Help Please...radiation after surgery????

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AngelBeliever
New Member


Date Joined Oct 2008
Total Posts : 7
   Posted 12/19/2008 8:38 AM (GMT -6)   
My husband, history below, had RRP on 10/31/08.  One week post surgery, he had catheter removed and doctor advised he may need additional therapy - IGRT.  I said I didn't understand, and he said he thought there might have been something left behind in the fatty tissue surrounding the prostate.  I asked for copy of pathology report and received it upon checking out.  FYI...doctor was highly recommended and has performed 700+ RRP's, however, he doesn't have much of a beside personality. Full review of pathology report at home says:
 
"The carcinoma is found from the left mid prostate to the left prostatic base and is all Gleason grade 7/10 with extensive perineural invasion.  No tumor is found at the apex.  Primary poorly differentiated prostatic acinar adencarcinoma, Gleason grade 3+4=7/10.  Confined to left side with multifocal perineural invasion, multifocal capsular invasion, and focai extension to posterior capsule at left base posterior.  All other margins completely tumor free. Seminal vesicles are completely tumor free."
"Comment: This is a stage T2A, NX, MX primary moderately differentiated acinar adenocarcinoma, glease grade 3+4=7/10."
 
My husband had first post-op PSA last week and results were < or = to .1 UNDETECTABLE!
 
Met with doctor again yesterday, discussed incontinence issues, he advised he is right on target; discussed ED matters and began Cialis and has appointment in January for someone to get pump.  Doctor then said we will start the radiation therapy in 3 to 6 months; he doesn't start RT less than 3 months to let bladder fully heal.  He was getting up to leave at that point and I said hold on, I have a few questions.  He sat down, with a sign and a shrug (visibly and my husband said he saw this too).  I said I didn't understand why he was needing radiation therapy at this point, when PSA was undetectable and his pathology report said he was a T2A which I believed to be cancer confined to prostate.  His response was "He is a stage T3A and I think there might be cancer left behind and we don't know if the cells are dead or alive".  I said, "But the pathology report said he is a stage T2A" and his response was "Pathologists don't know how to stage properly, I have given him a stage T3A dx".  I then inquired why in his pre-op biopsy (which was done by another doctor) it said the cancer was found in the apex and mid-prostate and yet the post-op pathology report said there was no cancer in the apex but the base.  His response was "The biopsy samples are so small, it picked up a minute cell.  There was cancer in the apex but it was a very small.  Also, when they do the surgical pathology, they do not look at all of the tissue.  Now this is why we don't like patients having these reports because they try to be clinicians and they just don't understand it all."  To which I responded, "I am not trying to be a clinician, but my husband and I are trying to understand his illness, so that we can make well-informed decisions and choices about his course of treatment."  He then said to set appointments for a 3 month PSA test and one week later to discuss results and radiation.
 
I should mention that I have shown his pathology report to other doctors that I know outside of our local area, as well as have talked to the pathologist right after the first post-op visit (turns out he is a client of the firm I work for) and they all said my husband's prognosis was excellent, the pathology report was great news and we would be enjoying many Christmases to come together.  I asked the pathologist why the doctor would be recommending radiation therapy at this point and he said, he had one small positive margin, which the doctor would probably feel he needs a little "housecleaning" in that area.  (I did not tell the doctor I have spoken with the pathologist).
 
I should mention one more thing, I joined this forum right before my husband was having surgery and while I have not posted often, have read many posts by all and have heard many important comments and opinions.  Often I see others say you should have a second pathology report done by one of the experts in the US.  At the first post-op visit, I asked the doctor if he felt we should have a second pathology opinion done at John Hopkins or some other expert in the field.  His response was "It is not necessary, the pathologist who did this report is excellent and knows what he is doing."
 
I am so confused, upset, angry, depressed and really don't know what to do next.  It seems I am getting conflicting information.  Should I go out on my own and get forms and get another pathology report?  Should we see another doctor at one of the specialist hospitals in the US?  Am I over reacting and just don't understand this all?  My husband has aked me to do the research and ask questions because he doesn't like to do that sort of thing and as he puts it, he trusts everyone, and I outside of my family and close friends, make others earn my trust, and with the two of us, we make a good team to find middle ground.  Also, I am an accountant/auditor and it is my profession to research, find facts, test. keep professional skepticism and make conclusions based on my findings.
 
