Query on radiation following prostatectomy?

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BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 4/1/2008 6:14 PM (GMT -7)   
I would be interested in members opinions and experiences on radiation following protatectomy. I had my surgery last August and as my signature says, there was a small focal extraprostatic extention but the surgical resection margins were clear. Three PSAs since have been undetectable. Ongoing reading and research on my part suggests in cases such as this, some patients have a course of follow up radiation as a precaution. Is the radiation a wise precaution and how is it directed? I mean, if surgical margins are clear how do they locate the specific area to be radiated or is a scattergun radiation of the whole prostate bed area done. Any advice is greatly appreciated.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcima-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP 8/07
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable


FairRider
Regular Member


Date Joined Jan 2008
Total Posts : 32
   Posted 4/1/2008 8:51 PM (GMT -7)   
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
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


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 4/1/2008 10:06 PM (GMT -7)   
FairRider,
How ya going? There does not seem to be an email address with your profile. I'm looking forward to any feedback with this question. Our stats certainly are similar. I don't know whether it would be classed as a special diet but I have decided to cut out red meats and almost all dairy products (the exception being a little milk and spread in mashed potatoes-------Mmmm) as well as white bread and biscuits. I do take a few supplements such as capsicain, fish oil and vitamins now. Exercise level is up a good deal as well. Whether it has any long term effect on the PCa is up in the air I suppose, but it has certainly been a boost to my overall feeling of good health with quite a few excess kilos disappearing as a bonus. And that has to be a good thing. :-)
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcima-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable

Post Edited (BillyMac) : 4/2/2008 12:43:06 AM (GMT-6)


mozart250
Regular Member


Date Joined Jan 2007
Total Posts : 102
   Posted 4/2/2008 9:27 AM (GMT -7)   
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.
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
Regular Member


Date Joined Jan 2008
Total Posts : 32
   Posted 4/7/2008 8:31 AM (GMT -7)   
Hey, Billy Mac and Mozart -

We got another opinion on the Pathology and seems the more we explore, the worse it gets. Now are told there is a positive margin at the extension......

It frustrating because feel like we need to put together a team who will have a conversation with us about our case, but not sure how to put that together. We do have Uof Michigan 2 hours away - perhaps that is what to do.

Now, too, it looks like there is a hernia bulge........

I believe I have now enabled the email, so feel free to write anytime. Maybe we can sort these things out together.

FairRider
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
Both Nerves Spared - Pre-surgery DRE - TC1
Post Op Pathology - T3a Extra-prostatic Extension,
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, minimal with Bimix


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 4/7/2008 8:55 AM (GMT -7)   
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.
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!!!
 
 

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