What I have decided to do

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 7/14/2009 1:41 PM (GMT -7)   
Was up late into the night thinking through all my options and possibilities.  Here is what I came up with, my wife is 100% on board with my thinking.  If any of you think I am misdirected or shooting myself in the foot, please speak up freely.
 
The radiation oncologist wanted me next Monday to come in be marked for radiation.  Not.
 
I went to my urologist/surgeon's office and set up another PSA to be taken on Aug.11th.  I wanted it there because all of mine have been done there since last August, even drawn by the same nurse, and always at the same lab.  I want some consistency to make a decision and thought it wise not to switch labs in the middle of this.
 
I will meet with my urologist surgeon on Aug. 18th, to discuss the latest PSA, and to let him know about the two pathology report stories.  Didn't mention today on purpose, as it wouldn't prove anything, and didn't want any bias on their part.
 
I re-scheduled the "marking" visit with the radiation center for Aug. 19th, the very next day if it proves it is still needed.
 
My logic:
 
Post surgery PSA is sitting at .11.
Let's see what the next one shows (it will be at the 9 month mark), if it is still at .1 or let's say no higher than .15, then whatever is going on is going on super slowly.  If has risen much more, then off to radiation I will go with a clear consicious.
It will also give me a month to get other opinions, or another look at the pathology report, or both.
 
Salvage radiation is the 2nd bullet in our gun for surgery patients, and I don't want to waste it or use it if not really needed.  If I do, I won't have anything left if it ever comes back with a vengence.
 
Even the rad. oncl. dr. said waiting a month or two wouldn't endanger my case, so I want a little breathing room, I don't want to react to this out of either fear (me) or pressure from either my urologist or the radiation center.
 
I think this is a good compromise.  If it goes up some more, then so be it, then  I will be sure.  If not, then some "watchful waiting" after the fact may be in order.
 
I have made all the arrangements with the appointments, so this is it for me, for now.  I can only hope I am right in my thinking.
 
David in SC
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, 5/9 .10, 6/9 .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 7/14/2009 1:57 PM (GMT -7)   
Nice plan,
It looks good on paper and in practice. I'd stick to it and use the time for more learning. Second opinions will be a great gift in this...

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!


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/14/2009 1:59 PM (GMT -7)   
This is pretty much the course that would appeal to me. My guess is that both of us are still at the point that the probability of treating when it is not needed is higher than the probability of not treating when it is needed. Personally, I worry about the possibility of delayed side effects from radiation. At the present
I feel up to confronting many issues like incontinence and ED, but I am not sure how I would cope if side effects popped up in the future. Perhaps I am hiding from reality, but I want to be fairly certain I truly need radiation before doing it. I think that with that viewpoint I will be more ready to accept whatever comes.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/14/2009 2:09 PM (GMT -7)   
I would second the comments. I think you have made a reasonable decsion, and even the timetable layed out could be delayed if it doesn't feel right in your gut.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 7/14/2009 2:17 PM (GMT -7)   
geezer, you and and I seem to be on the same page, scary isn't it? lol.

goodlife, of course it can be changed based on the reality at the time.

tony, this is the first time i have felt relaxed about my situation in weeks.

and for those that are curious, none of this makes me second guess my primary treatment, even the new rad oncologist said that he would have had surgery, and that radiation probably would not have worked for me on the first pass. he said what many of us know, that gleason 7 situations are fickled and can be very dangerous in disguise. when they thought i was a 4+3, he said you have to assume its acting more like a gleason 8 situation. he also said that had i put off my surgery by even a few months, not a doubt in mind that it would have been a strong stage 3 situation instead. so i am thankful there.

david in sc
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, 5/9 .10, 6/9 .11
Lastest 7/13 met with Rad. Oncl, they want to start radiation, 70 gray, I am still considering all options and opinions
 
 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/14/2009 2:41 PM (GMT -7)   
David, this sounds like an excellent plan. Congratulations!
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good  


london2000
Regular Member


Date Joined Jun 2009
Total Posts : 36
   Posted 7/14/2009 2:43 PM (GMT -7)   
The strategy you are proposing, David, is logical and makes sense. Taking a step back, as you intend, is the right thing to do, rather than being bounced into something you are uncomfortable with. This strategy puts you more in control.

I wish you all the best, Roger
Diagnosed with PCa in April 09, aged 59. PSA 9.5 ng/mL, Gleason 3+3, 3/8 cores positive on biopsy.

