Salvage radiation for SVI

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Jonar
New Member


Date Joined Mar 2008
Total Posts : 9
   Posted 7/24/2008 8:18 PM (GMT -6)   
I had the DaVinci RP in January.  Post op pathology showed seminal vessicle involvement.  My PSA never got below 2.1 six weeks after surgery.  My doctor immediately put me on Lupron and I have been on it ever since.  Now he is recommending radiation, but all of the literature points to no real change in outcomes if you have svi.  I know if I take the radiation I will have side effects. 
Has anyone else been presented with this dilemma?
Age 55
Routine physical 9/18/07 showed PSA to be 13.5.
Diagnosed PCA 11/14/07. Biopsy 2 positive cores out of 12.
Gleason scale 4+3=7.
Da Vinci prostatectomy on 1/30/08.
Negative lymph nodes, negative margins, positive seminal vesicles.
Post op Gleason 4+4=8. Stage T3b.
Dry after 4 weeks.
First Post Op PSA at 4 weeks = 2.6.
Second Post Op PSA at 7 weeks= 2.1.
Started on Lupron 3/21/08
Will begin IMRT in the fall.


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 7/24/2008 9:52 PM (GMT -6)   
Without knowing what your current PSA is, it seems prudent to get that, then make an informed decision based all factors. When is it best to do radiation? What are the outcomes and how does this fit into the way you want to proceed? All things have to be weighed....including the "me" (what do you want ?) factor. Good Luck no matter what direction you head.

Swim
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/24/2008 10:17 PM (GMT -6)   

Jonar,
I went back and read your previous posts and I'm not sure how I missed your joining us back in March.  And wouldn't you know it, I'm on a self imposed vacation from HW and I look in tonight and see you posting.  First off ~ Welcome.  This group is the best on the internet for helping each other.  You and I are very close everywhere, and we have only a few 3b peers here.  I, too, had bilateral SVI, but also I had margins consistent with carcinoma.  I am a year ahead of you.  I was fortunate to achieve an undetectable PSA, but like you, my doctors did not expect it to hold up.  So I immediately went with HT, I declined a 6 round dose of Taxotere, and I debated with my medical oncologist, and my radiation oncologist at the same center on whether radiotherapy was beneficial.  Eventually, I went with my RO after he produced the following study: Stanford Study on WPRT Post RP in High Risk Patients

I studied RTOG 94-13 in detail and the arm that still shows the most promise is Whole Pelvic Treatment with HT when performed as in the Stanford study post operatively.  Even my medical oncologist said the 6 year numbers do show improvement in biochemical relapse rates.  He remains skeptical for the long term rates, but I went with it anyway.  I had IMRT with the WPRT method and I am in good shape a year later.  My worst side effects are the games that HT plays with my mind.  The radiation was a relative breeze.  Some have not fared as well.  A year and a half later, and three of four options selected, fatigue and depression are present but they both are more from the HT.  Aside from, what I beginning to believe is permenant ED, all else functions well.  I would not change the treatment modalities I selected.  And as long as I can stay undetectable while on HT, I can avoid that talk with my oncologist.

Back to my vacation.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
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 (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 7/25/2008 8:37 AM (GMT -6)   
My father had salvage radiation and is currently on HT. He had negative svi, but a positive lymph node and one focally positive margin. I still don't understand how that happens, but we are beyond that now :) Anyways, the decision to do IMRT was very controversial and he was not wanting to do IMRT, however, our family really encouraged him to do so. He tolerated IMRT extremely well, however, he did experience fatigue and diarrhea for a couple of the weeks. The diarrhea responded well to Imodium. I know not everyone does as well as he did, but his experience was very manageable. Since his radiation, a study came out (http://news.healingwell.com/index.php?p=news1&id=616579) and I am very happy that he decided to do IMRT. Only time will tell, but we are hoping for the best. Good luck in your treatment decision!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 7/25/2008 12:47 PM (GMT -6)   
I would say give the radiation a shot.  There is alot of research lately pointing to the fact that even though radiation may not cure the prostate cancer it does seem to impede metastes, I think that makes it worth doing.  Good luck.

Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 7/25/2008 9:17 PM (GMT -6)   
Any side effects from salvage radiation therapy are far less than doing nothing and the cancer heading out to other locations in your body.  Yes, the radiation destroyed any of the nerves my surgeon probably saved, but I had no others effects from radiation.  The hormones have caused some mild "hot flashes" and some fatigue, but I have been keeping active, and will make it through this for another 9 months.  I choose to do whatever is necessary to keep this beast at bay.  Do more reading and thinking before heading off on either salvage therapy or nothing.

Age 57 at diagnosis (2006),  PSA 4.7 (up from 3.2 one year previous)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5, 2007:  0.01    5 month PSA  0.08
Adjuvant therapy began June 26, 2007 with Zoladex injection
Radiation began August 23, 2007, ended October 8
First post radiation PSA, December 18, 2007:  0;  March 2008 - still 0;  July 2008 - 0
 
 


Jonar
New Member


Date Joined Mar 2008
Total Posts : 9
   Posted 7/26/2008 8:04 AM (GMT -6)   
Thank you for the replies.
I appreciate the article from Tony on whole pelvic treatment. I will make sure I take a copy when I meet my RO next month to plan treatment.
Best of luck to all of you.
Age 55
Routine physical 9/18/07 showed PSA to be 13.5.
Diagnosed PCA 11/14/07. Biopsy 2 positive cores out of 12.
Gleason scale 4+3=7.
Da Vinci prostatectomy on 1/30/08.
Negative lymph nodes, negative margins, positive seminal vesicles.
Post op Gleason 4+4=8. Stage T3b.
Dry after 4 weeks.
First Post Op PSA at 4 weeks = 2.6.
Second Post Op PSA at 7 weeks= 2.1.
Started on Lupron 3/21/08
Will begin IMRT in the fall.

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