We have already changed doctors once because the doctor he had only did PRP, and then it turned out the doctor scheduled him with some other surgeon in the practice we never even met because he was so busy he couldn't fit him in timely and I was doing research and we came to conclusion RRP could offer better results.  My husband is my soul mate and I will go to the ends of the earth and do whatever is needed to help him and be a good partner.  So...sorry for lenth of this post, however, I wanted to share all I felt was pertinent info to get opinions and suggestions.  Please help, I am so scared.
 
 
 
 
 

Husband's History:
Age 49 @ Dx 08/08/08
May 2007 PSA 5.1 DRE Normal 23.4 cc Biopsy-12 samples-Benign
May 2008 PSA 7.5 DRE Normal
July 2008 PSA 7.4 DRE Normal Biopsy-2/12 samples-Postive
Left lateral mid prostate Adenocarcinoma (3+3) 5% of core
Left apex prostate Adenocarcinoma (3+4) 15% of core
No evidence of perineural invasion
Dx: Adenocarcinoma T1c Gleason 7
Awaiting davinci 10/31/08
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/19/2008 8:56 AM (GMT -6)   
AngelBeliever....it is always so difficult to make decisions that you are not comfortable with...especially when we want to trust our doctors to the fullest...afterall we committed our life to them during surgery. The subject of staging between T2 and T3 based on positive margins has changed over the years. Typically, focally positive margins are not given a T3 stage so it would seem that the pathology report of T2 is accurate. But, it is still debated to have adjunct treatment for positive margins. You can ask as many doctors and will find them on both sides of this question. My particular surgeon suggests to wait until there is a rise in PSA before doing radiation. The belief is that most of the time, any remaining cancer cells die off because of the trama of surgery and loss of blood supply and to scar tissue. However, there is some consensus that performing adjunctive radiation increases the number of disease free years.

I would continue talking with other medical professionals and then decide what direction you want to go. For me, I am satisfied on waiting to see if the PSA rises, because I don't feel comfortable with the additional treatment right now. But that is my opinion...others will speak otherwise.

Best of luck in your journey
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


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 12/19/2008 10:32 AM (GMT -6)   

AngelBeliever,

My condition and decision is very much similar to Les.  I do feel your Surgeon, in his opinion, is sincere in wanting to do all he can for your husband.  As Les has said some Docs believe that Adjunctive radiation is the way to go in our situation and others do not.  I consulted with an oncologist, a radiation oncologist and my surgeon who is a uroligist oncologist. The oncologist and radiaiton oncologist suggested to do the adjunctive radiation but my Urologist Oncologist thinks that he got it all and that any remaining cells may die off or were pushed to the edge as the prostate was removed from the body by the Robot and transferred to a fellow. He  strongly feels it is necassary to test every 3 months and watch the PSA very closely and if it shows any sign of reoccurence he states he will suggest to do radiation. In fairness he also is the guy who does not want to admit he failed to get it all as well. You must balance that opinion.

Now Surgeons are so busy, do not think for a minute that they will call you up and remind you 6,9 or 12 months down the road to get tested.  You need to be orginized and dont become complacent if you decide to watch the PSA.  If you forget to get tested and you experience chemical failure you could be in trouble.

I suggest you see an oncologist and a radiation oncologist even if you choose to wait.  Develop and find a radiation oncologist that you can go to if you have a problem.  If I need to be radiated it will be at another Hospital for the daily drive to where I had my surgery would be very hard to do.

I wish you all the best in your decision.

Frank


Age 54
DRE normal , 2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
PSA @ surgery 6 
Bone and Ct scans negative
clinicaly Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008, University of Chicago.
Catheter out in 7 days normaly expected leakage
Post Pathology T2C, Gleason 7, 10 % of both portions of prostate
Seminal vessels clear, fat tissue clear, single positve margin at apex measuring less than 1/2mm. 
Six week PSA < 0.1 , 4 month PSA <.05 Gen II test. 6 month PSA  <0.01
Watching PSA closely,  will do salvage radiation if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. 
 


