William wrote:
> at eighteen months after seed implant and radiaton therapy, I have once
> again started burning every time I urinate.
> also some mornings I have small blod clots and a little blood in urine.
> Is anyone else experiencing this at 18 months after seed implant? Rad doc
> said it would last 2 or three months.
> I am miserable, thanks
I thought about it a little more.
My burning and stinging while pee'ing started sometime during the
spring or early summer; that would be right about at the 21 month
point. It came on gradually so I didn't really notice it. That was
also the time that I stopped taking
Aleve-once-a-day, so I figured it
might be related.
The tip-off for me was one morning, I looked down in the toilet and saw
a couple tiny clots of blood on the leading edge of the porcelain bowl,
just where it touches the water.
Since then, and for the last 4, 5, 6 months, I occasionally see a
dilute drop or two of blood there. This might be once a week.
At my appointment 3 months ago, my PSA was way up. This is at 21
months, not 18. The Rad-doc was more concerned about the rising PSA
and whether it was "the bounce" or mets.
We knocked it around. I don't think it's mets because in the 3 years
leading up to the treatment 2000, 2001, 2002, 2003, my PSA was a steady
at 9. I calculate a doubling time of decades.
Then in 2004, they start me on 8 months of
Lupron, 25 IMRT sessions,
and Pd-103.
My PSA drops like a rock on Lupron, goes to < 0.1 for two tests three
months apart, then starts climbing. It was 6.4 this summer. A doubling
time of months. This is on a Testosterone of about 300.
Figuring that the IMRT and Pd-103 hammered the cancer in the prostate,
Where is the PSA coming from? The bone scan and Prostascint was clear
(not that they mean that much, too many false negatives according to
the docs.)
Given all the radiation and my low-normal Testosterone, either the
prostate cancer is a superstrength variety or I'm having a classic
bounce.
I think it's all connected in a poorly understood mechanism. The full
court press of radiation takes out the prostate cancer. The radiation
programs the cancer and the ancillary tissue to burn off, peaking at 18
to 24 months.
The dieing cancer and prostate cells release PSA as they rupture.
Cells in urethral lining break down at the same time; a small amount of
blood leaks and forms tiny clots.
In the old days, before the precision delivery systems, there would be
hot spots and cold spots. Over the couple years after the treatment,
small groups of cells would die at different times. A tiny section of
the uretha, some cancer over there. Hot spots die early, cold spots
take longer, maybe even survive unscathed.
The blood leak and the PSA release would be distributed over time and
space because the radiation was non-uniform. On any one day, the
blood leak and PSA release would be a percent or so of the total. This
is an amount that's too small to detect.
The precision delivery of radiation causes everything to go at once,
right at the 18 to 24 month period.
With today's precision delivery, a larger percentage of the urethra is
leaking blood. It's still a small amount but it's enough to pool at
night and manifest as a tiny clot in the morning.
Instead of the dieing cancer releasing PSA over 4 or 5 years, it's
concentrated in the 18-24 month period. I have some graphs of bounce
PSA and one thing that stands out is how fast it rises at 18 months and
how fast it drops after 30 months.
I'm guessing that the burning, blood, and PSA bounce are artifacts of
better treatment.
-kh
18 months after seed implant 
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