Had laparoscopic radical prostatectomy in 21 May 09. Histopathology raised Gleason score to 3+4 but cancer confined to capsule with surgical margins being negative. Stage T2c. Nerves spared.

Catheter removed on 4 June 09. Currently coping with incontinence issues, but making progress!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 7/14/2009 3:37 PM (GMT -7)   
thank you sleepless and roger, i hated things just being up in the air and feeling pressured to react
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
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4019
   Posted 7/14/2009 4:43 PM (GMT -7)   
David:
 
I believe you have a great plan with one exception.  Here is what JohnT wrote in your previous thread:
 
David,
Why don't you get a consult from a noted prosate oncologist. A phone consult could work well as you have all the data. You will get a good unbiased opinion from someone who is familiar with advanced PC.
JT
 
I totally agree with John.  It should give you some peace of mind and, frankly, it's certainly what I would do if I were in your situation.  It's great that all of us on the forum are agreeing with you but...we are not medical professionals.   Since your uro-doc is suspect at this point and you are actually choosing not to follow the advice of your radiation doc, don't you think it is wise to get this other opinion???
 
Best,
 
Tudpock
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 7/14/2009 5:16 PM (GMT -7)   
David,
I think you are right on. Your PSA is so low that you don't need to rush into any decision. Another PSA test in August at the same lab will clear any unknown. If it does go up -and I hope it doesn't- then you would have had time to think about an attack plan. Enjoy the moment and relax. I wish you all the luck.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 7/14/2009 5:28 PM (GMT -7)   
Tud, I am not opposed to the radiation doctor's thoughts or plans, just don't feel its high enough to committ to another drastic remedy without thinking it through. If it is indeed reaccurance, of course my only real chance is in salvage radiation. How would I find a specific prostate oncologist in my area? Not sure there is such a thing.

Thank you, ED C
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
 
 


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 7/14/2009 5:41 PM (GMT -7)   

David,

I have been following your journey for a couple of months now. I can only imagine how many nights of little or no sleep are a regular occurence for you. I hope that you can find some peace in the upcoming weeks.  Its great that your wife is on board.  Our spouses should have an interest in our treatments and healing. They have a different viewpoint and that may give us some beneficial insight. I wish you only the best in the coming months. Thank you for sharing,

Dan  


PSA 01/07 1.2, PSA 01/08 1.9, PSA 01/09 2.5
BIOPSY 02/24/09  PCa DX age 52
Right: 3+3=6, 3/6 cores 10% involved,PNI-Y
Left:  3+3=6, 1/7 cores <5% involved,PNI-N
LARP 04/09/09 nerve sparing. Final pathology:
GS 3+4=7, Margins uninvolved, 2 lymph nodes negative
Catheter out 04/17,1st no-pad day 05/03
25 mg Viagra nightly;100 mg:not ready for prime time
Followup PSA 05/28/09 <0.1
 
 


down not out
Regular Member


Date Joined Jan 2009
Total Posts : 25
   Posted 7/14/2009 6:00 PM (GMT -7)   
Dave: Just a quick note to say I wish the best for you and will keep montoring your progress. Mark.
Open retropubic prostatectomy 12-15-2008
Catheter removed 2 weeks later, no leakage problems
Margins clear, nodes clean
Return to work 6 weeks post-op
Resumed regular workout routine 8 weeks post-op
Taking Cialis daily
Age  55
pre-surgery PSA 9.04
3 month post-op PSA 0.07


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 7/14/2009 6:50 PM (GMT -7)   
David-
It sounds like you have made your decision and it sounds like a great one to me. I think the best feeling in this entire process is deciding on a treatment option and team and the ability to breathe that follows. I hope that you will sleep well tonight and not second guess your decision. Congrats and best wishes in the next chapter!
Father's Age DX 62 (now 64)
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


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 7/14/2009 7:00 PM (GMT -7)   
Sounds like a great plan. I will keep notes when/if I am in the same boat. Thanks for sharing! I still worry and have sleepness nightsas well. Sometimes I don't know who to avoid it.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4044
   Posted 7/14/2009 7:10 PM (GMT -7)   

David:

Sounds like a very logical plan.  I know you have thought about it with great self interest.  Congrats on makeing the decision. I do wish you the very best.  You know we are all here to support each other.  Thanks for letting us know.

Jeff


Jeff T Age 57
9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable
 ED- 5 mg Cialis daily, pump daily,


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/14/2009 7:35 PM (GMT -7)   
Does Duke have a cancer center ? My urologist referred me to a prostate oncologist at University of Michigan. It did help me reaffirm the next step I should take, even tho I don't want to.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 7/14/2009 8:28 PM (GMT -7)   
Dan, my wife is a very experienced and caring nurse for the elderly, she is one person that has a deep natural understanding of what is going on, and for that I am thankful.

