Adjuvant therapy, yes or no, chemo, radiation, hormone

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goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/2/2009 2:49 PM (GMT -6)   
Follwing a sucessful DaVinci procedure on a Gleasion 9 with EPE, I must soon decide on adjuvant therapy of some sort, either through a clinical trial, or radiation of some sort, or other means.
 
Looking for feedback from some you who have done so, and some of your thought process.  Thanks !
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
Living the Good Life, cancer free
6 week PSA undetectable. 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 6/2/2009 3:36 PM (GMT -6)   
Boy yours is a tough one to call. The EPE with a gleason 9 doesn't give you much wiggle room. At your age with many years of living still to come, I would recommend at least radiation as adjunctive therapy. The good news is that even with the EPE you had negative margins. Which means any escaped cells might still be in the protate bed which would respond well with radiation. I would use the other protocols of hormone treatment only as needed, but only because of the side effects hormone therapy offers. But that would be a choice from your point of view.

There are some here with similar stats as yours that unloaded all the weapons so to speak, had adjunctive radiation, and followed up immediately with hormone treatments. One of our moderators Tony (aka TC-Las Vegas) is one of those that fired all the torpedos and is glad that he did. He is nearly three years out from surgery with an advanced case with undetectable PSA.

I am not familar with any of the trials that are available, but look into those as well.

Good luck with your treatment plans whatever they maybe.
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 w/PNI - 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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/2/2009 3:59 PM (GMT -6)   
Hi goodlife,
Les has said it well for me.  It was not without side effects, but I am in relatively good shape.  I leak very rarely and only slightly if I do, still no action on the ED, that is to be expected with the HT.  My medical oncologist questioned the effectiveness with adding radiation before I overruled him but he has since changed his tune.  I completed my last radiation (IMRT) 22 months ago.  I am still on HT but it is the last round.  In September I discontinue using Casodex.  October is my next oncology visit and we will watch the PSA and T levels monthly.  My hope is to have normal T levels by early next year and no PSA detected. 
 
The link below is to another post I did here on studies that have shown that surgery/RT/HT is by far outperforming any other combination for the T3 (especially the T3b) guys. 
 
As far as how I feel, the HT has had the longest lasting effects.  I don't care for it much at all.  Still my oncologist made me stick with the original plan of 2 1/2 years on it.  He wanted me to remain on it until year 5 but agreed that we can stop this year.  He knows I want the break.
 
You can Email me if you want to talk real time.  I don't post my phone number here, but many of the folks have it.  I am also on Facebook and we can stay close that way as 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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 6/2/2009 6:05 PM (GMT -6)   
I did not have the adjuvant therapy, but participated in a clinical tril for neo-adjuvant chemo. The theory is that for us high risk guys, any escaped cells have to be treated systemically and the best way to see if the treatment is working is to monitor the cancer's response in the prostate. I had a Gleeson 8 and PSA 33 before treatment and my chance of organ confined disease was 17%. After the protocol and the surgery, PSA was undetectable, Gleeson downgraded to 4+3 and disease was confined. I did have a positive margin and have a rising PSA now that I intend to treat with radiation shortly. My hope is that is is the margin and not the systemic spread that causes the PSA rise. The time will surely tell...

I agree with may here who say, for high risk disease and a young guy - hit it early and hit it hard.

Previous 5 biopsies over 4 years negative

PSA going from 3.8 to 28

Father died from PCa @ 78 - normal PSA and DRE

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by RRP at Duke (Dr. Moul) on 6/16/2008

Gleason downgraded 4+3=7, T2c N0MX, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/26/2009

0.17

5/22/2009

0.20

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