Former bladder cancer now has PCa

Recently a man who lives in the same city called to discuss proton therapy because my name is listed on the references from UFPTI. He mentioned that he had bladder cancer a few years ago and his treatment was successful, and he was considering proton therapy but wondered if he would be a candidate for radiation to treat his prostate cancer. His biopsy revealed 4 3+4's and 2 3+3's. He met with an RO who advised him not to have radiation because if he had a recurrence of bladder cancer he might need bladder surgery and that usually includes removal of the prostate. Radiation of the prostate now would make that surgery much more difficult. The RO recommended brachytherapy.

I thought brachytherapy is another form of radiation. Doesn't it also cause scarring and difficulty in surgery later?

He's having a scan of the bladder on Wednesday to see how it looks. I don't know how doctors predict recurrence of bladder cancer. Perhaps they think radiation might increase his chances of recurrence. Removal of the prostate is still an option. He just has a strong interest in proton therapy.

Tumor stage and grade generally determine the risk of the cancer coming back. Ta tumors are non-invasive papillary lesions. TIS or CIS is characterized by cellular dysplasia, and T1 tumors are by definition, high risk.

If his bladder cancer is non-muscle invasive, Grade I or 2 papillary lesions, the recurrence of invasive cancer is < 5 %. T1 tumors are much more likely to recur, especially if Grade 3.

Paul

Forgot to add, would advise (if not done already) a 2nd higher opinion on the biopsy, to see if the Gleason 7's are truly 7's. If not, then AS might be a safer choice, in case the bladder issue becomes the bigger of the two issues. The prostate could be removed in the future, especially if entire bladder needs to be removed.