Treatment Options

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Dave's Wife
New Member

Date Joined Feb 2008
Total Posts : 8
   Posted 2/20/2008 1:55 PM (GMT -6)   
My husband (age 53) has been diagnosed with PT3A PC, had robotic prostatectomy on 2/1/08, seminal nerves involved, perineural extension, no lymph node involvement, preoperative Gleeson high 8.  Any suggestions on further treatment, right now surgeon wants to repeat PSA in 6 weeks and take a wait and see approach.  I strongly feel we should look into radiation and/or hormone therapy.  Father-in-law, age 84 also has high 8 Gleeson, did 4 months of daily radiation, within one year PSA began to rise and is now on Lupron injections; told it was a testosterone fed tumor.  If anyone has any suggestions (from experience) we would appreciate some input.

Regular Member

Date Joined Jun 2007
Total Posts : 176
   Posted 2/20/2008 2:21 PM (GMT -6)   

As hard as it is to be here and not know, your doctor is following the recommended path post surgery.  Usually, they don't want to start radiation anyway until at least that amount of time post surgery. 

You may want to get a second opinion on it to feel comfortable, but consistent with what I have heard.

Best wishes.

42 yo. now
5/07 PSA 4.65 at routine physical
6/07 biopsy positive for cancer...Gleason 3+4...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - Radical Retropubic Prostatectomy Surgery at Northwestern Memorial in Chicago by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op pathology was Gleason 3+4 with negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
9/27/07 - Catheter removal...let the games begin...
12/07 - Threw out the pads.  I only had to use 1 pad per day for protection against minor drips. 
I started Trimix 8 weeks after surgery with success.
I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.

Dave's Wife
New Member

Date Joined Feb 2008
Total Posts : 8
   Posted 2/20/2008 2:28 PM (GMT -6)   
Thanks for the reply. I know we are early in the post operative phase, I just want to be as informed and ready for whatever it is they are going to pass on to us.  My husband is right now in complete denial, feels he is "cured", however is also very depressed.  I guess I am trying to be one step ahead so I can help him deal with what might be coming our way. 

Age: 53
DX: 12/07
Robotic Prostatectomy: NYC 2/1/08
Gleeson Stage 8
Perineural Spread
Seminal Vessicle Spread
Pre-Operations PSA:  2.68 (True - not a typo)
8 out of 10 biopsies positive for tumor

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 2/20/2008 2:54 PM (GMT -6)   

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Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 2/20/2008 3:03 PM (GMT -6)   
Welcome Dave's Wife,
HealingWell is a very special forum where we fellow patients and loved ones get to share first hand experience. If you check my signature below you will see that I am pretty much in the same boat. I have been through a gambit of treatment like what you are suggesting. But I would agree to test again in six weeks. The best reason is to see if the PSA can go to undetectable (<0.1) without additional treatments. For me it was good to know that the surgery did most of the heavy work. I have advanced prostate cancer and it was still necessary to undergo adjuvant therapies even though I did get to undetectable after surgery. But in the end it was my decision to wait then go on the offensive. Always remember, doctors recommend, but we ultimately make decisions. Stay with us for a while and you will see many variations at Dave's stage. Education is the best weapon for fighting this disease. My motto is Stay Positive! For me the therapies were provided by doctors. But I have additional weapons. I keep Faith, Love and Hope as my front line of defense. God Bless you and lot's of luck to you.


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Visit my Journey at:
Prostate Cancer Forum Moderator

Ken S
Regular Member

Date Joined Nov 2006
Total Posts : 120
   Posted 2/20/2008 4:36 PM (GMT -6)   
Dave's Wife,

I had a focally positive margin and perineural invasion and was told radiation treatments were in my future but we had to wait for things to heal a bit before we could do so. That may be a major reason for the "wait and see". Also I was a little depressed following the prostatectomy but talking to people who have been there and this site helped tremendously. Best of luck to both of you.

Age 54 (2006)
PSA - 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06
Post-Op Biopsy, still Gleason 6 (3+3),
T2c, right apical margin positive
CT Scan 1/07, tumor discovered on right
kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07
IMRT (37 Treatments) started 4/23/07
PSA 11/07 - less then 0.01

Regular Member

Date Joined Jul 2006
Total Posts : 474
   Posted 2/21/2008 8:47 AM (GMT -6)   
Hi, Dave'sWife - we were a Gleason 6 upgraded to a 7 on the path report, with possible bladder/perineural involvement. The wait for that first post-op PSA was agony. However, it did come back undetectable and sometimes, as we've learned here those random prostate cancer cells have nothing left to feed on, so they "go away."

We're now 18 months out and still getting undectables. Our surgeon recommended no further treatment until we started to see a rise and we're believing that we won't. Our percentages on a return continue to go up in our favor with each clean PSA.

You definitely want to take the time for healing first before making any decision and, sometimes, the "wait and see" approach pays off. I do want to say, however, that if that first PSA had come back anything but "undetectable," we would have jumped on an aggressive treatment program.

None of it is easy, is it?
Husband: Age 67
PSA had doubled in 14 mos to 4.3/Gleason 6
da Vinci 8/06 in Austin with Dr. Randy Fagin
Post surgical path shows encapsular penetration; possible bladder neck involvement.
PSAs remain undetectable; no further treatment at this time.
Next PSA: April 08

Regular Member

Date Joined Apr 2007
Total Posts : 101
   Posted 2/21/2008 6:10 PM (GMT -6)   
Hi Daves Wife,

Your hubbys case sounds very similar to mine, high gleason score and outside the capsule with seminal vesicles involved. He will probably go back to the doctor about 6 weeks after surgery to have a psa test. Provided what that indicates ( you may luck out and it be undetectable) or less than .1 which is what I understand is considered as undetectable. If that is the case he may still want you to have radiation therapy. However, on the flip side if you still have considerable psa present, hormone therapy and also radiation would probably be coming. There are many different courses of treatment but from my experience from reading on this forum and my own personal experience one or both of the above could be expected. Good luck in your journey....jwb.
age: 62
PSA 4.57 - Positive DRE
Biopsy 3-19-07 - Gleason 4+4=8
Negative bone scan 3-20-07
DaVinci 4-24-07
Catheter out 5-01-07
post op pathology:
positive margin left side of prostate
left seminal vesicle involved (both removed)
No lymph node involvement
New gleason score 9
T3B....radiation consult on 5-9-07.
June 5, 2007 1st psa post surgery 0.62
June 27, 2007 second psa post surgery 0.59
June 27, 2007 started Lupron injection (24 mos)
September 6, 2007 scheduled to be marked and prepped for radiation therapy.
Start IMRT therapy on September 13, 2007.
September 26,2007 psa test .08
Finished IMRT therapy October 31!!!
January 17, 2008 psa test .05...

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