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 818
   Posted 12/19/2008 10:37 AM (GMT -6)   
Angel,

The phrase "focal extension to capsule" seems to be key. I think I have basically the same thing, though my doctor called it a "microscopic" extension. He told me that it is an area of controversy, and that many doctors would prescribe radiation in that situation. He said he personally prefers to wait until we get a PSA reading to decide.


Sorry your doctor has such a lack of bedside manner. But it may be that his decision is respectable, even though he does a poor job explaining it go you.
DJ

Age 53
PSA 2007 about 2
PSA 2008 4.3
Diagnosed September 2008.
Biopsy: 6 of 12 cores positive
Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter removed on 7th day, replaced on 8th day
pT2c
lymph nodes negative
"microscopic margins"


Gordy
Veteran Member


Date Joined Jun 2005
Total Posts : 528
   Posted 12/19/2008 10:37 AM (GMT -6)   
AngelBeliever-

My view is that the patient has to take charge of his/her healthcare. I had 5 "second opinions" before making my final decision and have fired several doctors along the way because I wasn't comfortable with either their bedside manner or expertise.

Your words: "I am so confused, upset, angry, depressed and really don't know what to do next." This is a very trying time for your husband and you. I believe you should do whatever it takes to become comfortable with the treatment he is receiving. In my case, it meant traveling from New Jersey to Houston because I found an oncologist in whom I have the utmost confidence and who practices in a hospital which I believe lives up to its reputation as being the best cancer hospital in the U.S.

From one accountant to another: try to leave the emotions out of it, be as analytical as you can, make joint decisions with your husband and do what has to be done. And keep a stiff upper lip - whatever that means.

Good luck It will work out.

-Les
1/2005 Dx PSA 26.5 Gleason 7 (4+3) @Age 61
1/2005 Start Casodex and Zoladex
PSA drops to <0.01
7/2005-8/2005 5 weeks of IMRT and then HDR brachy
1/2007 Rad Oncologist orders CT scan of pelvis
because of complaints of pain in both thighs
MRI confirms pain not caused by cancer BUT
1/2007 CT scan of pelvis picks up a nodule at bottom of left lung
5/2007 CT scan of lungs shows 1/2007 nodule has grown and
there are numerous nodules on both lungs.
6/2007 Thoracic surgeon removes wedge of left lung for biopsy
6/2007 Path report says 95% chance of metastatic PCa, but she's
never seen cells like this before.
8/2007 2nd opinion at M.D. Anderson in Houston.
They confirm: mutated PCa, very rare, but seen there 2 or
3 times. Recommendation: have CT scans every 6 weeks
and watch for change. At that point start chemo and will
survive for 22 - 24 months thereafter.
PSA still undetectable, but get Lupron shot to bring T down from 27
2/2008 Trip to Houston – PSA now 0.5 and nodules larger. Lupron shot.
6/2008 Trip to Houston - Finally got results from doc. A number of lung nodules have grown, but, more important to him, is the fact that the malignant lesion on my pelvis seems to have flared up and he wants me to start chemo. He said I could wait a few months, but I told him I want to start now. He to get me signed up for a clinical trial in nearby NY.
9/2008 Interim bone and CT scans show progress vs. scans done before beginning trial. I'm cautiously optimistic. Next scans 10/30/08.
10/2008Bone and CT scans continue to show improvement. Med onc attributes mostly to Taxotere/Prednisone while I believe majority of progress attributable to investigational drug, Sprycel.
12/2008 Latest scans show no change. Bah Humbug!


hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 12/19/2008 10:55 AM (GMT -6)   

Angel -

I don't really have much to add other than to say that I am in the same boat and I can understand your frustration. I too had a focal positive margin and I agonized over a decision on adjunctive radiation. We decided to wait for now and see how the next PSA test shows. I am due for one next week. My surgeon also told me he recommends to wait. The oncology radioligist thought I should do the radiation now but also said that it was perfectly fine and understandable to wait since there is some controversy on this.

My case might be a little different since the PSM was at the apex and I have a gleason 6.

I'm sorry you had this uncomfortable situation with the doctor.

All the best to you.


Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08 < 0.05


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 12/19/2008 11:00 AM (GMT -6)   

You have been given better advice on this forum than your doctor has given you.  He sounds like far too many doctors who are out of touch with their patients.  As DJBear says, "{He does a poor job of explaining"}.

