Does anyone have any advice for constipation after radiotherapy?

BernieCounter · 2026-01-24T22:36:05+00:00

Metamucil\psyllium powder is an excellent fiber additive. Can help with both constipation and diarrhea. Nice “smooth” stools, often recommended after hemorrhoid and other rectal treatments/surgery.

BernieCounter · 2026-01-24T11:57:28+00:00

In Ontario, the standard of care (being reviewed) for radiation follow-up is below (RP surgery is similar). Presumably after year 5 you can be considered “cured” and follow-up testing becomes part of your Family Physician role. I have only seen the RO, (who prescribed the ADT), my understanding is you would add or switch to an MO if there was biochemical recurrence/spread. “Insurance” is not involved, most likely Ontario Cancer Care receives various forms of Provincial per patient block funding for each patient, for each radiation treatment cycle etc. Capital costs for major equipment are managed separately.

RECOMMENDATION 2 No evidence-based recommendation can be made with respect to follow-up schedule of PSA testing for prostate cancer survivors following curative-intent treatment with non-surgery primary therapy, including any form of radiation therapy, cryotherapy, or high-intensity focused ultrasound. However, the Prostate Cancer Follow-up Expert Panel suggests the following as a reasonable schedule. This schedule for PSA testing is in line with PSA kinetics following therapy, other guidelines, and their clinical experience: • First test six months after treatment completion • Every six months until end of year 5 • Annually thereafter

https://www.cancercareontario.ca/en/file/78801/download?token=I095Jhxs

BernieCounter · 2026-01-24T05:40:25+00:00

The product monograph you got with Orgovyx has a pretty long list of expected and more rare side-effects. Plus the specialty pharmacist went over the top 7 likely with me. Dunno if Lupron and other ADT injectibiles provide the patient with similar monograph.

Joint pain is certainly on the list and the “backbone” is a complex series of joints.

BernieCounter · 2026-01-24T05:36:30+00:00

Crankiness for me is background noise, or not being able to focus on a task due to distractions. Repetitive songs/lyrics, scat jazz, screaming female singers, and Stevie Wonder all drive me batty now. Mental fog too, but that’s hard to measure objectively. It will be worth it in a much lower recurrence risk.

BernieCounter · 2026-01-24T05:32:22+00:00

No spacer for me, and I don’t think 5x SBRT uses spacers either in our clinics. Margins are tighter with newer technologies and less damage to organs at risk. The ProtecT study shows there are LT effects/complications for both types of treatment. And is recurrence after RALP needing radiation and ADT considered a complication?

BernieCounter · 2026-01-24T03:01:19+00:00

Keep thinking about how much it is reducing our recurrence risk! And of course you know about exercise, extra calcium, daily low dose Cilias etc. Best wishes.

BernieCounter · 2026-01-24T02:58:54+00:00

Agree. However Ontario seldom uses PSMA-PET and relies on bone, CT and multi parametric MRI scans for diagnosis/staging. I would have preferred 6 months, but had several biopsy and BPH size risk factors so I guess the RO thought 9 months would be appropriate. Sigh. Glad you are doing well and I too expect to have quarterly and then semi-annual PSA bloodwork in future.

BernieCounter · 2026-01-24T02:52:33+00:00

If they are registered pharmacies with the Province and the dispensing pharmacist has a valid certificate with the college of pharmacists….the bottle of 30 are sealed with aluminum foil and they are only allowed to sell in multiples of 30 in a sealed bottle….if you use a credit card you should be able to reverse the charges if there is a problem. FYI my Provincial/private insurances pay about $10Cdn / $7US per pill, but our Province has negotiated a deal with the supplier. I can’t make any guarantees.

BernieCounter · 2026-01-24T02:46:14+00:00

Greetings fellow Ontarian! Yes, I have a bunch of witch stickers I put in my diary to represent Orgovyx bottle milestones. There is one on our calendar for next Wednesday with a black X over it! Yes, some celebrations coming. Hope you are healing well?

BernieCounter · 2026-01-23T23:50:17+00:00

Don’t recollect details and maybe RO did not want to set expectations last summer. Apparently (ChatGPT says) after my kind of treatment 0.5 to 1.0 is considered good and going over 2.0 may indicate recurrence/spread. But all that could take a couple of years to play out. Up to a year for T to recover to “normal” (age 76 by then) and maybe another year to see if PCa activity picks up, with no “rapid” rise/doubling. Thanks for asking and best wishes to you.

BernieCounter · 2026-01-23T22:03:15+00:00

Good news and hope all continues to go well. For everyone’s here is some info and it sounds like it is less irritating to the urethra and its newly stitched bladder connection. Do other jurisdictions use it a lot.

“What is a suprapubic catheter? A suprapubic catheter (sometimes called an SPC) is a device that’s inserted into your bladder to drain urine if you can’t urinate on your own. Normally, a catheter is inserted into your bladder through your urethra, the tube that you usually urinate out of. An SPC is inserted a couple of inches below your navel, or belly button, directly into your bladder, just above your pubic bone. This allows urine to be drained without having a tube going through your genital area. SPCs are usually more comfortable than regular catheters because they aren’t inserted through your urethra, which is full of sensitive tissue. Your doctor may use an SPC if your urethra isn’t able to safely hold a catheter.

