Getting ready for SRT/ADT

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reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 1/9/2013 10:36 AM (GMT -6)   
Yesterday I met with my urologist, after meeting with the radiation oncologist last month. I’d appreciate any comment from you guys who have walked this path ahead of me in case anything I jotted down doesn’t sound right to you.

The urologist went through my CT with contrast scans and said my bones look clear, no evidence of any spread. He said he expected this, and only ordered the tests to have a baseline for the future. That’s pretty much what I expected as well after reading the experiences on this site.

He agreed with the RO that I should go ahead and have SRT with the IGRT machine and my regional hospital.

We then discussed ADT, and I told him the RO didn’t think I needed it. I took with me printouts of a couple of studies that showed the benefits of ADT with SRT but was concerned about its duration and SEs (studies I learned about from this site). One of them showed survival benefits with just 6 months of ADT. He said he knew about all of those studies, but they’re for radiation as primary treatment, there’s no controlled studies about the effectiveness of ADT with SRT after surgery (is that right?). However, he did agree that with my numbers and history, I could go ahead with ADT but he thinks 6 months should be enough to give me whatever benefit I can get. With 6 months I will get benefit but avoid the long term SEs of ADT. The SEs he said to expect are what I already heard about – hot flashes, muscle loss, tiredness, mood swings, but he didn’t think I’d have to worry about any serious SEs such as heart problems or diabetes. I asked him if I could go off ADT if I was one of the rare guys who get serious SEs and he said yes but that there’s ways of lessening the SEs if they occur.

This is consistent with Mel’s experience, it seems ROs don’t really encourage ADT, but the numbers we’ve all seen suggest at least some improvement in outcomes.

As far as the type of ADT he suggested Lupron and I asked him about the testosterone flare that I’d heard about, and about Casodex (I’m surprised he didn’t bring this up himself, maybe he would have eventually). He said rather than Casodex he recommends Firmagon as a 1 month shot, because it works immediately, then a 6 month Lupron shot for a total of 7 months. He said he had no problem with Casodex (which he says is more popular in Europe) but that it comes in a daily pill that I’d have to remember to take every day, and it’s more expensive. I told him I take a lot of pills anyway so I wouldn’t forget, and I didn’t mind the extra cost. He then said he could put me on Casodex but would have to test my liver function because it was hard on the liver. This got me to thinking, and maybe Firmagon/Lupron shots would be easier. I asked him why not monthly Firmagon shots and he said I could do that but they can hurt a lot, so now I’m back to the 1 month Firmagon and 6 month Casodex, which I could begin in a couple of days.

I now need to ask my RO if I need to wait after getting the Firmagon before beginning SRT. My urologist didn’t think I’d need to wait.

I also asked him if there’s any benefit for Tomotherapy vs IGRT, because my RO said I could have either type. He said he’d leave that to the RO and me, but in his opinion, since the entire prostate bed is getting radiation, he didn’t think I’d get much extra benefit from the more precise tomotherapy. Makes sense to me but I’ll ask my RO again.

One thing I'm doing for myself is signing up with a personal trainer to maintain my muscle mass while on ADT.

So that’s where I am. Again, I’d appreciate any comment from any of you, this site is a great source for sharing information and supporting each other. I felt like a very informed patient when I went to see my doctors.
Age: 66
PSA: bounced around from 2.6 to 5.6 over 2 years
Biopsy 8 of 12 +, G 3+4, T2a
DaVinci 9/09, path G 4+3, - M, NX, MX, T2c
Continent right away
ED pills did't work, Trimix works well
Post-surgery PSA:
12/09 <0.1
4/10 <0.014
6/10, 9/10, 12/10 <0.1
4/11, 5/11, 9/11 all .05
12/11 .06, 3/12 0.13!, 6/12 0.14, 9/12 0.17, 12/12 0.26

JerseyGuy
Regular Member


Date Joined Apr 2010
Total Posts : 30
   Posted 1/9/2013 3:24 PM (GMT -6)   
Reachout:

I understand your questions and concerns, every doctors has a different approach. I have just finished the HT path after having IMRT and surgery. It has been difficult, but the results have been positive. As you can see from my signature I have the Surgery first and the PST continued to creap up, I had 36 IMRT treatmenent (64Grey) and then was put on HT for two years. When I started the HT, my Uro gave me Casodex pills for two weeks prior to my first 6-month Eligard shot to prevent T-Flare. I don't understand your doctors reluctance to give you the pills, it is better than shots. Secondly, I was given the choice of 1, 3 or 6 month shots of the Eligard, I chose the 6 months, because getting a shot every month in your stomach is not fun. Even my Oncologist gave me the choice of Fermagon every month or Eligard every 6 months.

I have worked out consistently during my treatment and have maintained my muscles, however the fatigue is my biggest complaint, the hot flashes, I take in stride, watch your diet because your metabolism with go down.

Best of luck.

Joe
DX 5-1-2009,age 54. Biopsy 6/12 core samples positive - Classified 3+3 T2C.
DaVinci surgery performed -7/30/09.
Nerves spared
No PNI involved
No Seminal vessel involvement
Positive Margins - Left Apical Microscopic margin.
Post surgical PSA = 0.2
Nov 2009 - 100% Continence (no pads).
PSA Dec 1, 2009 = 0.4
Urologist recommeds Adjuvant Radiation using Rapid Arc.
Jan 27, 2010 - Began IMRT x 36 treatments @1.8 Gy = 64.8 Gy. Completed March 17, 2010. Minimal side-effects.
April 28, 2010 = Follow-up exam with Radiologist - PSA = 0.8.
July 2010 - PSA = 1.0
Sept 2010 - PSA = 1.2
Oncologist and Urologist both recommend HT.
OCT,2010 - 1st Eligard Shot
Jan 2011 - PSA <0.1
April 2011 - PSA <0.1,2nd Eligard Shot.
Oct 2011 - PSA <0.1, 3rd Eligard shot.
April 2012 - PSA <0.1, 4th Eligard shot.
Oct 2012 - PSA <0.1
NO MORE SHOTS... At least for now!! :)

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 1/9/2013 6:02 PM (GMT -6)   
Thanks for your response, Joe. Your comments reaffirm my question as to why the reluctance on the casodex. At first, I was all in on the Firmagon shots, and asked him why I couldn't just have those every month for 6 months. Then he told me about the pain, and I rethought it. I can handle pain, but from what I've now read, it can be pretty intense for 2-3 days. If the pills are painless, I'd rather do that even if they have to monitor my liver function. My doctor did mention the cost, though that's not a problem for me with my insurance. Maybe he didn't know my insurance would cover it.

So now I'm thinking of asking for 30 days of casodex and a 6 month Lupron shot. Could the pain from the shot interfere with my ability to get SRT during that time, though? Seems the old bod can only take so much at one time.
Age: 66
PSA: bounced around from 2.6 to 5.6 over 2 years
Biopsy 8 of 12 +, G 3+4, T2a
DaVinci 9/09, path G 4+3, - M, NX, MX, T2c
Continent right away
ED pills did't work, Trimix works well
Post-surgery PSA:
12/09 <0.1
4/10 <0.014
6/10, 9/10, 12/10 <0.1
4/11, 5/11, 9/11 all .05
12/11 .06, 3/12 0.13!, 6/12 0.14, 9/12 0.17, 12/12 0.26

JerseyGuy
Regular Member


Date Joined Apr 2010
Total Posts : 30
   Posted 1/9/2013 7:14 PM (GMT -6)   
Reach out:

The shots should not interfere with the radiation, the path of the radiation for treating the Prostate bed usually is across your lower abdomen right across the middle of your hips, with the HT shot being located either the left or right side of your belly button, at least mine were. I know what you mean about this old body, it has been tough, but working out relieves a lot of the stress and makes you feel better, even though When I come home from work, working out is the last thing I feel like doing. Hang in there!