There is not a need to fire your doctor, but you do need to get OTHER OPINIONS.  He might be right, but he seems far to defensive.  It sounds like it is more important for him to be "right" than to do the right thing.  Anytime a doctor says you don't need to get another opinion, then it is time to go out out and get another opinion.

Your doctor is causing you undue problems.  He is suppose to help not hinder.  Good luck getting the answers you need.


PSA up to 4.7 July 2006 , bump noted during DRE
Biopsy 10/16/06
stage T2A  -  Psa 4.7
Gleason  4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion found
No continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02)
ED still a problem, minor succces with bi-mix
plaque buildup due to injections 
 
 
 


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 12/19/2008 11:25 AM (GMT -6)   
I would suggest to you that you have done all the right things so far - one of the reasons some of us chose surgery over other treatement options is because with surgery and the pathology report (which is superior to the biopsy) you are able to know for sure whether the cancer is confined to the prostate. The pathology report does tell you that the cancer extended just beyond the margin. This is not something that you wanted to happen, but the blessing is now that you know that - you still have the option of salvage radiation.

Now, as others have stated - some doctors want to commence the salvage radiation as quickly as possible (thinking it has the best opportunity for cure), while others choose to wait and see if the PSA rises. I like others would suggest you do lots of reading and consider bouncing your decisions off other medical experts - get lots of opinions. But do be encouraged that you still have good prospects for cure, even if the surgery failed to get all the cancer. I know this stuff is all difficult to handle emotionally but take one day at a time and educate yourself. Blessings.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


AngelBeliever
New Member


Date Joined Oct 2008
Total Posts : 7
   Posted 12/19/2008 2:29 PM (GMT -6)   
I can't thank you all enough for your wisdom, experience, opinions and kind words. This forum is like a grounding rod for me. I am so impressed by the compassion of others to share their journey and help others. I think all of you basically have said the same thing. The pathologist did tell me the positive margin was unifocal and very microscopic. I will do as you suggest, because I believe it is the right thing to do. I will do my research, get other opinions and I will let my husband decide what is best for him, for it is his body and his cancer. You are the best and I will get back to reading this forum more often and will post to help others as well.
Husband's History:
Age 49 @ Dx 08/08/08
May 2007 PSA 5.1 DRE Normal 23.4 cc Biopsy-12 samples-Benign
May 2008 PSA 7.5 DRE Normal
July 2008 PSA 7.4 DRE Normal Biopsy-2/12 samples-Postive
Left lateral mid prostate Adenocarcinoma (3+3) 5% of core
Left apex prostate Adenocarcinoma (3+4) 15% of core
No evidence of perineural invasion
Dx: Adenocarcinoma T1c Gleason 7
Awaiting davinci 10/31/08
 


jerryg
Regular Member


Date Joined Feb 2007
Total Posts : 30
   Posted 12/19/2008 3:13 PM (GMT -6)   

AngleBeliever,

   You have received much good info. in the above reply posts.  I was told of Seminal Vesicle involvement and possible nerve bundle involvment by my Urologist after surgery.  He wanted to wait and see, but I had seen this report at- http://journal.medscape.com/viewarticle/557937_print -

and decided it was in my best interest to persue adjuvant therapy as soon as possible after my RRP surgery.  I decided to get a second opinion right away. A Rad/Onc told me I needed to wait 6 months after surgery to let the surgical area heal before starting radiation.  He would talk again about it if I had 3 consecutive 3 month PSA tests that rose reguardless of the amount.  I then talked with the Chair of a large teaching hospital and he told me this was the best plan I could follow.  I eventually decided to have Salvage Proton therapy.  In my 2 months of treatment, I talked with many other PCa patients while waiting in the lobby for treatment.  The number one thread from talking to these many patients was the indecision about what kind of treatment and when to start either adjuvant therapy or salvage radiation therapy.  They are the same as I am concerned, only the time from surgery to the start treatment is the difference.   I can recommend a couple more sites and forums to research, but that would not be appropriate here.  Taking charge and making your own informed decisions is about the best advise you can receive.  My wife has been an invaluable help and support thru this journey so far.  It is so great that you are involved. Hope this helps.

