Post surgery radiation

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Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 4/17/2009 9:25 AM (GMT -6)   
I visited my Radiation Oncologist today for a consultation because of a rising PSA post surgery. Because of my positive margin he felt that I should have had radiation as soon as my continence returned.  I am still undectable and have another PSA in May.  I do not want any treatment that it is not needed.  I am still recovering from the side effects of surgery.  I think the 10 year recurrance rate from RT is about 75%. He indicates with the positive margin it is about 50-50 because most likely the tumor is still in the prostate bed.  Any advice?
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/17/2009 9:46 AM (GMT -6)   
He ( you Doc) is probably right Bootheel. The +margin is significant enough to say, yes, there is still cancer left in the prostate bed. You can certainly wait until your PSA gets up around .2-.5 but don't wait much beyond that point. Every protocol and publication I have ever read calls for radiation follow up to be "considered" at .2. Our radiology friend says after a PSA of .5 the lymphatic spread is more commonly seen in early post-operative scenarios therefore, he tends to encourage his patients make a decision by then. Good luck and hang in there.

Swim
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 4/17/2009 10:17 AM (GMT -6)   
Boot, I would tend to go with your dr on this one. You could wait some more, and hope for only a tiny gradual rise, but you would be gambling that you didn't wait too long. It's unlikely you will be able to avoid the salvage radiation, and if it must be done, the sooner the better I would think.

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4252
   Posted 4/17/2009 11:01 AM (GMT -6)   
The best time to kill the cancer cells by radiation is when they are very weak and haven't had the time to establish. Do it as soon as possible. You may want to ask your doctor about taking Casodex while you are healing. This will screw up your PSA tests, but will stop any cancer from growing while you heal. If you know you have a positive margin then the cancer cells are still in your body and will eventually grow.
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.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 4/17/2009 12:17 PM (GMT -6)   
I guess I am going to be the only one to say wait for a little bit longer. My reasoning comes from reading from sources like Dr. Walsh. Just because you have a positive margin doesn't necessarily mean disease progression. What I read is that only 30% of those men with positive margins will experience recurrence in the first 5 years. In most cases a positive margin the remaining cells will die off and will not re-establish. BUT...you need to know just how large the positive margin is. The larger the cross section, the more likely the recurrence will be in 5 years. Your rise to .09 is suggestive and should be carefully monitored I will agree.

Personally, I have a positive margin that was not focal (> 3 mm). When I see a rise, I will base my decision on how fast it is rising and take action when prudent. To me...while damage from SRT is very low...it does happen and I am one that doesn't want to be over treated if the remaining cancer is basically indolent.

I know that everyone is going to disagree with me on this...but it is my opinion that I will apply to myself when the time comes. I respect others in their opinions, so I am just offering mine.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 4/17/2009 12:56 PM (GMT -6)   
You make a good point, on that point, Les, I can see where you are coming from
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 4/17/2009 1:53 PM (GMT -6)   
Bootheel,

I had adjuvant radiation therapy within 6 months of having a RRP. It would have been sooner but I was side tracked when they found a tumor in my kidney (unrelated to PCa). Ironically if I didn't have a positive margin I wouldn't have had a CT scan in prep for the radiation and who knows when the kidney tumor would have been discovered.

Anyway, there are two schools of thought about adjuvant and salvage radiation therapy. Most studies show chances are slightly better of non-recurrence with adjuvant therapy but some studies show no difference. If you go to Urotoday and search "positive margins, adjuvant therapy" you'll get quite a few studies to read.

I had three doctors (urologist, oncologist and of course radiologist) that stongly suggested that I have the radiation treatments. I was just about continent when I started treatments but half way through I had to go back to wearing one pad a day (stress incontinence) and still do to this day. ED has remained the same since my RRP - 60% - 70% erection without any aids.

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: 3/09 - 0.03


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 4/17/2009 2:46 PM (GMT -6)   
There is not much room for waiting actually. I see some room but, not a whole lot. Freedom from further treatment is a good thing but, like all good things, we humans tend to ignore when we've had too much. Not on purpose but, we're all human. People are subjective, not always objective.

There is a confirmed, measurable +margin noted and a rise already being detected. Everyone, just follow the solid medical information from the most trusted and reliable Physician's you can find and afford. Our best is all we can do.

Swim
 


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1211
   Posted 4/17/2009 2:59 PM (GMT -6)   
Hi Bootheel,

As you can see by my signature, I had a rise in PSA after my RRP and when it reached 0.09, my Uro, my Onc and myself decided that this was a indicator that some cancer cell are most likely alive and well. We decided that RT was the next logical step. When I started EBRT the PSA was 0.1. It is my understanding that chances of successful treatment are best when the PSA is still very low. The decision to go to the next step in treatment is not easy, but if a recurrence is suspected I would not wait to long to go to the next battle.
All the best to you.

Magaboo
Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA on the 26 Jan., 09, =0.05. PSA tests now every 6 month

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