Joe
DX 5-1-2009,age 54. Biopsy 6/12 core samples positive - Classified 3+3 T2C.
DaVinci surgery performed -7/30/09.
Nerves spared
No PNI involved
No Seminal vessel involvement
Positive Margins - Left Apical Microscopic margin.
Post surgical PSA = 0.2
Nov 2009 - 100% Continence (no pads).
PSA Dec 1, 2009 = 0.4
Urologist recommeds Adjuvant Radiation using Rapid Arc.
Jan 27, 2010 - Began IMRT x 36 treatments @1.8 Gy = 64.8 Gy. Completed March 17, 2010. Minimal side-effects.
April 28, 2010 = Follow-up exam with Radiologist - PSA = 0.8.
July 2010 - PSA = 1.0
Sept 2010 - PSA = 1.2
Oncologist and Urologist both recommend HT.
OCT,2010 - 1st Eligard Shot
Jan 2011 - PSA <0.1
April 2011 - PSA <0.1,2nd Eligard Shot.
Oct 2011 - PSA <0.1, 3rd Eligard shot.
April 2012 - PSA <0.1, 4th Eligard shot.
Oct 2012 - PSA <0.1
NO MORE SHOTS... At least for now!! :)

Post Edited (JerseyGuy) : 1/9/2013 5:21:39 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24150
   Posted 1/9/2013 7:26 PM (GMT -6)   
With SRT, there is no hard and fast thinking on adding HT to the mix. I met with 3 RO's before undergoing SRT. 2 of them, had strong opinions about not doing HT with SRT, as they wanted to see what the radiation did on its own. the 3rd ro, was pushing for HT, but when I pushed for evidence, he didn't have it, and in the end, he admitted that he couldn't prove that I needed HT with the SRT, and that he couldn't prove that it would help. that was enough for me to bypass mixing up HT with the radiation.

I had tomography on the latest and greatest IMRT machine in my area at the time 3 years ago, for all the talk of precision aiming, etc - for me, it turned into a disaster of biblical scale (lol), and left me disabled for life with perm. chronic pain. I was one of the unlucky ones.

Sounds like you are doing all the right steps in learning your options, so choose wisely, and choose well.
BTW, I had 72 gys just in the pelvic bed, spread over 39 sessions.

david in sc
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 548
   Posted 1/9/2013 8:38 PM (GMT -6)   
Reachout:

The Memorial Sloan Kettering nomogram for likelihood of recurrence after RT with and without ADT shows a strong benefit to the combination approach. The difference was significant at the .001 level. You can plug in your own data and see what difference is predicted by the nomogram, with and without ADT. Link is here:

nomograms.mskcc.org/Prostate/SalvageRadiationTherapy.aspx

The article on which the nomogram is based is here: www.ncbi.nlm.nih.gov/pubmed/17513807?dopt=Citation. Note that this study deals with RT in the salvage context, after surgery, not RT as primary therapy.

Good luck with your decision!

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 1/9/2013 9:08 PM (GMT -6)   
David, I didn't know you had tomotherapy, I missed that in your earlier posts. Ouch, goes to show that the doctors and techs are much more important than the technology. When I spoke with my RO he suggested the IGRT machine and when I asked about tomo he sort of threw it out there like, you can have that if you want. I note tomotherapy is in a separate facility from the hospital, so maybe he's not as closely connected with that as with the IGRT guys. I'll probably just go ahead with the IGRT.

proscapt, thanks for those great links. I have a 20% better shot with ADT by that nomogram. I wonder why my urologist didn't refer to that? He said there were no controlled or large trials, maybe those nomograms are based on smaller or uncontrolled trials. Doesn't matter, if that's the best data we have.