Jerry


Prostate Cancer diagnosed Dec. 18, 2006
Biopsy 12/13/2006 Gleason score = 3+5=8
RRP Jan. 5, 2007
Pathology - negative margins from succesful surgery
10 mg Cilias M_W_F for 8 weeks
Almost no leakage after 5 weeks
Used Vacurect pump for 4 weeks before useable erection.
Presently using injections - PGE and Trimix caused really bad pain.
Now using Bimix - Bingo, good times are back.
Using very little Bimix and 50 mg Viagra-best combo
1-yr PSA .02
PSA July 2008 - 0.08.
PSA Aug. 2008 - 0.10
Started salvage Proton radiation treatments Sept 2008 at UFPTI.
35 treatments ended Oct. 21st.  Ending PSA .20
Minor uniary and rectal problems cleared up after a month.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/19/2008 6:22 PM (GMT -6)   
Angel,
I recommend a second opinion on the pathology and the what to do next, and Johns Hopkins is a great choice for both. Also I recommend an oncologist that is known for prostate cancer once that is completed. Additional treatments by HT and RT are shown in many studies to be more effective on the front end than after relapse in high rtisk patients. I have been through surgery, HT, and RT and I am doing well. My disease was listed at pT3b ~ with a note on the pathology report that indicated residual disease was likely. At first, even my prostate oncologist felt that RT was not a proven winner with my stage, but he has since changed his mind on the matter. We have also been very dilligent to test for circulating tumor cells (CTC). I have made friends that relapsed with lesser disease after surgery, but I have been so blessed to keep forging along with an undetectable PSA.

If your doctor said in one sentence that there is no need to have a second opinion on the pathology, then in another sentence he tells you that he is restating the stage because "pathologists don't do that well"...I'd thank him for his work on the surgery and wish him well. It's time for you to take control of this because this guy sounds like he is more into himself than the patients. Second opinions are very welcome to doctors who are sure of their work. A Gleason 7, focally positive margin is way too close to high risk that you should have at the very least a second opinion.

But don't panic. You have time for the surgery to heal and then in 2009 deal with the what next part. Instead, have a great holiday. And keep a positive mind set.

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, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/20/2008 9:10 AM (GMT -6)   
From One Wife to Another: AngelBeliever, I am sorry about your husband's PCa. Take heart, though, as scary as this all is right now there is often a light at the end of the tunnel.

I understand the confusion over the pathology report and the stage of your husband's disease. My husband's stage is III (pT3a). While all his margins and seminal vesicles were clean any disease, he did have a miniscule extension into the prostate capsule which, according to our urologist, makes him a T3a. There is alot of confusion not just among the medical profession but even on various websites describe the staging of prostate cancer. But, from what I have been able to figure out, once the cancer has left the prostate gland proper it moves in the III stage. Don't let the stage number frighten you too much - my husband's PSA was 0.0 seven weeks post op and has remained there for 8 months.

I truly do understand how frightened you are - cancer is one of the scariest words I know. However, a bit more research - and having a very open and frank discussion with our urologist and then with his partner - taught me that stage III prostate cancer is different than, lets say, stage III lung cancer. PCa is generally a very slow growing cancer and while the number of men diagnosed each year is in the hundreds of thousands, very few of them succumb to the disease.

Angel, take a deep breath. I assure you as one who has been on the road you're on that it will get better.

Please come back and keep us posted.

AngelBeliever
New Member


Date Joined Oct 2008
Total Posts : 7
   Posted 12/20/2008 8:58 PM (GMT -6)   
Thanks again to everyone. I do have a couple more questions to some of you in your posts should you check back here:

In hang-in's post he said that his case was a little different because his PSM was in the apex. I have searched but cannot find any research whether there is a difference in the areas of the prostate the cancer is in. Also, because his post-op biopsy said cancer was positive in left apex (15% of core) and the surgical pathology said there was no tumor in the apex, but the base, makes me wonder if in that pre-op biopsy someone mixed up the sample cassettes. My husband's pre-op biopsy was done by his first urologist who we ended up walking away from for various reasons, the last of which was mentioned in my post above. Any knowledge here in the difference between PC in base vs apex would be helpful.

To all, besides John Hopkins and MD Anderson, does anyone have any other recommendations of where to go for a second opinion. We are in the SW FL area and I want other opinions from outside our local area.

