Hip pain?

Hi guys I hope your summer is going well. As for me, everything was pretty uneventful after my dad's radiation up until two weeks ago. He has been experiencing some hip pain and he won't go for an MRI. (He hasn't seen a doctor but we are pushing him to at least get it checked out.) I am really concerned, I am actually really scared. I don't even want to think of what it could be.

I mean, could it be with a psa of .55 after surgery and both CT and Bone scans were negative?

Also, I did read online that some people do experience bone and hip pain following pelvic radiation. I guess my ultimate question is has anyone had pelvic radiation and experienced hip or bone pain as a side effect? Just wanted to hear your feedback. Thanks guys.

Lynne

Hey 142 thanks for your reply.
No they havent taken a PSA yet because he is on hormones and that will artificially lower the PSA. To get a completely accurate reading they decided that by October (his last shot was in June) that the hormones should wear off to see whether the radiation worked or not.
We are waiting on that.
I really hope its from the radiation and nothing else. He really doesn't want to do anymore scans, I really dont blame him.

Luv,

In addition to radiation origin, the pain could be related to HT treatment. Joint pain is a known side effect. I am on HT treatment and have joint pain frequently. Not in the hip, but knees and shoulder.

I do think that being on HT and just after the radiation, it is very unlikely that the pain is PCa related. However, your dad should get PSA and T tests every three months, before his Lupron (or other) shot. This way you know the HT is working and the PSA is not growing.

Greg

Hi Deer Hunter,
Thanks for your reply. Wanted to ask you, following your husbands radiation has his PSAs dropped to zero? Also, my sister just told me that the pain is not really in the hip area its in the back area, isn't that right in the radiation zone? I dont know why I think thats better news. I really dont know what to think but I am so stressed out.
I really dont understand how a .55 can cause pain? I really dont know what to think.

No he hasnt noticed any dark spots anywhere on his body. See the thing is he is not truthful with me (I think because I am too emotional) everytime I ask him something, he tells me he feels wonderful.

But I did notice that when he gets up he feels stiff and a little in pain. Like you said, its hard to get up. Its very recent and he told me its getting better. I really am hoping its from the SRT, he did bone and ct scans only 6 months ago and they were all negative. I just am having a hard time believing it could be mets with a .55. I know his hormone shot is starting to wear off, you think it could be from that?

Hey Deer Hunter,
First of all I really appreciate you answering all my questions. It's so comforting to talk to someone about this. Okay, my dad's PSA before surgery was a 4.1. He did not have positive margins but on the path report it said that the cancer was very close to the margin but "did not touch it." They drew his PSA after 5 weeks because his urologist (which is his best friend who performed the surgery) told him to seek adjuvant therapy as early as possible because of his path report which was T3a gleason 7 (4+3) with tertiary 5.
So within a month we got him an appointment at Sloan to set up for IMRT. Rad Onc at Sloan put him on combo therapy. His last shot was in mid June. He completed his IMRT the first week of June. I think about now is when it begins to wear off right? Im not sure but I remember the doctor telling us that. They are going to check his PSA in October to see whether the IMRT worked. (Fingers crossed).
But this pain, it's really stressing me out. I just keeping running things through my mind. 1) urologist said right after surgery that he was positive the cancer was contained because everything was soft. 2)His path report said otherwise--it was out. 3)Then I see people who have bladder neck invovlment who achieve zeros after surgery and wonder why my father didn't. I know cancer is so unpredictable but it just doesnt seem logical with a low PSA going in.
I know I am obsessing over this, but do you think its mets or just a bad reaction to the rad?

Luv,
There seems to be a lot of confusion in the notes above,

1) The surgeon can only speculate just after the surgery, unless there is something very wrong (i.e. they biopsy the lymph nodes during surgery, and find them involved). The path report is the first indication of what they really found. My surgeon said everything went well. He told the family that, and that the path report would tell us more.