One thing I still don't understand is when SRT should begin in relation with ADT. My urologist thought they could begin at the same time, but from what I've seen in reports and posts here show the SRT often being delayed for several months after ADT. Seems like you'd want time for ADT to weaken the cancer cells before zapping the with radiation. On the other hand, both ADT and SRT have long tails so maybe it doesn't matter. Is there a protocol for the timing?
Age: 66
PSA: bounced around from 2.6 to 5.6 over 2 years
Biopsy 8 of 12 +, G 3+4, T2a
DaVinci 9/09, path G 4+3, - M, NX, MX, T2c
Continent right away
ED pills did't work, Trimix works well
Post-surgery PSA:
12/09 <0.1
4/10 <0.014
6/10, 9/10, 12/10 <0.1
4/11, 5/11, 9/11 all .05
12/11 .06, 3/12 0.13!, 6/12 0.14, 9/12 0.17, 12/12 0.26

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3229
   Posted 1/9/2013 9:18 PM (GMT -6)   
Seems like you'd want time for ADT to weaken the cancer cells before zapping the with radiation. On the other hand, both ADT and SRT have long tails so maybe it doesn't matter. Is there a protocol for the timing?
 
i did HT, BT and IGRT as a primary treatment.  the first treatment was lupron and then about two months later i had the seeds implanted.  just as you said the doctors wanted the lupron to stop and shrink the cancer first.
 
ed
 
 
age: 57
12/09 -- PSA 6.8
G7 -- 3+4
HT, BT and IGRT
9/4/12 -- 2-year post treatment PSA 0.2
(PSAs .2, .3, .2, .3, .2)

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24150
   Posted 1/9/2013 11:02 PM (GMT -6)   
i was offered igrt or imrt, but in the end my ill-fated RO chose the tomography/imrt, because it was suppose to be safer and more accurate. i started getting burned by the radiation on a completely empty bladder by my 4th of 39 treatments. these claims were laughed off and dismissed by the RO and the operators. the burnings continued to worsen till the very last treatment, but by then, my bladder was essentially destroyed, along with my bladder neck. i got to live the next 51 weeks with a suprapubic catheter, hoping for natural healing that never came, and thus had to consent to the ileal conduit surgery, bypassing my bladder for life, leaving me with a stoma to urinate through. rare? perhaps, but there are plenty of other horror stories out there from short and long term radiation damage aside from what happened to me. the biggest slap in the face, was that for all that radiation, 72 gys, it didnt remotely slow down my remaining cancer. either it missed the targeted areas, or it was never in the prostate bed to begin with. hope one day, there can be some kind of super scan that could determine that before any many undergoes salvage radiation.

david
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

nenea
Regular Member


Date Joined Feb 2012
Total Posts : 60
   Posted 1/10/2013 2:26 AM (GMT -6)   
Reachout:

Have you the possibility of getting C11-Choline pet scan (or acetate) before any further treatment? This is the latest scan for relapsed PCa and can give you the chance to avoid unnecessary treatment.
I missed that chance and regret.I was exactly in your situation at the beginning of last year and blindly
hurried to radiate and castrate my body. Although my PSA is 0.003 now (pre HT+SRT PSA=0.24) ,I have severe SE from both therapies.We react differently to these therapies.

GOOD LUCK.
Al

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 1/10/2013 10:13 AM (GMT -6)   
Al
I hadn't heard of that C11 treatment. I looked it up, and it appears to be a way of imaging small areas of recurrent cancer. But I wonder, if the PSA is up, and there is no prostate, doesn't that already indicate there are cancer cells somewhere, but not sure where? So, if the C11 scan finds it, what is the benefit? Can they go in and remove it surgically, or would they only radiate that specific area and avoid many of the SEs from a wider treatment? Sounds very interesting, I'm arranging an appt with a research oncologist and will certainly ask about that.

Last night I hit the wall of worry and didn't sleep much, thinking about all the SRT/ ADT options, SEs, etc. One thing I've tried to tell myself is that self-pity is not allowed. It's a lot easier to follow that in the daytime than in the middle of the night when the brain isn't working well.

