Beginning Again (Treatment)

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jfrmontana
New Member


Date Joined Feb 2009
Total Posts : 9
   Posted 3/10/2009 9:44 AM (GMT -7)   
Just for the record, I was diagnosed with PC in the fall of 2006.  On Feb 18, 2006 had robotic surgery.  My PSA went down to zero, but is now going back up.  My Urologist did not support my choice of treatment, he was for surgery, not for robotic however.  Because of this, I did not feel like utilizing him now that my PSA has started going up again.
 
I live in a smaller community where he is the only Urologist.  I did travel to a neighboring town with a urologist I had received a second opinion from during my original diagnosis.  He, and the original hospital and doctor that did my surgery all recommended radiation.  Thankfully, my town is again supposedly blessed with an excellent Radiation Oncologist.  Thankfully some doctors enjoy rural Montana, or in this doctors case, his wife is from Montana and he moved back to keep her happy.  (The previous Rad. Oncologist was very well respected in the region, and I friend of mine.  However, his wife was from the "big city", and missed the theater.  Forcing him to move back.) 
 
Anyway, to cut to the chase, I began my radiation treatments on Monday, 3/9/2009.  For the next 6 to 7 weeks, I will be making the daily trip to the hospital.  Just wondering if anyone who has had radiation could shed some light on the  subject.  I have read some, and asked lots of questions, but sometimes I feel like I may be missing the point, there is more to the story.  The side affects, urinary control, bowel irritation, and abdominal tenderness have been discussed, but what other unpleasentries should I expect?  What should I really be prepared for, How tired will I really feel? 
 
No second thoughts, I just don't like surpises!
Diagnosed with PC in 2006 @ age 48
Robotic surgery in City of Hope on Presidents day 2007
PSA never went to "0", always about 0.2
Fall 2008 PSA 0.5
Retested 3 months later, PSA 0.7
Urologist was very unsuportive of my treatment choice so I have not been back
Oncologist believes I should take a wait and see approach, But is ordering baseline bone scan.
 
I am very concerned!


BillSD
Regular Member


Date Joined Sep 2008
Total Posts : 143
   Posted 3/10/2009 10:03 AM (GMT -7)   
Hi jfrmontana,
 
I completed seven weeks of radiation at the end of January. For the most part, it was easy. The first side effect was fatigue. If you have never experienced cancer related fatigue, get ready. I've been "bone tired" before, but cancer-related fatigue takes it to a new level. You get so tired, you cannot think! And sleep does not always help.
 
I thought I had breezed through the radiation, but began having some urinary setbacks two weeks after the treatments were over. I am on (get this) flomax. Isn't that for enlarged prostates? I have no prostate now, but it does help with the weak stream, starting and stopping, and other issues that arose after the treatments were completed. Guess the radiation scars the urinary track. Doc says this too will heal in time.
 
Best of luck.
 
Bill in SD
Age 60 (59 when Dx) PSA 4.4
Biopsy 5/15/08 Gleason (3+3=6)
Bone scan and pelvic CT: clear
HT - 2 mo Casodex, 3 mo Trelstar
RRP Surgery 9/15/08 La Mesa California
Post-OP Gleason 3+4=7, Stage pT2c pN0 MX
Seminal vesicals, perineural margin, 18 lymph nodes, bladder neck: all carcinoma free
Perineural invasion & Distal Margin: Carcinoma present
IMRT adjuvant radiation (35 Treatments) End 1/27/09
PSA (10/13/08): <0.1
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4155
   Posted 3/10/2009 10:11 AM (GMT -7)   
Montana.
Prostatepointers.org web site has all sorts of patients posting on their experiences with radiation. Sign up for the ERBT list.
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 3/10/2009 10:27 AM (GMT -7)   
Hi JF,
First what type of radiation have you opted for? IMRT?

We had the same center for surgery, and now just staggered in time we share the experience of radiation. I had adjuvant radiation beginning 4 months after surgery. My experience was good. As they suggest, drink plenty of water on your way there, don't urinate until after they have completed the procedure. As my own precaution I started walking after surgery and during IMRT. I would have treatment at 7:00am and walk up to 4 miles after treatment. Usually three, but I extended it from time to time. I only had mild fatigue and I still worked during the whole process. I was warned that by week 28 effects would at their strongest. I was also told that after weel 28 they would begin to subside. It never happened. Just fatigue, and I tolerated it well.

I do recommend some exeicise because it's just plain healthy anyway. I believe it also helped me get through surgery and radiation better. I remain on hormone therapy and that just plain sucks. but again, I am pretty much working normally. I do get bouts of fatigue, but after two years of this stuff it is not a burdon I can't bear.

Peace to you, and get well.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 3/10/2009 6:25:15 PM (GMT-6)


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 782
   Posted 3/10/2009 4:42 PM (GMT -7)   
Hi JF, in my experience with follow up radiation, I experienced fatigue in the last half of the treatment, which I countered by having a nap during the day, I travelled on the train to the radiology clinic, which involved a fair bit of walking( intentionally.) I think going every day to the clinic also tires you out, in my case it was a different time every day which was a pain, the side effects....halfway through the treatment I had a red bottom, not unlike sunburn, but not painful or itchy, my bowel habits changed, I had to be near a toilet in the am, even now I go several times a day, but with no urgency.