Thank you Mark, Daughter and Rob and Jeff.

goodlife, not sure about duke, i read tonight that there are only 50 prostate oncologists in the whole country? Is it possible there are so few? Couldn't find any in a reasonable distant to me, and with me being out of work for nearly a year, our resources are stretched now to the limits, I am not sure how to pursue that line of thinking, but I think it is a good idea if possible.

David in SC
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
 
 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 7/14/2009 9:33 PM (GMT -7)   
Hi David
 
I think that you are going for an early PSA reading in my last post I said that I had been looking at your PSA readings and what I was thinking that there must be a rounding up or down of PSA readings (I am new to all this so I am most probably wrong in this assumption) which on a 1 month reading could be very misleading an example is if your middle PSA reading was .104 the machine rounding down to .10 and your next reading was .106 the machine rounding up to .11 there could be very little actual difference of .002 and not .01 but your new plan will take care of this because by taking out the .10 reading it now gives you a 3 monthly comparison I hope this makes sense and like everyone on here I wish you all the best luck you can get
 
 
 
Age 64 From UK now in Thailand Baby boy born 2/14/2009
 First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/0924 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear 
Open surgery planned for 7/27/09
 


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/14/2009 10:07 PM (GMT -7)   
Hi David,

I am going to use your planning for this as a template for when (I hope if) I need to chose secondary treatment.

You and your sweetie have done an excellent job here.

I'm hoping that having this solid plan has provided you with comfort so you can enjoy your life right now as a prostate cancer survivor!

All the best, brother David tongue

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 7/15/2009 6:39 AM (GMT -7)   
Collins, I agree with your thinking, one reason I insisted on this next PSA test.

Barry, thanks for your kind words, I truly hope you never need to think about a Plan B with PC.
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
 
 


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 7/15/2009 8:02 AM (GMT -7)   
David,
Good Luck with your next PSA Test, and consults!!! It sounds like your at peace with your decision and have a battle plan!!!!
 
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).
4 Post OP PSA's from 9/2008 to 6/2009: <0.1
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 7/15/2009 8:39 AM (GMT -7)   
SHU, would really be feeling at peace if I never had PC to start with, or if I didn't have a post surgery psa rising situation, but it is what it is.

Waiting another month to get some additional opinions and another PSA will make it easier for me to digest it if I have to have the salvage radiation. Least I won't feel like I am making a rash decisions either based on fear or pressure or both.

Thanks for your words.
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
 
 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 7/15/2009 9:33 AM (GMT -7)   
David,

I think your plan is a sound one. However, if you do decide on a consult with PCa Onc, Duke has a great PCa center. I live close to New York City and could have gone to Sloan Kettering, but decided on Duke instead. They are number three in the country (after Hopkins and Sloan). There are several good docs there. I am treated by Dr. Phillip Febbo.

In my case, when my PSA rose to 0.17 he recommended checking it in three weeks and doing salvage radiation.

Good luck with your plan, I hope you don't need to implement the second part of it.

Greg

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

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)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, IMRT to start mid-Aug


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4019
   Posted 7/15/2009 10:27 AM (GMT -7)   
Hi David:
 
Tempted as I am to join the bandwagon with "great plan", etc, blah, blah, blah. I will just nag you a little more and then shut up.  Let me see if I can summarize your situation with your current physicians from a dispassionate point of view:
 
1.  You have a uro-doc who doesn't know whether or not he spared nerves or not, couldn't read your pathology report and couldn't get you off a catheter until you made a suggestion that you read on this forum.
 
2.  You have a radiation-doc whose advice you have chosen to not follow...or at least put on hold.
 
So, at this point you are following no particular physician's advice, but have made your own decision which, according to us experts on this forum, is probably ok.
 
I maintain that, if it was me, I would indeed consult a prostate oncologist at this point.  I understand limited finances and the difficulty of finding someone close to home.  However, as Geebra points out, Duke has a GREAT prostate cancer center and is probably only 4-5 hours from you.  Back and forth in one day if you like....  Besides that, as JohnT suggested, there is the possiblity of telephone consults if there are no suitable doc nearby.  Anyway, that's what I would do rather than sitting around for another month.  Please don't get me wrong, I think your logic is sound...but I'm no prostate oncologist...
 
Tudpock
 
 
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!
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