I think that I can deal with a lot, as long as I can stay fairly active. I plan on getting a personal trainer, and I play golf a couple of times a week. If I can keep this up, I'll be OK, and my doctor tells me I should be able to do these things even with SRT and a short 6 month course of ADT. But then I've read some posts from some guys who've had a hard time even climbing stairs while on ADT and frankly that scares the hell out of me.
Age: 66
PSA: bounced around from 2.6 to 5.6 over 2 years
Biopsy 8 of 12 +, G 3+4, T2a
DaVinci 9/09, path G 4+3, - M, NX, MX, T2c
Continent right away
ED pills did't work, Trimix works well
Post-surgery PSA:
12/09 <0.1
4/10 <0.014
6/10, 9/10, 12/10 <0.1
4/11, 5/11, 9/11 all .05
12/11 .06, 3/12 0.13!, 6/12 0.14, 9/12 0.17, 12/12 0.26

tooyoung4this
Regular Member


Date Joined Nov 2011
Total Posts : 325
   Posted 1/10/2013 2:39 PM (GMT -6)   
Hi, I just want to make a couple of comments from my experience... I had a rising PSA 11 months after surgery... My RadOnc wanted me on ADT for 4 to 6 months before SRT. He said although there are no major studies to support it with SRT, there was some data that showed it to be favorable... ( what ever that means).
Secondly and more importantly... ADT for me hadn't been too bad "so far" ( I do reserve the right to complain later). I do work out' so that helps, I'm a little more tired by days end but overall not a big deal. Hot flashes are very manageable only slight warming on my face. And sex is still possible... Just a lot more work.
I know it is hard to not worry but I hope this helps.
Age at dx 42
Aug 11/11 Psa 6. Aug 15/11 Psa 7.4 %Free 25. :(
Biopsy 2 of 10 cores +'ve left side. G7 (4+3)
Surgery Sept 29/11 Nodes & Margins Clear, upgraded to G9 (5+4)
Catheter for 15 days.
99% Dry at another 10 days.
ED... Not like it used to be but working, no meds.
Dec 11 & May 12 <0.04 Sept 2012... 0.21 @%$!
Started ADT Oct 3... .
SRT to start in Jan.

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 1/22/2013 6:41 PM (GMT -6)   
Well, this week I have my "simulation" for SRT this Thursday. Thanks to compiler and all the other SRT guys that have gone before and shared their experience with us. Makes for captivating reading :)
Age: 66
PSA: bounced around from 2.6 to 5.6 over 2 years
Biopsy 8 of 12 +, G 3+4, T2a
DaVinci 9/09, path G 4+3, - M, NX, MX, T2c
Continent right away
ED pills did't work, Trimix works well
Post-surgery PSA:
12/09 <0.1
4/10 <0.014
6/10, 9/10, 12/10 <0.1
4/11, 5/11, 9/11 all .05
12/11 .06, 3/12 0.13!, 6/12 0.14, 9/12 0.17, 12/12 0.26

NewspaperLover
Regular Member


Date Joined Sep 2009
Total Posts : 215
   Posted 1/22/2013 7:16 PM (GMT -6)   
Hi Reachout,

In this situation only the SRT can provide a "cure," that is find and destroy lingering malignant cells left over from surgery. The purpose of the ADT is to support the SRT by "weakening," that is starving such cells. The drawback is that one has to wait six months or so after treatment for the ADT to flush out of the system, to properly gauge the effect of the SRT. The goal at that time is to see an undetectable PSA and a testosterone level climbing back towards "normal." At least, that was the protocol followed by my oncologists. Here's to a happy outcome with your one-two punch. Best wishes!

