Need RP salvage radiation advise

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CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/25/2009 9:45 PM (GMT -6)   
Had my RP on 2-3-09 approx. 11 weeks ago. Had the nerve sparing procedure that ended with a positive margin on the right posterior of my prostate. Prior to surgery my psa was 1.7 with a gleason score of 3+3=6. My current psa is .26 and has not changed since surgery. Just had a bone scan and MRI last week and both were clear.
 
I am now trying to decide if there is any advantage to using Proton instead of Photon(IMRT) radiation for salvage. I have met with the two IMRT radiation docs for initial consultations and both seem good.

Got my third opinion on Thursday up at Loma Linda. Here is a brief synopsis on my initial consultation.

The doc spent over 2 hours with me going over my history, salvage situation, side effects possible, a brief physical exam, and a tentative plan. He has been at Loma Linda for 21 years.

For salvage he plans on targeting the prostate bed, seminal vesicles, and close surrounding area building up to 70-72 GY total (will shrink the target as treatments progress). Will then target my positive margin(right posterior) with up to 74GY. This is all just preliminary and will depend on what my CT scan looks like, along with other factors put together in the mapping and planning of treatment.

I do realize that the overall results appear to be similar whether using proton or photon in a salvage situation. The doc seems to think proton is the way to go if you have access to it. He has the ability to use either IMRT or proton. Higher GY dosage with potentially less side effects and very precise targeting are all plus's in my mind.

Since I live within driving distance of Loma Linda I will am planning to choose proton radiation for my salvage treatment since I have the option. Can't think of any reasons not to? I am scheduled for my CT scan with them next Tuesday unless I see a reason to change direction. Opinions from others have always been very helpful for me in making important decisions.

Any feedback or input is appreciated.


BoisePSABantam
Regular Member


Date Joined Apr 2009
Total Posts : 20
   Posted 4/26/2009 11:17 AM (GMT -6)   
CS53,

If you can get Proton, I've heard that it's less damaging than conventional IRMT. It's good you are close to Loma Linda.
If my next PSA test comes back progressively higher, than I'm looking at salvage radiation as well. If I could get Proton, I'd do it too. The Radiation of 74Gy sounds right. The higher they can safely give you the better.

You might seriously want to look at 1 year of Hormonal Threapy. Blast it down with ADT3 then go on Avodart maintenance. I've read studies from the Mayo Clinic that show a much longer survival with BOTH Salvage Radiation AND Intermittent Hormonal treatment. Talk to a Oncologist who specializes in Prostate cancer.

Good luck!

CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/26/2009 11:45 AM (GMT -6)   
Thanks BoisePSABantam
 
I asked about hormonal therapy in conjunction with the proton treatment during my initial consultation. The doc said he would discuss it with other colleages and see what they had to say. He did indicate he didn't think it was necessary in my situation but wouldn't rule it out. He did say that there are some pretty unpleasant side effects that can occur with hormonal therapy. Some may go away quickly and some may continue for years. I will be seeing him again in the next week or so and see what plan he has come up with. I will defineately do whatever it takes!
 
Thanks
       CS53

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4202
   Posted 4/26/2009 8:13 PM (GMT -6)   
CS53,
Before you decide on either proton or IMRT you need to determine if the PC is local or if you have micromets. The positive margin is one good indication that it could be local, but not conclusive. On the other hand if it escaped the prostate you could have micro mets.
I would have more tests run by a good prostate oncologist and have a better idea of what you are dealing with before any salvage procedure. Salvage procedures are only 30% effective because in most cases the cancer was beyond the surgical or radiation margin in the original procedure.
Radiation docs and urologists are not just not equiped to evaluate if you have a local or matastic spread.

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

 


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/26/2009 9:14 PM (GMT -6)   
Thanks JohnT
 
I will talk to my doc at Loma Linda tomorrow about having more tests by a prostate oncologist to verify no micromets. With a gleason score of 6, and no lymph node involvement wouldn't the chance of micromets be pretty slim?
 