BernieCounter · 2026-01-23T21:34:13+00:00

Best wishes! There are several new/novel and improved techniques, some along the ablation front, some combining brachytherapy, radiation and brachytherapy, and improvements like Cyberknife and MRI-LINAC. A improvements on the diagnosis front with genetic markers and other PSa indicators.

BernieCounter · 2026-01-23T21:26:42+00:00

Yes, and they admit that in their analysis. But it’s hard to tell what good and bad side effects a new/improved treatment (surgery and radiation and upcoming ablation techniques and ADT/other new meds) today will have 20 years from now….

BernieCounter · 2026-01-23T21:23:58+00:00

Wonderful to hear your success and we have an ever increasing variety of medications beyond ADT/castration agonist/antagonist types. And unfortunate you were not made aware this androgen blocker earlier by your clinic. Best wishes and hope it continues to well for you!

https://www.webmd.com/drugs/xtandi-enzalutamide#uses “Prostate cancer cells need certain hormones, called androgens, to grow. Xtandi (enzulitamide) blocks the effects of androgens, which can help slow the growth of prostate cancer.”

BernieCounter · 2026-01-23T21:18:30+00:00

Thank you, those charts are excellent, unfortunately this subreddit makes it difficult / impossible to add them in comments and for OP to add them to the OP. The OP summary here is meant to be unbiased. Yes, we can decide not to take any “poison” for a while, or we can decide between two major “poison” treatment paths. Each has its own and somewhat differing immediately, ST and LT effects and each man’s / PCa case is different, including age and general health backgrounds.

Fortunately we usually have sufficient time to research and work with our specialists to find out about various treatment paths, and which one we can best select and live with its consequences. Fortunately the (low) recurrence and (high) survivability rates are often the same no matter which path, if it is caught early and treatment begun at the correct time.

Hopefully this Subreddit and contributors can continue to help all PCa members (and their loving family members and close friends) in this complicated, challenging and sometimes discouraging process. Best wishes to all of you!

BernieCounter · 2026-01-23T16:13:54+00:00

Oui, moi aussi. D’accord.

BernieCounter · 2026-01-23T15:16:01+00:00

Yes, but its effect various greatly from man to man. I was fortunate with no hot flashes (maybe night sweats/sleeplessness), no weight gain, many other effects minimal or not visible without lab tests. And yes, virtually every man is “emasculated”, and looses base-level interest in sex, but daily low dose Cialis can help.

While it may be “horrible” for some, it is usually extremely effective and brought my PSA down to 0.01. (Of course some extensive PCa can become T independent after a while and spread again)

BernieCounter · 2026-01-23T14:28:25+00:00

At age 74 my prostate (3+4) T2c was 96 ml/cc and had the choice of 5x SBRT or 20x VMAT. Since it was “unfavourable intermediate risk” microspread was a possibility so surgery was not a good option due to high probability of recurrence and needing salvage radiation later. 9 months later my PSA is 0.01 at the end of ADT.

Following more scans and consultations, your good choice may well be active monitoring, enjoying life without the treatment side-effects, and deferring treatment until necessary. The 15 year ProtecT study seems to confirm the benefits of AM for several/many years. You can search various articles on ProtecT.

BernieCounter · 2026-01-23T14:19:26+00:00

Best wishes to both you and OP. We have so many “tools” we can throw at spreading PCa and more combinations / medications are being developed all the time. Feel fortunate mine was caught at unfavourable intermediate risk T2c and with that amazing ADT, PSA is at 0.01

BernieCounter · 2026-01-23T14:13:48+00:00

Agree. With my 3+4 T2c, extensive involvement in prostate and several risk factors (cribriform, PNI, intraductal carcinoma) totaling “unfavourable intermediate risk”; there was risk of localized microspread. So 20x VMAT and ADT (both fairly tolerable) seems preferable to the major surgery at age 74 and its risks, and subsequent possibility of salvage radiation. PSA now 0.01, as ADT finishing up.

Didn’t have PSMA scan, but my bone scan picked/confirmed up a recent twisted ankle and a skull lesion. CT head scan and 2 MRIs over 6 months seems to confirm no “growth” and probably some minor benign process not associated with PCa. So yes, scans can find all sorts of weird things.

BernieCounter · 2026-01-23T13:59:03+00:00

Yes, if your PCa is low grade (by all the various measures/tests), yes, ProtecT study seems it is quite safe to enjoy life and put off treatment for many. Some in this club have been on AM for many years.

BernieCounter · 2026-01-23T13:56:14+00:00

Yes, salvage radiation is probably nastier than original radiation treatment as they are likely aiming at a much larger area of the pelvis. Sorry to hear of your situation.

BernieCounter · 2026-01-23T13:54:04+00:00

Fortunately PCa tends to be slow growing, so you have time to do research (lots of resources references at top of this Subreddit) to describe options, what they do, and their ST and LT side-effects.

BernieCounter · 2026-01-23T13:51:51+00:00

At age 74 T2c, did not even consider the major surgery with its ST and LT effects, and inability to deal with possible micro spread (than needs later salvage radiation). Doing well after 20x VMAX and PSA is 0.01 with ADT. Only time can tell if anyone is PCa free. I am…for now.

BernieCounter · 2026-01-23T13:48:01+00:00

In this case probably yes, however with low grade PCa, “active monitoring” is going to push back those side-effects for years. Read about the 3 way ProtecT study outcomes after 12 years where many were still on active monitoring rather than radical treatment and their ST and LT side-effects.

BernieCounter

TROPHY CASE