Salvage Alternatives (Real Life cases)---Any Feedback Appreciated

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JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/13/2009 8:32 AM (GMT -6)   
I have posted a few times here without introducing myself. My name is Joe (Joey) and I live near Pittsburgh and you can read my signature below, which is concise. I just want to say that this is a great forum and I can feel the brotherhood here.
 
I'm sure many of you may ask why I went with cryosurgery (cryo) at 54 years old at the time, Well,  I chose cryo because my Uro was/is one of the best cryosurgeons in the nation and with my high GS, surgery looked to be the poorest choice. I will say, it was a battle of my mind between picking cryo or radiation. Besides the surgeon, it was pointed out to me that if I went with cryo and eventually required and qualified for salvage, both cryo and radiation would be available (I didn't know at the time that cryo as salvage for primary cryo is not covered by any insurance plan).
 
I am going for a "special" 3 month psa test tomorrow (my normal one would have been in October). I have little hope that my psa will remain at .07 or fall, although I have been taking pomegranite extract and drinking green tea for the past 3-4 months as a "shot in the dark."
 
Once I get back my results, the trip to the Uro and the tests will follow. My HOPE is that they find something in the prostate bed or adjacent and that all x-rays come back negative so that I can qualify for salvage cryo or radiation (if I were to choose salvage cryo, I can afford to pay for it, because it is the least expense; however I would highly consider radiation if it is covered).
 
At some point I will discuss cryosurgery on this forum because it gets much less coverage than it deserves. Even though I am looking at a failure, I think that it was too late for any of the conventional methods to cure me (although with a nadir of .02, I came close).
 
The question I have here is: has anyone had salvage treatments (any kind) and what success or failure has been experienced.
 
Thank you,
 
Joey
 
 
 
 
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/13/2009 9:59 AM (GMT -6)   
Hi Joey,
I admit to not being fluent in Cryo, but I do know many that were succesfully treated with it. Regardless of treatment modality, recurrent prostate cancer is no fun game. Since very few post here with cryo experiences, i have to draw from my friends in my US Too group who were treated by Duke Bahn. We had one such gentleman who was retreated with cryo and he was doing well. I am not certain if he went with a partial ablation or with total ablation, but i know he went with round two with the treatment. I will see him this Thursday and will ask for more details. I have heard that after a total ablation it is difficult to find recurrent prostate cancer. Thus making external beam radiation a logical choice. You certainly will qualify for radiation.

Good luck in your decision. I look forward to your discussion on cryo....

Tony
 Age 47 (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!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/13/2009 3:38 PM (GMT -6)   
Gleason 9 is a nasty one they say. I am looking at a Doxatacel NIH trial as an option to adjuvant radiation. I am not sure if the cryo procedure qualifies for this particular trial, but you might try looking on the NIH trial website.

I am just thinking with the possible side effects of radiation, and the possibility that the cancer has spread out of the prostate bed, that a systemic approach of chemo may make more sense for round 2.

Good luck
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
Living the Good Life, cancer free  6 week PSA  <.03


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/15/2009 6:13 AM (GMT -6)   
goodlife,
 
Are you just thinking ahead for the sake of looking ahead (because so far, all looks real good from a psa standpoint from your surgery)?  Just a word of wisdom, enjoy the success while you can and do your planning only if and when it becomes evident that you need to do it. Many of us become slaves to our condition; while we say we want the monster out of us, that monster stays in our mind 24/7, even if its been cut away. I'm not saying you are doing this but in general, most of us do...its only natural.
 
Anyhoo....that taxotere is pretty strong stuff and poses its own quality of life issues. Does the trial use doses smaller than the doses used for Stage 4 cancer? If that is the case, than the side effects would likely be much more tolerable. However, once I get further info on my own, I will look into it. BTW: the side effects from cryo are nearly non-existant, except for impotence. Even with that, with help (viagra) I can penetrate but it depends on my own libido, which isn't the same as it was at age 19 cool
 
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/15/2009 7:20 AM (GMT -6)   
Hi Joey,

I'm sorry for your situation and wish you the best.

I did have a question. Your post mentions a PSA of 0.07, but your signature mentions 0.7, which is correct?

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/15/2009 9:26 AM (GMT -6)   
Barry
 
Slip up of decimals..S/B 0.7 (from a nadir of 0.2).
 