Thanks

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4202
   Posted 4/27/2009 11:01 AM (GMT -6)   
I agree that given your stats the probilities are low. The positive margin is a concern because that is an escape path for the PC cells. given the seriousness of any salvage procedure it is wise to be as certain as you possibly can.
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

 


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/27/2009 11:27 AM (GMT -6)   
Thanks JohnT
 
I agree with you, best to know as much as possible. I am waiting to here back from my doc at Loma Linda. Doc said since I have a broad positive margin left from the RP it would probably be best not to take any chances. Hitting this stuff early appears to be best for success. On the DRE he performed on me he said he could feel a small amount of prostate tissue right where the positive margin is located. It is located close to my nuerovascular bundle. I believe the surgeon was not aggressive enough in that area trying to spare the nerves.
 
I will most likely make an appointment to see Dr. Sholtz.  I don't think I am a candidate for the Combidex MRI according to their web site. Not sure what other tests they can do since I have already had an MRI with contrast? Some good reading on Prostate Oncology Specialist web site using hormones and radiation.
 
Will some form of Adjuvant hormone therapy (along with the radiation) kill the micromets? Looks like it says treatment for up to 28 months is optimum? I am very worried about the possibility of micromets and would like to do whatever it takes to kill them off.
 
Thanks

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4202
   Posted 4/27/2009 1:20 PM (GMT -6)   
CS53,
Take it one step at a time, no sense worrying about something that is a low probability. Get a 2nd opinion from Sholtz and see what he says. Color doppler may be able to see the PC at the margins.
JT

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

 


BoisePSABantam
Regular Member


Date Joined Apr 2009
Total Posts : 20
   Posted 4/27/2009 1:23 PM (GMT -6)   
CS53,

I doubt hormonal therapy would kill of every single Micro Met. The best treatment is to do whatever it takes in the short term to achieve a complete remission then maintain the remission in the long term. The preponderance of evidence I've read is that most men with PCa have some micro-mets. Its just that some have immune systems that keep them in check and others don't. Some men have PCa that is genetically aggressive and some don't. Find out if you have aggressive PCa or slow growing. You'll know by the PSA doubling time. If it's aggressive, I'd hit it with both radiation and ADT3 (1 year). If it's slow growing, hit it with radiation and take good care of yourself. Diet, exercise, practice relaxation techniques and go on vacations. Build up your immunity. Take a wait and see if your own body is going to smite it down.

I too am still learning about this disease. My father has been fighting it for 12 years and has had a bear of a time. But, he's still around. Still works at farm full time at 73!

Good Luck!
Pre-Surgery PSA: 4.92
age: 45 at DX.
DaVinci 5/07
1st PSA 0.07 8/07
2nd PSA 0.04 11/07
3rd PSA 0.04 02/08
4TH PSA 0.04 7/08
5th PSA 0.08 2/09


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/27/2009 3:26 PM (GMT -6)   
Thanks Guys
 
Doc just told me the same thing. Guess I am a bit over anxious. He is considering giving me (at my request) some hormone treatment(8 weeks or so) prior to radiation just to knock the cancer down. Any thoughts on this? Thanks for you help and advise. It is really helping out.
 
Thanks
       CS53

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 4/27/2009 4:20 PM (GMT -6)   
I think HT prior to radiation is a good recommendation. A lot of the experts recommended this for my father and the good news was that he didn't experience side effects until I believe after the first couple of months. SO, maybe you will get by with minimal side effects from the HT if you are on it for only 8 weeks. Either way, I think it is a good idea. (In my humble opinion) My father's oncologists recommended two years of HT because of the positive lymph node, even though he had an undetectable PSA following surgery. The studies show it is better to hit it early, so we did. It sounds like you have a great plan of attack, with a top notch facility. I think the anxiety lessens once you have your game plan in place. It causes a lot of anxiety for everyone waiting for all the tests and trying to decided on the best treatment, when there are no guarantees either way. Stay positive and swing away!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/28/2009 10:52 AM (GMT -6)   

Thanks Doting Daughter

I am waiting to hear back from the doc (his advise) on the HT pre radiation. I am planning on telling him I want the HT first. I am also planning on meeting with Dr Sholtz on what his advise would be post radiation.