Newspaper Lover
Age 69
DaVinci surgery 11/09 upstate NY; Clean margins, clean seminal vessels.
Rising PSA noted 06/11
Gleason 8
Time to recurrence 18 months
Three month doubling time (summer 2011).
PSA rose from .07 on 06/11 to .17 on 11/11.
10/11 Moved management of my case to Memorial Sloan-Kettering in New York City
MRIs and bone scans negative so far.
Started hormone therapy (Lupron/Casodex) 12/11
Began radiation (SRT) 02/20/12.
Finished SRT 04/16/12
Last Lupron shot 03/12
07/12 PSA and testosterone "undetectable"
01/13 PSA “undetectable”; testosterone (T) level at 452 ng/dl
Next set of tests July 2013. Currently receiving no treatment

stixandstonz
Regular Member


Date Joined Nov 2012
Total Posts : 90
   Posted 1/22/2013 7:18 PM (GMT -6)   
I had 6 month ADT with proton for primary treatment, I was given 2, 3 month shots of Trelstar 11.25mg. Trelstar was given in the rear end, no real pain. My hot flashes have never been worse than a sweaty brow. No night sweats. I do wake up when I come to light sleep cycles, but go back to sleep. There were plenty of guys doing the Lupron and Casodex combo, but it seemed that their side effects were more pronounced. Lots of guys that said they would wake up soaked in sweat.
Just thought I would mention Trelstar as a possible alternative ADT.

Wish you the best,
Kris
Diagnosed at 51, 7/12 PSA 4.0, DRE negative.
Gleason 8, 3 of 12 cores positive. Left Apex GS 4+3=7 10% of specimen, Left Mid GS 4+4=8 10% of specimen, Left Lateral Apex GS 3+4=7 60% of specimen. 3 of 12 cores positive.
CT w/contrast & bone scans negative.
Decided on ADT w/Proton Therapy at UFPTI 8/12
Telstar 11.25 mg shot, ADT 8/12 and 11/12
Proton treatment finished 1/13, no incontinence or ED

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3136
   Posted 1/22/2013 8:37 PM (GMT -6)   
Fallacy on casodex, you can get generics very cheap now, if paying cash www.northdrugstore.com you can get generic casodex (bicalutamide) for like .67 or less per day (US dollars, $10 delivery to USA). You can wear estradiol patch low doseage along with any LHRH drug or even casodex and lessen side effects and build bone density (never hardly mentioned to patients). Degarelix/Firmagon is a GnRH and does not cause 'flare' so you could do that directly, like he mentioned then switch to any other LHRH.

There are even other drug options one could actually use, although not widely endorsed in the USA, it varies in other countries as to choices, and people do get good results. Lupron has 75% of the market sales and is profittable and the most commonly used LHRH drug, been around since about 1980 or so. Isn't it great that so much confusion exists on HT therapies?

nenea
Regular Member


Date Joined Feb 2012
Total Posts : 60
   Posted 1/22/2013 11:08 PM (GMT -6)   
Good luck Reachout.
Drink about 20 ounces of water before each session to protect your bladder or ask your doctor.
They don't usually give instructions about this.Just reminded!
best wishes.
Al
diagnosed 9/2010.age 54, psa=13(first ever)
3/6 cores positive,3+4=7,
RRP 1/2011
G-3+4=7(85%,15%)
pT3b N0(EP+,SV+,LV1)
psa<0.04 (9mons)
0.07
0.09
0.18
3/2012 0.23
BS,CAT clean
HT(trelstar).....1 year followed by IADT
4/2012 psa<0.04 T=15
6/2012 psa=0.011,started IMRT(WP+PB)RT,78GY(8weeks)
8/2012 psa=.003
11/2012 psa=0.003
1/2013 psa=.003 T=2.6

Post Edited (nenea) : 1/22/2013 10:31:51 PM (GMT-7)


PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 3779
   Posted 1/22/2013 11:43 PM (GMT -6)   
Before I started my IMRT I bought myself 37 20 oz bottles of low-calorie Gatorade (three twelve packs and a single.) I put them all in my trunk and each day before treatment I would take one out and drink it as I drove to the cancer center. That way I would arrive with as full a bladder as possible with my so-so continence. I always knew how many sessions I had left. I just had to look in the trunk and count bottles.
60
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
1)neg (some inflammation),
2)neg,
3)positive 1 of 14 cores GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
4)neg.
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
Start 24 mo ADT3 7/26/12
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Incontinent, Trimix, VED
Forum Moderator - Not a Medical Professional

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 1/23/2013 9:34 AM (GMT -6)   
News, stix, after buying a supply if casodex I got a second RO opinion, and decided to just go with the radiation. I had 2 recommendations for no ADT and one "could go either way," so I'm going cold turkey for now.

Got a call from the nurse for tomorrow`s appt. I have to use a fleet enema tonight, just a light meal no later than 2 hours before my appt, and drink water before to fill the bladder. Then drink lots of water afterwards to flush out the penile contrast. Penile contrast? Wasn't told about that. I don't know what it is, but I don't like any term that starts with "penile."

Thanks for all your suggestions.
Age: 66
PSA: bounced around from 2.6 to 5.6 over 2 years
Biopsy 8 of 12 +, G 3+4, T2a
DaVinci 9/09, path G 4+3, - M, NX, MX, T2c
Continent right away
ED pills did't work, Trimix works well
Post-surgery PSA:
12/09 <0.1
4/10 <0.014
6/10, 9/10, 12/10 <0.1
4/11, 5/11, 9/11 all .05
12/11 .06, 3/12 0.13!, 6/12 0.14, 9/12 0.17, 12/12 0.26

Bohemond
Regular Member


Date Joined Apr 2012
Total Posts : 386
   Posted 1/23/2013 12:12 PM (GMT -6)   
Reachout,

Best of luck tomorrow. FWIW, when I had SRT my RO recommended Casodex only (no Lupron), which I took for 3 months, beginning a week or two before the start of SRT and continuing for about 3 weeks after--until I finished that month's supply of pills. My RO also said Casodex is much more common in Europe, but that he liked it in conjunction with SRT because it had fewer side effects than Lupron and might improve outcome, though he said he had insufficient evidence to say that it would. In my case the SRT has been successful for going on three years, but it's anybody's guess whether the Casodex had anything to do with it. I am glad, under the circumstances, that I was able to forgo Lupron. My only SE from the Casodex was my nipples began feeling sore after 6 or 8 weeks, which resolved a few weeks after I stopped taking the pills.
Age 66
-DX March 2002 - PSA 9.4, needle biopsy PCa 75% left lobe.Small focus right.
-RP April 2002. Pathology PT3B N0 MX Gleason=7 (3+4), seminal vesicle involvement. No lymph node involvement.
-Post-surgery PSA low of 0.01; slow rise to 0.4 (August 2009).
-SRT Jan/Feb 2010. Enlarged lymph node near prostate bed targeted. Casodex 3 months during SRT
-PSA 0.00 for 2 years
-PSA 0.01 April

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 1/24/2013 5:01 PM (GMT -6)   
Had my CT scans today. I thought it was supposed to be the simulation but all they did was a CT scan and three tattoos. Simulation is Feb 4 then daily treatments. Worst part was holding a full bladder while they were delayed for another patient. Best part was the tech telling me she checked with the RO and I didn't need a penile contrast after all. She was young and good looking, would've been an interesting exercise even without trimix :)
Age: 66
PSA: bounced around from 2.6 to 5.6 over 2 years
Biopsy 8 of 12 +, G 3+4, T2a
DaVinci 9/09, path G 4+3, - M, NX, MX, T2c
Continent right away
ED pills did't work, Trimix works well
Post-surgery PSA:
12/09 <0.1
4/10 <0.014
6/10, 9/10, 12/10 <0.1
4/11, 5/11, 9/11 all .05
12/11 .06, 3/12 0.13!, 6/12 0.14, 9/12 0.17, 12/12 0.26
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