The radiation I feel is a good thing, designed to "mop up" and target any remaining cells, it made me feel that the extra treatment gives me a better chance so just go with it brother.

I am at present waiting for the postie to come with my latest PSA results...fingers crossed!!

Regards Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7  right side tumour adenocarcinoma stage T2a
RP on 30th July,
Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck, free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.
 
Post op PSA 0.5 26th Sept.
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 3/10/2009 5:06 PM (GMT -7)   
Hi jfrmontana,
First off I envy your living in Montana, I have been to Glacier Park and it is spectacular. We also flew into Missoula and on south to Yellowstone on another trip.

I finished my Salvage RT in the middle of Jan. and about the only side effects I had was some tiredness, urinary burning and some minor bowel issues 3 weeks after I had completed my treatments. I worked everyday after my treatments the whole time except for a couple of weeks at Christmas.

I am now waiting to see if my psa will show a positive trend!

I look for you to do great as todays RT is very specific so there is not a lot of collateral damage.

The best of luck to you,
David
Age 53
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09 YEA!


Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 3/10/2009 5:22 PM (GMT -7)   
jfr,

I had adjuvant therapy 5 1/2 months after RRP. The biggest problem for me was that I regressed incontinence-wise. I was off the pads about 3 weeks before radiation started but had to go back to one pad a day about halfway through treatments. To this day I'm still using one pad a day - just enough leakage to be embarrassed. But I believe that if you are continent for a length of time before therapy you won't have a problem. Another minor problem was soreness
around my anus but Preperation-H took care of that.

My radiologist told me that younger patients shouldn't have a problem with fatigue and I did not (54 at the time). As mentioned before drink water before the treatment. I would empty my blatter and then drink a 20 oz. bottle of water an hour before my treatment. If they where running late I would partially empty my blatter and drink more water.

For me it was a piece of cake and I got to see a great group of people everyday. Best of luck to you.

Ken
Age 54 (2006)
PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06
Memorial Hospital, Pawtucket, RI
Post-Op Biopsy, Gleason 6 (3+3), T2c,
right apical margin positive
CT Scan 1/07, tumor discovered on right
kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07
R.I. Hospital, Providence, RI
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 11/08 - 0.03


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 3/11/2009 5:11 AM (GMT -7)   
You've been given good advice on the exercise --- I walked and worked out faithfully during treatment and it helped. about half way through, I'd get extra tired at night. I had some urinary burning and got some meds for it. Same thing with butt --- a little bleeding and soreness--- got meds for it. BIt of a setback on incontienence -- I had dried up completely but got just a bit leaky after treatment --- nothing terrible.

Best part -- clean PSAs ever since (Knock on wood)! Good luck!
Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 3/11/2009 5:46 AM (GMT -7)   
Good luck with your treatment jfrmontana!!! Just curious what did the Doctors Recommend Radiation instead of Surgery? Also what was your post op pathology report where the margins clear?
 
LIVESTRONG!!!
Age Dx 37, 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA 9/2008: <0.01
2nd PSA 12/2008: <0.1 (Different Lab then 1st)
3rd PSA 3/2009
 


jfrmontana
New Member


Date Joined Feb 2009
Total Posts : 9
   Posted 3/11/2009 9:23 AM (GMT -7)   

SHU93

Not sure of your first question, my original urologist wanted me to have "open"  surgery, Or after I indicated I was interested in the Davinci (Robotic) surgery, he pointed me towards lapricopic surgery.  He was pretty set against robotic.

 

Post op pathology was cancer at the margins, and Dr. Wilson did extensive scraping and cleaning the prostate bed prior to closing up.

 

On the exercise, I diligently work out, and I ski hard every weekend.  However, once my original diagnosis, I continued to ski, but quit working out.  I gained quite a bit of weight, and have never really dropped it.  Again, for the past 6-7 weeks, I again became lethargic, and very inactive.  This past week I have gotten back into my routine, and will continue the workouts. 

 

The suggestion to drink lots of water will be taken to heart, and I will begin to consume more.  I never really got that recommendation from my treatement center!

 

TC-LasVegas

My treatment is external beam radiation, at 60-70 Gy.  Not sure if that answers your question!

My original post, you mentioned we probably passed each other in the hallway.  Not sure if the almost 6 months from diagnosis to surgery was a factor in the margins issue, but it sure could not have helped the situation.  For that reason alone, I have decided I am not waiting for any future treatement.  I want to beat this thing to death. 

 

Thanks for all the input.

JR


Diagnosed with PC in 2006 @ age 48
Robotic surgery in City of Hope on Presidents day 2007
PSA went to "0"
Fall 2008 PSA 0.5
Retested 3 months later, PSA 0.7
Urologist was very unsuportive of my treatment choice so I have not been back
Oncologist believes I should take a wait and see approach, But is ordering baseline bone scan.  Bone scan negative.
 
Began Radiation on 3/9/2009 after visiting with a consulting urologist, and recommendations from COH. 

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