As a side note I was doing OK with all of this until this positive margin got dumped on me after surgery. I was ready to be done with all of this and move on. At first there was panic, then a lot of second guessing. Then trying to formulate a new plan of attack(who to use, which therapy, and where). It has been devastating to say the least. I feel like a cat now using up my ninth life. I am trying to make sure I do all I can now to keep favorable odds on my side. I really thank everyone who has responded. I have really learned a lot.

Thanks
       CS53

Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 4/28/2009 1:06 PM (GMT -6)   
I struggled with Proton vs Photon when I was making my decision and it really boiled down to convenience, money, and long term results.  I live in Mississippi so Loma Linda would have been tough on me and my young family and much more expensive.  My radiologist also convinced me that while Proton looked very promising it does not have the long term track record of photon, there is no doubt about the effectiveness of photons if they hit the target with sufficent doseage.  The real advantage it seems to me with Proton is the ability to do less damage to surrounding tissue but that doesn't make much since in a salvage situation when you are basically carpet bombing the pelvic and prostate bed area.  The surrounding tissue damage argument has been mitigated in recent years with the accuracy of IMRT.  For what it is worth I am doing well so far and have my annual PSA coming up in August and hoping for good results, at this time I have no negative side effects from the IMRT.  Good luck.
Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03
 
PSA August 18th 2008 = .01 or less, test only goes down to .01


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/28/2009 1:20 PM (GMT -6)   
I decided on IMRT because of the reasons that Proton states are it's advantage. The intent of proton therapy is to acquire less collateral damage in the prostate area. After surgery it was found that my cancer was outside my prostate in multiple directions. I found it difficult to believe in proton therapy getting all of the areas that the cancer may be residing. The fact that IMRT would assure a wider coverage area was my reasoning. I could have been wrong about it. And I could be right about it. Even though I expected some SE's with the IMRT, it went well and I don't have any issues.

Good luck in your decision.

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!


BoisePSABantam
Regular Member


Date Joined Apr 2009
Total Posts : 20
   Posted 4/28/2009 1:28 PM (GMT -6)   
CS53,


I understand your fears. Most of us do. Take Heart!

1) You are very lucky to have such superior medical care. If you're able to go to Loma Linda and see Dr. Sholtz, you are in great hands. Try Living in some smaller towns where recurrence = being ignored.
2)You don't have Brain, Pancreatic, Liver, Lung, or other nasty cancer. Prostate cancer can be mitigated in every stage. It may not be what you want, but you'll be here for a very long time. Like decades.
3) medical advances in the treatment of PCa are incredible. Provenge and other treatments will likely cure the condition sooner than later. Your job is to just make it that Great Day! Do So!


Good luck and take it easy.
Pre-Surgery PSA: 4.92
age: 45 at DX.
DaVinci 5/07
1st PSA 0.07 8/07
2nd PSA 0.04 11/07
3rd PSA 0.04 02/08
4TH PSA 0.04 7/08
5th PSA 0.08 2/09


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/28/2009 1:35 PM (GMT -6)   
Provenge has had some good news today. Unfortunately it wasn't a cure, but it is life extending. Dandreon announced that the Provenge study resulted in 4.1 months of life extention on average. I was hoping for better after all the hype.

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!


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/28/2009 1:38 PM (GMT -6)   

Thanks Pelahatchie

Glad to hear you are doing well using IMRT. I also struggled with which form of radiation to use. I do realize results are similar in a salvage situation using either Proton or IMRT. I guess I am basing my decision on a couple of things. Proton allows a higher dosage with potentially less side effects (everything I read says more radiation is better to a point). The doc has the ability to use either Proton or Photon and seems to think Proton is the way to go if you have access to it. I live within driving distance of Loma Linda so I really see no negative reason not to use Proton radiation? If anyone has a differing opinion or see's things differently your suggestions are greatly appreciated.

Thanks


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/28/2009 9:40 PM (GMT -6)   
Thanks for the words of encouragement BoisePSABantam. I am going in for a Lupron shot tomorrow. However I am a little worried about the side effects that can occur. I will make a final decision after talking with the hormone doc tomorrow. Then the plan is to wait 8 weeks for the stuff to work(knock the cancer down) and then start radiation. I am hoping this will be the most effective course of action.
 