2) T3a indicates that a tumor extends through the prostate capsule in one lobe (i.e. not contained). You also need the Nx Mx values (N is lymph nodes, M is distant metastasis, and the second character of each tells what was seen in the path exam).

3) You can be T3a and have negative margins if they took a large-enough swath of tissue around the capsule.

Unless a bone scan shows a "hot spot", and even then I have several due to multiple broken bones over time - there is not much to say about bone mets - they may be there, and not large enough to see (or treat), or simply not there. Until proven otherwise, discuss pain with the doctor, and expect it to be generic aches and pains.

Also, if they put him on Cialis for circulation therapy, that can cause quite a bit of lower back pain. I had to stop taking it during my IGRT, as it was too painful to remain still during the sessions. This was not the hip joint/bone, but spine and lower left back.
I also have pain due to previous surgeries, which was aggravated by all the things around the surgery and "rehab".

Deer Hunter wife ,

Wasn't a comment on your last note, just the whole thread.

- yes, HT has added impact on bones when done together with radiation. I elected to not have HT, so any pain I have would be pure radiation, or something else. I'm hoping for something else, except mets, but by default we all think that at the first ache or pain.

My observations on the T3a and margins was because of Luv's comment on what the doctor said just after surgery vs. the path report. I am very surprised the surgeon was so optimistic in his comments. I was told before surgery that there could be no evaluation unless it was very bad, so I did not expect anything beyond did he accidentally get to save the nerves (he did not) and whether I needed blood or not (I did not). Just my opinion that the surgeon went too far in comments before having the path report in hand.

Also, I was thinking that Luv needs to know the Nx Mx numbers from the path report. They normally don't tell much, but they are a valid part.

I think that the early "everything is great" set Luv & family up for a let down, and that understanding that, things are not bad until there is consistent evidence that they are.

Post Edited (142) : 8/16/2010 7:14:20 AM (GMT-6)

Thanks Deer Hunter and 142 for your support and feedback.
It's just so hard because I feel so helpless. I really hope the rad takes care of it and this ordeal will just be history. He has been through so much I just want him to have a breather and just relax and now thIS PAIN creeps up. It just never ends but you know it can be so much worse so I should just look at the cup half full and be thankful I guess.
Deer Hunter, is your husband on 2 yrs of hormones? Just wondering because my dad only did 6 months and I know some people are on 2 yrs combo therapy. When I asked the doctor he said 2 yrs of hormones are for patients in the high risk group and my dad is intermediate but it seems as though people with mroe of a favorable prognosis are getting 2 yrs. Just a thought

Luv my husband was in a clinical trial at Emory in Atlanta .Our first uro. wanted him to start SRT 8 mths after his surgery but he was scared and didn't fill comfortable with the rad onc where we live. So our first uro. suggested a second opinion so we went to Emory and that's where we are now .but the uro.there keep telling him HT treatment and radation treatments were ruff and didn't what to do that even tho his PSA keep climbing we saw him for 1 yr we had decided to change uro.when his PSA came back .50 and he said we needed a med.onc. Med onc immediatly !!!!!!!!! sent him to a rad onc that day they checked his PSA 1 wk later it was .55 Med onc upset that uro had not done something and keep letting his PSA go up PSA at the time we started seeing uro was .08 it climbed to .50 in a yr, So he was asked about Doing the trial and he was picked for arm 2 of the trial.If you read his post you'llsee that they couldn't find where the cancer went it never showed it still in the prostate bed. but that was the only place they could start.since that is where it began.He was on casdex for 4 mths i mth before Rad. and 2 shots of Lupron during RAD. [full pelvic Rad] He has been off casdex since Dec.09 So thats why we stillaren't sure if RAD or HT worked PSA for now is low, Also I do remember the surgeon and the first Rad,onc telling me My husband didn"T have the normal PC that it was highly aggressive.And also the uro,at Emory when we first saw him said my husband was in for the fight for his life!!!! That has always stucky in my head what the 3 of them said!!1