Radiation and RP?

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ScottyMo
Regular Member


Date Joined Oct 2008
Total Posts : 32
   Posted 11/12/2008 8:46 AM (GMT -7)   
I have been reading soemwhere ( hmm the Internet  ! )  that they cannot tell if a PCa is truly agressive or not, and that alot of useless RP are performed;  also that perhaps even if a RP is performed it might not get it all anyway; so my question if you are conservative and what a nerve sparing RP; would follow-up treatment be available (Hormaone therapy, radiation of the Pelvic area, s an additional precaution?) 
PSA 12/01/2007:  1.38
PSA 10/21/2008:  5.9
PSA 10/21/2008:  2.6
Biospy has been rescheduled; awaiting 2 weeks with Cipro


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 11/12/2008 9:16 AM (GMT -7)   

Hi Scottymo,

The answer to your question is "yes". If you have RP you can have a follow up with hormone or radiation or both. You can also have hormone concurrent with RP. Common belief is that if you have radiation first you cannot have salvage surgery. I have seen some evidence that you can do salvage surgery it is just that the side effects are not good and come with a high probability of occurence. Cryo is also available and getting better as salvage but you still have the SE's.

You do not give your age but your PSA score on 10/21 repeat does not look that high. Or is the date on the 5.9 a typo?

Good luck and I hope the news from your biopsy is good. By the way the biopsy is not that bad of a procedure so don't let your mind work you up over it.

Take care,

Don


Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/12/2008 11:32 AM (GMT -7)   
Scotty...I don't think there is such a thing as useless RP not when it comes to cancer. True, in some very limited cases, surgery isn't required and the Watchfull Waiting approach may be better than treatment. This is limited to a very few, mostly the elderly and your biopsy will give the urologist a better understanding of your particular cancer (if you do indeed have cancer) and the best treatment approach if required.

The biopsy will show just a snap shot in time of the aggressiveness of your cancer. Unfortunately, it can and in most cases will turn more aggressive as time goes by. So that is why it is so unpredictable...for some it may take years...others a mere few months. (Like me)

If you are diagnosed with cancer, by all means at your age get it treated with whatever means is best for you. If you elect surgery, you can go the route of either radation or hormone adjuvantly...but follow you doctors recommendation. There isn't any form of treatment that doesn't come with some side effects. So weigh carefully before promoting additional treatment for yourself unnecessarily.

Meanwhile, continue your research and hopefully the biopsy will be be negative and therefore no treatment will be required and you can live your life with much more knowledge about this disease than before.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


wiggyann
Regular Member


Date Joined Apr 2007
Total Posts : 171
   Posted 11/13/2008 12:28 PM (GMT -7)   
Scotty,

This just came in from John Hopkins about RP. My husband had Radiation treatments and a seed implant and the same kind of physician experience is required for these procedures also. So, whichever one men choose as their treatment option, make certain that the physicians performing it have the experience required. Read Below:

According to a recent study, the risk of a prostate cancer recurrence after radical prostatectomy appears to depend in large part on how many procedures the surgeon has performed. The take-home message: experience counts.

Radical prostatectomy was developed at Johns Hopkins at the beginning of the 20th century. The operation was not popular at first because of the high rate of erectile dysfunction and urinary incontinence associated with the prostate surgery procedure.

But in the early 1980s, Johns Hopkins urologist Patrick Walsh, M.D., developed a new approach to the prostate surgery operation. He devised a "road map" that allows surgeons to remove the prostate with less risk of damaging the nerves that are essential for erections and urinary control. This "nerve-sparing" prostate technique has reduced the risk of severe incontinence to 1-3% and the risk of mild incontinence to around 10%.

The risk of erectile dysfunction varies according to a man's age and the surgeon's skill. One group of researchers reported that nerve-sparing prostate surgery achieved successful recovery of erections in 68% of patients. Dr. Walsh has performed the prostate procedure on more than 2,000 men with early prostate cancer, preserving erectile function in 90% of men in their 40s, 75% of those in their 50s, and 60% of those in their 60s.

The importance of surgeon's experience as it relates to prostate cancer outcome is underscored by the results of a study reported in the Journal of the National Cancer Institute (volume 99, page 1171).

Researchers analyzed the outcomes of 7,765 radical prostatectomies performed by 72 surgeons between January 1987 and December 2003 at four major academic medical centers. "Biochemical" recurrence was defined as a postsurgery PSA level greater than 0.4 ng/mL followed by a subsequent higher PSA level. The analysis took into account patient and tumor characteristics, such as pre-operative PSA level and Gleason grade. The men's PSA levels were measured every three to four months in the first year after surgery, twice in the second year, and annually during the following years.