Thanks
       CS53

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4202
   Posted 4/29/2009 10:48 AM (GMT -6)   
CS53,
Ask your doctor about Casodex and Proscar along with the Lupron. ADT3 is more effective than mono therapy and adds very little to the side affects.
JT

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

 


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 4/29/2009 11:02 AM (GMT -6)   
Thanks John T. Will do.

CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 5/1/2009 11:49 AM (GMT -6)   
Just an update here. I decided on adjuvant treatment. I start hormone treatment(ADT3) on Tuesday. Going to give the hormones approx. 8 weeks to weaken the cancer and then start radiation.
 
Any idea how important it is to choose a radiation doc that is well versed in salvage? Most I have talked with do very little for obvious reasons. Not sure there is any magic strategy that is employed? Thanks for all your input and suggestions.

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 5/1/2009 3:17 PM (GMT -6)   
Sounds like a good plan. May the treatment be quick, side effect free and cancer be gone!!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 7/1/2009 3:02 PM (GMT -6)   
Another update:
Started ADT3 HT the first week of May (psa now undectable as expected) with planned adjuvant proton RT starting 8-12 weeks later. A few weeks ago I decided to consult with Dr. Mark Scholz of Prostate Oncology Specialist. I have heard he is one of the top experts on prostate cancer. I wanted to get his opinion on my plan moving forward.
 
DR. Scholz DRE exam revealed a small area of nodularity in the distal right prostate fossa.  This is consistent with my positive margin located on the right posterior lobe.
 
A Color Doppler Ultrasound was performed showing approximately 7 cubic centimeters of retained prostate tissue. There was no overt hypervascularity suggestive of aggressive cancer.
 
Dr. Scholz ordered a more thorough pathologic review of my original slides and prostate tissue by Dr. Bostwick to determine how extensively positive the margins are and also to do some additional tumor markers such as Ki67, p53 and p27 to determine the aggressiveness of the tumor. These are proteins that can be used to predict recurrence.
 
Results came back with protein markers all in my favor for low recurrence. Gleason score of 6 remained the same.
 
What is worrisome is that very little cancer was found in my prostate biopsy. My initial biopsy pre op showed grade 3+3=6 adenocarcinoma in the right base, right mid gland and in the left mid gland. The core involvement was 30%, 25% and 5% respectively of those areas. This leads us to believe there was definitely cancer left behind in that 7 cubic centimeters of prostate tissue.
 
Doc says about 50% of patients who have positive margins after surgery will never have a recurrence.  The benefit of radiation, which will almost certainly be curative, needs to be weight against the possibility of erectile dysfunction which may occur in about 1/3 of cases.
 
He is leaning towards 6 months of hormone blockade and then stop and monitor the situation over time versus immediate radiation. So now I have another decision to make. Seems like they never end. However I am happy with all the positive news and fortunate to have some options.
 
Sorry for the long winded post. I am looking for help once again. Any opinions, suggestions, or advise on what might be best from all the wonderful people of this forum would be greatly appreciated. Thanks soooo much.
Thanks
       CS53

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4202
   Posted 7/1/2009 6:52 PM (GMT -6)   
Sounds like it makes sense, 6 months of ATD3 should cause no long term side affects and will stop any PC growth. If it looks like it is still there you can still have radiation and have a very good chance of a cure, but with the chance of long term ED. Overall you have good news and two good options.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


RonE
New Member


Date Joined May 2009
Total Posts : 12
   Posted 7/1/2009 7:57 PM (GMT -6)   
Has anyone seen any "long-term" studies that compare the efficacy of using proton versus photon radiation for adjuvant or salvage treatment?
Oct 2007 - Family doctor checkup at age 53
PSA 2.4, ~10% increase from 6 months previous
Nov 2007 - Consult with urologist
Biopsy 1/12 cores positive 1% Gleason 6=3+3
Jan 2008 - DaVinci radical prostatectomy
Hospital stay of 3 days, JP drain in 1 week and catheter 10 days
Gleason 7=3+4 with early foci extracapular extension
Surgical margins clear, prostate 5x4x4cm & 43g, involvement 3%
Mar 2009 - Consult with radiation oncologist about adjuvant radiation therapy
Post surgery PSA undetectable thru Jun 2009

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