Joey
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 7/15/2009 9:46 AM (GMT -6)   
Lot of difference in thinking between a .07 and a .70, thanks for clarifying that number.
Age 57, 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 capsule, one post. margin, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, they want to start radiation, 70 gray, I am still considering all options and opinions
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/15/2009 1:25 PM (GMT -6)   
Joey,
I hate to ask this question but did your Cryo surgeon inform you that you were a very high risk case that more often than not would likely require the need for additional therapies down the road? There is always a lot of controversy about stage 3 or high Gleason cases, or other high risk diseases, and one could easily argue that you should have been offered these options. I wouldn't fault anyone for electing to not do so, but these treatments are usually more effective before a rise in PSA than after a rise in PSA. I saw your post in goodlife's thread and left you an answer there about my adjuvant treatments and about my story in my blog below. If you look closer at the signatures at this site, you will see many guys like me that chose not to wait for an increase in PSA before taking pre-emtive action. Many of them have very similar numbers to you before treatment. Many clinical studies support that adjuvant therapies are very effective and can be well tolerated.

Tony
 Age 47 (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!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/15/2009 8:54 PM (GMT -6)   
Joey,

Great question that I don't know the answer to. Part of it is every doctor I see looks at Gleason 9 and says go for radiation. Kind of makes me nervous. I was shown this study today. http://prostatecancerinfolink.net/2009/01/22/new-data-from-two-studies-on-adjuvant-radiation-and-thalidomide-post-surgery/

Those are number I can start to justify adjuavnt therapy with !
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
Living the Good Life, cancer free  6 week PSA  <.03
# mont PSA <.01 (different lab)


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/16/2009 5:24 AM (GMT -6)   
Tony and Goodlife,
 
I had two biopsy sessions prior to the treatment, both of which showed (the best they could) that the PCa was confined to one side (left) of the gland, with no extension to the margins or to the seminal vessicles. My uro made no promises but did indicate that that the possiblity existed that I would need salvage at some point, for which I could choose from another cryo (if there was evidence of further PCa in the same area) or radiation. The 3 month PSA of .02 (nadir) was looked at very positively because with a lot of supporting history, those with psa nadirs of .02 or less had about a 70%+ chance of long-term cure . Also, I had a follow-up biopsy that came out clean. At some point I will find the link to the 2007 release by Cohen/Miller that showed a lot of positive results for cryosurgery based on ten years of data collected from their surgeries and follow-up. In fact, the cryosurgery study showed good results for aggressive, but confined cancers. 
 
However, I just had a psa test on 7/14. Once I get the results, my journey to salvage will begin.
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/16/2009 5:47 AM (GMT -6)   
I just realized, I got my decimals wrong again in my last response and can't edit it; so here goes:
 
My post treatment psa nadir was 0.2 not .02; those with psa nadirs of 0.2 or less had about a 70%+ chance of long-term cure.
 
Sorry about that (again)...even more sorry because I work with numbers every single day! blush
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/16/2009 7:28 AM (GMT -6)   
Hi Joey,
Good luck to you on the results. Hopefully it goes down. In any case, before commencing with any plan of attck, a second opinion goes a long way. You should have many options at your hands...

Peace,

Tony
 Age 47 (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!


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/16/2009 10:50 AM (GMT -6)   
Thanks Tony!
 
And here's hoping that September will be a month with :-) for you!
 
Joey
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/16/2009 6:58 PM (GMT -6)   
Joey, welcome to our site. I have been following this thread and it contains good information. Being a gleason 9 myself I am always wondering when the PSA will start rising. So far I have been fortunate. I pray your next test will have the psa going down again. Keep us posted as to how you are doing and remember life is a blessing and we should live it with love every day.

peace and joy
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/17/2009 5:45 AM (GMT -6)   
Dale,
 
I hope that your psa continues at the low levels that they have recently been. Just a thought...was your last psa done by a different lab? I say that because the one before it (.016) rounds to the .02 (only two decimal places) of your most recent test. Therefore, I look at that at being "no change." 
 
I do have a question: since you received radiation as your primary, how did they biopsy the lymph nodes? If all tests come out clear for me, I may insist that they do a biopsy or some kind of test on the lymph nodes in the pelvic area. That way, I know I am not wasting time if I get salvage. Just thinking ahead....
 
BTW: I will be shocked if my next psa comes in lower or even the same. Over three years it has gone from .2 to .3 to .4 to .3 to .5 to .7. I look at the one drop as an abberation; with that it has been rising since nadir, so a drop now would be totally a fluke.
 
I should know soon and will continue posting. The "fun" will begin in August pretty much for certain.
 
 
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/20/2009 5:04 AM (GMT -6)   
I received my 3 month psa on Saturday from the lab. It remained at 0.7. I'm not ecstatic but nevethlesless relieved a bit that it didn't go up. I will be calling in to my Uro today or tomorrow because there is something more there than just some "leftover prostatic tissue that wasn't frozen to death." Anyhoo.....
 
JoeyG
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 7/20/2009 6:23 AM (GMT -6)   
Joey, I understand the mixed news feeling, but the good side, is that it didnt rise during that 3 months period, so please keep us posted.
Age 57, 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 capsule, one post. margin, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, they want to start radiation, 70 gray, I am still considering all options and opinions
 
 

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