The researchers found that surgical outcomes improved along with the number of radical prostatectomies a surgeon had performed, leveling off only after about 250 surgeries. The five-year probability of experiencing a recurrence of prostate cancer was 18% for surgeons who had performed only 10 operations compared with 11% for surgeons who had performed at least 250 surgeries.

Bottom line on prostate cancer surgery: The results suggest that you can improve your odds of a successful outcome from radical prostatectomy by taking time to find a surgeon with extensive experience.

Wiggyann

ScottyMo
Regular Member


Date Joined Oct 2008
Total Posts : 32
   Posted 11/13/2008 1:26 PM (GMT -7)   
hmm, interesting,  did they have an answer as to why an experience surgeon have better outcomes? 
Age:  52
PSA 12/01/2007:  1.38
PSA 10/21/2008:  5.9
PSA 10/28/2008:  2.6
Biospy has been rescheduled; awaiting 2 weeks with Cipro


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/13/2008 1:44 PM (GMT -7)   
The best answer I can think of...no two men are identical...so the more experience a surgeon has...the better understanding he will have to those differences between men. A less experienced surgeon will have a learning curve in which he will be come comfortable with over time and the number of surgeries. I certainly would not want a surgeon just out of training to operate on me and by the same token I would not want an older surgeon that doesn't have a steady hand...regardless of how much experience he has.
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 11/13/2008 5:39 PM (GMT -7)   

Hi Scottymo,

I think that I may have a bit of an answer for you on the influence of experience on surgical outcome. about ten years ago I was faced with open heart surgery to correct about four arteries that had become blocked. Diet nor drugs were able to prevent the build up. I was otherwise quite healthy. Anyway, in researching the success factors two things kept coming to the fore front in terms of patient morbidity or relapse. First: How many surgeries did the thoracic surgeon perform in a year. Second: How many surgeries were conducted at the surgical facility. Rest of it was pretty much a wash. Where he went to school, what his grades were, was he left handed or right handed, etc. Clearly experience was the trump card.    

Why might this be? Think of your own experience. The more times you do something the better you get at it. Particulary where motor skills are required. Such as playing a musical instrument. I would also believe that a surgeon who sees a lot of patients would be more attuned to the potential risks associated with a particular patients characteristics.  

In the case of the facility it was shown that a hospital that did a large number of the procedures was better equipped to handle the procedure and the support personnel were also more experienced in providing acute care following surgery.  

In my case I had one of the best heart surgeons around and the hospital was in the top of those rated by US News at the time. I have had no futher complications since that time. In short, I believe in experienced hands and minds.

Don

 


Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


ScottyMo
Regular Member


Date Joined Oct 2008
Total Posts : 32
   Posted 11/14/2008 9:18 AM (GMT -7)   
Selmer, 
 
I agree with what you say  (first of all , hurray my number PSA went down!)
your numbers would not yet inidicate a Biopsy;
As you can see my PSA lowered after 2 week treatment of; even lower than the 1.38; so dicovering the baseline and velocity may be difficult.  I would think the lowest number ever (assuming no lab issues); would be your baseline; then every 3 months anotehr pSA test; and if it jumps; maybe another after a 2 week trratment as I had;  this way a true (as best as we can) PSA velocity can be determined.  As far as I can tell; if every man had a Biopsy they would find a ton of cancer; and depending on teh Biospy one would know whether they needed treatment only some of the time;  for alot of these cancers; they would not know whether it was aggressive or not;  The Biopsy does help in that area; so I could understand doing it for everyone who had some PSA rise; however; I am not sure if I would want to Biopsy a non life threat cancer; as I read that it may disturb it; although I doubt it; I dont think it has been proved one way or the other.  So alot to dicsuss; but it is clear that PCA can be aggressive and early detection is a key for those cases.
Age:  52
PSA 12/01/2007:  1.38
PSA 10/21/2008:  5.9
PSA 10/28/2008:  2.6
Biospy has been rescheduled; awaiting 2 weeks with Cipro
PSA 11/13/2008:  1.0  (Wow!!!)
Next PSA 3 months


pcainaz
New Member


Date Joined Nov 2008
Total Posts : 7
   Posted 11/14/2008 10:24 AM (GMT -7)   
ScottyMo,
Your PSA swings are not typical of prostate cancer. What is your age? Be sure that your antibiotic course is long enough to deal with a potential resistant infection. Use of a NSAID is potentially useful in case of inflammation causing PSA protein leak into the bloodstream.

Wish you the best possible outcome: No prostate cancer!

ralphv
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