issues discussed on this forum, can CK also cause IBS?
radsrus
Posted: Tuesday, July 29, 2014 1:34 AM
Joined: 10/10/2008
Posts: 4148


No, but it can cause radiation proctitis. Ask your doctors about steroid foam or suppositories

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Rotorhead
Posted: Tuesday, July 29, 2014 3:49 PM
Joined: 7/28/2014
Posts: 2


Thanks for the help. I will check with my Urologist and Oncologist about radiation proctitis. It seems like this is a possibility. I am 70 but my urination problem only started after my Cyberknife treatment. That is why I have been following this thread.
 

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