Sephie...thank you much. Both my husband and I have had experience with cancer before. My husband lost his first wife to pancreatic cancer 9 months after diagnosis. My nephew lost both eyes after a six year battle with retinablastoma that was dx when he was 10 months old. I lost my wonderful mom and dearest friend after her three year battle with colon cancer. Of these three, only my nephew, now 17 has been cancer free for 11 years. My husband and I have been together 7 years and only married 2, so this has shaken us to the core. Has your husband had any post-surgery treatment?

jerryg...I would be grateful for any other websites that would be helpful. I found the one in your post most informative and interesting.

Thanks again everyone for sharing.
Grace
Husband's History:
Age 49 @ Dx 08/08/08
May 2007 PSA 5.1 DRE Normal 23.4 cc Biopsy-12 samples-Benign
May 2008 PSA 7.5 DRE Normal
July 2008 PSA 7.4 DRE Normal Biopsy-2/12 samples-Postive
Left lateral mid prostate Adenocarcinoma (3+3) 5% of core
Left apex prostate Adenocarcinoma (3+4) 15% of core
No evidence of perineural invasion
Dx: Adenocarcinoma T1c Gleason 7
Awaiting davinci 10/31/08
 


jerryg
Regular Member


Date Joined Feb 2007
Total Posts : 30
   Posted 12/21/2008 12:32 PM (GMT -6)   

AngleBelieve;

I would be happy to send you some more info. that I have saved during my 2 year Journey.  I will make no opinions on what you guys should do, just some ref. material that might help you make a easier decision. I have allready made my choices. I have saved copies and they would would much easier to send by e-mail than links.  My e-mail address is on the bar on the top left of my message response.  I see SW FL., we are in The Villages, Fl., just No. of Leesburg.

Jerry

 


Prostate Cancer diagnosed Dec. 18, 2006
Biopsy 12/13/2006 Gleason score = 3+5=8
RRP Jan. 5, 2007
Pathology - negative margins from succesful surgery
10 mg Cilias M_W_F for 8 weeks
Almost no leakage after 5 weeks
Used Vacurect pump for 4 weeks before useable erection.
Presently using injections - PGE and Trimix caused really bad pain.
Now using Bimix - Bingo, good times are back.
Using very little Bimix and 50 mg Viagra-best combo
1-yr PSA .02
PSA July 2008 - 0.08.
PSA Aug. 2008 - 0.10
Started salvage Proton radiation treatments Sept 2008 at UFPTI.
35 treatments ended Oct. 21st.  Ending PSA .20
Minor uniary and rectal problems cleared up after a month.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/21/2008 7:43 PM (GMT -6)   
Angel, I was sorry to read about your family's history with cancer. I lost both parents, my mother in law, 2 brothers in law and the best man at our wedding to cancer, not to mention coworkers. Everyone it seems has been touched by this disease.

My husband has not needed any followup treatment. His margins and seminal vesicles were clean, and his PSA dropped to zero and has stayed there. The only thing he needs to do - which is something every man does after surgery - is to have his PSA checked every 3 months. He will continue doing this for the first 2 years (normally the PSA is checked every 3 months for the first year, then every 6 months between years 2 and 4 - at year 5, it once again becomes an annual thing). Because of his stage and the fact that the cancer had begun to move into the capsule, his surgeon wants to keep a close eye on his PSA which is just fine with us.

When I spoke with the surgeon to discuss the pathology report, I asked about radiation treatment. Surgeon's response was essentially there are 2 ways to go: we can do some radiation to the prostate bed to make sure that we got all the cancer cells or we can watch his PSA and use radiation when and if his PSA rises. Since radiation treatment is not benign and since you only have 1 chance at radiation treatment, we chose to watch his PSA carefully and to resort to radiation only if it becomes necessary. Some men have chosen to take the bull by the horns, so to speak, and treat the prostate bed with a couple of zaps of radiation to ensure that all cancer cells are dead.

The discrepancies between your husband's biopsy report and the surgical pathology report seem to me to be a classic case of different interpretations by different doctors. Of course, the concern is always which one is the more accurate. Generally, the surgical pathology report is the definitive one because it is more extensive.

I pray that your husband's PSA is zero - and stays there forever. I pray for all the men on this board - and those who love them - that they too have a lifetime of zeros (this is the only test where zero equals success!).
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