Seeing Radiation Onc. on Wed-need help with questions to ask

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New Member

Date Joined Nov 2008
Total Posts : 6
   Posted 7/26/2009 2:03 PM (GMT -6)   
My husband is the one with numerous health problems.  I wrote a couple of weeks back.  He has Gleason 4 & 3, 7 of 12 positive, 90%, 90%, 60%, 60%, 60%, 30%, 10%.  All on right side except one. Perineural invasion noted.   PSA at Dx 10.2, % free 8.    CT & Bone scan clear, except significant uptake in scrotum area (?) and what appears to be arthritis in the facet joint (?)   He does have severe pain in his hip/pelvic area. 
Urologist has given us a name of a Radiation Oncologist - we see him this Wednesday.   Does anyone know if the doctor will request a 2nd reading of the biopsy slides as part of the work-up?  We haven't had another reading of them.   Due to many other health problems, and bad heart, he cannot undergo surgery.  Uro says seeds and radiation is the way to go.  I'm afraid that with hubby's other significant health problems, the radiation may cause too many problems.  He cannot use his left hand/arm due to stroke a few years ago - I keep thinking of him having urinating problems/catheters, etc.  There are lots of things he can't do, due to his only having to use one hand.  In addition, there are other numerous colo-rectal problems due to congenital problems, and only 1 kidney. 
I just am afraid that since the right side seems pretty full of cancer (all 6 cores w/ cancer, 2 with 90%, 2 with 60%, 2 with 30%), that it has escaped the capsule.  If this is so, and the radiation leaves bad side effects that will be very hard for him to deal with, any side effects sustained would be in vain.    I'm afraid the doctors will not take the "whole" picture and QOL into the equation of how to treat his prostate cancer - he is for sure a horse of a different color when it comes to trying to decide what to do.
If anyone can help me with what kinds of questions to ask, it would be so appreciated. 
Cranky's wife

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 7/26/2009 3:06 PM (GMT -6)   
Be sure your oncologist has as complete a record of your husband’s health as possible. Then tell him about your concerns just as you have been telling us. Listen to the answers and be willing to repeat a concern if it is not addressed. You want a doctor who is giving thoughtful consideration to your issues and concerns not just giving the “standard” answers. You want to hear concern from him and even uncertainty. Trust yourself – you will know if you are getting what you need.

The facet joint is part of each bone of the spine, which is a lot more complicated structure than you might think. My internist has been watching my lumbar region, the lowest part of the spine, for facet joint arthritis because I have a malformation of that part of the spine (I don’t know if you can have this problem in other parts of the spine). My doctor says that facet joint arthritis is usually very slow in developing.
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

Regular Member

Date Joined May 2009
Total Posts : 476
   Posted 7/27/2009 9:34 AM (GMT -6)   
You should ask about ADT v. Radiation.

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

Regular Member

Date Joined Jul 2009
Total Posts : 162
   Posted 7/29/2009 10:52 AM (GMT -6)   
Should also ask the oncologist about cryo. There are no complications from cryo other than impotence and some pain "down there" for a few days. Incontinence improves by the day. Tthey got it down real pat, it has long-term success  and very few bother to look at it as a primary treatment. I would save the ADT for later, if needed.
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation

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