Query on radiation following prostatectomy?

Hi BillyMac -

We have simialr stats and similar questions, so I hope some of the very wise folk here will jump on and share their wisdom on this situation.

Are you doing a special diet? We keep reading about the huge impact of diet, so at least it is something we can do.

I'll keep track of this - feel free to email.

Good luck and glad to read the undetecables.

FariRider

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Age 54; (Father, paternal uncle and 1 brother so far with Pca)
1999 PSA 2.8; 2004 PSA 2.88; 1/2008 PSA 5.6 & repeat 4.37
DRE - "Unremarkable, L side slightly larger"
Free PSA 0.46 and ratio 0.11
Biopsy 1/25/2008 - 10 Cores - 4 with adenocarcinoma
3 cores Gleason 3+3=6 and 1 core 3+4=7
No Stage given on report, maybe T1c or T2c ?

Robotic Surgery March 17, 2008 - Vattakuti Institute - Dr. Menon
Both Nerves Spared - Pre-surgery DRE - TC1
Post Op Pathology - T3a - 2 small foci of Extra-prostatic Extensions,
CLEAR margins, 4 Lymph Nodes Clear, Seminal Vesicles clear.
Gleason now 4+3+7, Tumor 20-30% of gland
Dry immediately! - no pads by day 9 Post-op
No response with Viagra

Hi BillyMac:

I am undergoing radiation as we speak.  I had a positive margin after surgery.  At first my psa was 0.0, but it then climbed to 0.1 for three consecutive readings.  At that point I sought a second opinion, and we decided upon radiation.

From what I have figured out, the proper course of action given our staging is debatable in the medical field.  My urologist would have preferred to wait until it climbs above 0.2.  My radiation oncologist felt that the safest course of action would be radiation since my PSA was not zero.

And there are some folks here who didn't even wait a year but had radiation shortly after their surgery.

My one piece of advice would be not to hesitate to get a second opinion on your condition.  I think the medical field is divided concerning the proper action given our staging.

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52 Year Old DBA by profession; amateur pianist by passion.

June and Aug 2006:  PSA 4.6.  DRE prostate enlarged.  Second opinion

Sep  2006:  Biopsy results positive one lobe.  Gleason 3+3.

Nov  2006:  RPA performed at Fletcher Allen in Burlington VT.

Nov  2006:  Pathology report: Stage T3a and Gleason 3+4.

Dec  2006:  PSA 0.1

Feb, May  2007:  PSA 0.0 (under 0.1)

Aug, Nov  2007 and Feb 2008:  PSA 0.1

Mar-May  2008:  IMRT Radiation

Trying my hand at blogging.

FairRider-
I feel your frustration. One of the most frustrating parts of this disease for our family has been that the medical community is divided on treatment options. We consulted with three radiation oncologists, two oncologists and two urologists regarding my father's post surgery report. The more opinions we sought, the more frustrating it was. The jury is out on when to begin adjuvant therapy following surgery with a positive margin and increasing PSA.
One oncologist we saw recommend .2 and another recommended >.1. The guidelines vary as well from different teaching institutions.
My dad had a positive lymph node and one focally positive margin, so his situation is a little different, but in regards to the radiation portion of his treatment, everyone but one RO advised waiting until the first PSA and then based on that reading to start radiation.
What we discovered, is that YOU need to be your own advocate, get the medical opinions and remember that they truly are opinions and make the best decision based on the information you gather. We have decided that no matter what the outcome, we refuse to look back. We have gone with what we believe to be the best course of action based on our research and that is all we can do. It's hard to get a grasp on that there is no if A then B with cancer. It just straight up sucks and doesn't follow a protocol. Good luck and keep us posted!
P.S. You should be able to have a tumor board review your case. Most major institutions have a team that reviews each case and comes up with a game plan. I would inquire about it.

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Father's Information

DX July 15, 2007

Age 62 (now 63)

PSA 5.5

Original Gleason 3+4=7 

Post Surgery Gleason- 4+3=7

DaVinci Surgery Aug 31, 2007

Focally Positive Right Margin

One positive node

Bone Scan/CT Negative (Sept. 10, 2007)

T3a N1 M0

Oct. 17 PSA 0.07

Nov. 13 PSA 0.05

Casodex adm. Nov 07

Lupron beg. Dec 03, 2007 2 yr

Radiation started March 03, 2008 7 weeks 5x a week

2 weeks of radiation down!!!