Brachytherapy... no psa test at 18 months ?

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wiggyann
Regular Member


Date Joined Apr 2007
Total Posts : 171
   Posted 11/25/2008 4:44 PM (GMT -6)   
 
My husband had brachytherapy in April of 2006 and
this morning he went to his radiation oncologist for
his 18 month check up.  I have been a little anxious
because sometimes there is a bounce in psa at this
point. However, when my husband came home, he
told me that his radiation oncologist did a digital rectal exam and told him that his prostate was flat, but that he
was not going to do a PSA and leave it for his urologist
to do.  My husband doesn't see his urologist again until April.  So his 18 month PSA is being skipped confused
and his next one will be at two years. 
 
Has anyone else who had brachytherapy skipped their
18 month psa test? 
 
Sure would appreciate hearing from someone.
 
Husband 68 at diagnosis, PSA 7.2 
Gleason score 7
eight out of twelve cores positive
seven 3+3 and one 3+4
25 IMRT and Seed Implant April 2006
psa at one year 0.5
 
Wiggyann   
 

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 11/25/2008 10:42 PM (GMT -6)   

Hi Wiggyann,

I have not had brachytherapy but did have external radiation. It was suggested that I have my first follow up PSA 6 months post radiation. I thought that was a little long so I have requested a PSA by my Urologist with a 3 month follow up. I suggest you do the same (make the request) and if you can not get the uro to do the test find a GP that can order the test. I did have a PSA test done at a local health fair but I do not know how accurate they are compared to the Uro's lab.

You seem to have the same problem that I have. It is hard to tell who is managing the follow up. Even though my Uro and Onc are in the same practice I get the impression that they do not talk and thus things fall through the crack if I don't take action.

Take charge and be a bit demanding.

Good luck to you and your hubby.

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
 
 


wiggyann
Regular Member


Date Joined Apr 2007
Total Posts : 171
   Posted 11/26/2008 2:33 AM (GMT -6)   
Hi Don,

Thanks so much for responding. You know, I wondered today if maybe his regular GP would order him a psa test. I don't know if my husband would ask him to. He never wants to
cause any problems and just goes along with whatever the doctors say. My husband is not the demanding type. I do wish he would be a little more assertive though. He did ask his regular doctor once when he was scheduling him for some blood tests if he would do a psa and he did. I was sort of disappointed. I had just assumed he would have a psa test today and I had been waiting for this 18 month follow up.

Thanks a lot for your help Don. Hope your psa test in March
is all zeros.

Wiggyann

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 11/26/2008 8:09 AM (GMT -6)   
I think that you are correct, you should have gotten that 18 months test. I'd be assertive and push for one. The good thing about them is they are readily available in almost any doctors office, so the GP or the Urologist can/should test for it. I'd follow up on this and get the test drawn. I'd also discuss the 'breakdown' in treatment with the 2 or 3 offices and see who is really in charge and responsibile for blanket coverage of long term testing and monitoring. Just my opinion, of course.
James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 11/26/2008 8:35 AM (GMT -6)   

WiggyAnn

Request the test - my husband has a PSA done when he sees the Urologist and a PSA done when he sees the Oncologist.  He sees them, alternatively, and each doctor orders the test before his appointment so he is never without (a) monitoring and (b) care.

Get the test - for your peace of mind and his.  He needs to learn to "rock the boat" a little and advocate for his health care.  Unfortunately some doctors are so busy some patients fall through the cracks unintentionally - don't let your husband be one of them.

Tell him this - the doctor that did my husband's biopsy told him he didn't see the need - he was too young to be a prostate cancer candidate.  If he had listened to him his cancer would have gone undetected - take no chances - get the test.  I don't know what it costs for a PSA test there, but even if you have to pay for it, for peace of mind it would be worth it in my opinion.

JustJulie


Husband diagnosed in December 2005
PSA of 3.74
Gleason 6
Brachytherapy (91 stranded seeds) April 2006
PSA of 0.39 - November 2008 - whoo hooo!
 


wiggyann
Regular Member


Date Joined Apr 2007
Total Posts : 171
   Posted 11/26/2008 2:46 PM (GMT -6)   
Thanks a bunch James and Just Julie for your help.

I think I know what happened. When my husband had his seed implant, he was given a paper which said to call his uroloigst
in several weeks and schedule a follow up appointment. Since my husband already had an appointment with his oncologist
for four weeks, he just waited and went to him. The oncologist
did a cat scan and checked the position of the seeds and did a psa test. Then, when my husband went to see the urologist, he asked him how he was doing and then said, "Well Dr. --- did
a psa, so there really isn't anything for me to do. The urologist's nurse ended up phoning the oncologist and jumped on him for giving my husband a psa test. I really think that is the reason
that he didn't give my husband a psa test yesterday and told him he would let the urologist do it.

Wiggyann

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 11/26/2008 2:51 PM (GMT -6)   
Wow - I would rather err on the side of caution under these circumstances.  I guess we're really blessed that the Urologist and the Oncologist are truly practicing "shared care" as each doctor is in contact with the other as they rotate visits every few months - and they're not even in the same city.
 
Hugs to you, sometimes wives carry just as big a burden on this journey.
Husband diagnosed in December 2005
PSA of 3.74
Gleason 6
Brachytherapy (91 stranded seeds) April 2006
PSA of 0.39 - November 2008 - whoo hooo!
 


chinito
Regular Member


Date Joined Dec 2008
Total Posts : 28
   Posted 12/8/2008 10:16 PM (GMT -6)   
my husband just was diagnosed with prostate cancer and is considering brachytherapy...how is your husband doing?
wiggyann said...
My husband had brachytherapy in April of 2006 and

this morning he went to his radiation oncologist for

his 18 month check up. I have been a little anxious

because sometimes there is a bounce in psa at this

point. However, when my husband came home, he

told me that his radiation oncologist did a digital rectal exam and told him that his prostate was flat, but that he

was not going to do a PSA and leave it for his urologist

to do. My husband doesn't see his urologist again until April. So his 18 month PSA is being skipped [img]/community/emoticons/confused.gif[/img]

and his next one will be at two years.



Has anyone else who had brachytherapy skipped their

18 month psa test?



Sure would appreciate hearing from someone.



Husband 68 at diagnosis, PSA 7.2

Gleason score 7

eight out of twelve cores positive

seven 3+3 and one 3+4

25 IMRT and Seed Implant April 2006

psa at one year 0.5



Wiggyann
confused

divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 12/9/2008 7:57 AM (GMT -6)   
Wiggy, I would definitely get the PSA test. My husband had external radiation and seeds and then lupron for a year...He had the first psa test six months later, and then another six months....some how we missed the 18 month and then had it another year later....It started to rise, and then began rising very fast.
We sort of had the same problem....the oncologist and the surgeon and the urologist....although they were in the same practice..(Sloan Kettering), I feel that he did fall through the cracks....My husband didnt want to push for the PSA tests....he thought somehow if the doctors didnt follow him closely it meant he didnt need it... Anyway, to make a long story short...I would definitely push for the PSA on schedule. It might have saved my husband from the salvage surgery that he had later...Now I am still pushing him to get a psa test again. It has been over six months.. Diane
Husband Pete
dx Jan 2001 age 67 gleason 4 + 3 PSA 16.5
seed implant and conformal radiation Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06
Fistula operation 2/07 MSK
Many cystoscopies and ER visits with strictures
catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/07
AUS Operation at MSK Sept 8. Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008

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