Back from lengthy visit with Radiation Oncologist

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/14/2009 6:02 PM (GMT -6)   
What a day, many severe bladder spasms despite the med for it.  Met with my new Radiation Oncologist, part of Cancer Center of the Carolinas here in Greenville, SC.  We spent 2 1/2 hours together total, but one on one was about 90 minutes.  He got called out of my meeting 5x for emergencies.  He has been a Rad. Onc doctor for 30 years, he said that 85% of his practice is prostate cancer only.  He said he there use to be a Prostate Oncologist in this area, but due to lack of biz closed down his practice and moved to a larger area.
 
He said after reveiwing my entire case from biopsies, through surgical notes and pathology reports, etc, if he had been me, he would have had surgery, based on my age, and the  agressiveness of the PC.  That kind of made me feel good.  He spent time drawing pictures for me of how things looked before and since surgery inside.  He's very up to date and stays that way.
 
He wants me to have 2 months of Lupron, then two months of radiation (70 grys) for 35 treatments over 7 weeks, and two more months of Lupron after.  He did say however, that he is not convinced that I need the HT portion, but more that it was standard procedure for his practice.  He said it may or may not help or make any differnece.
 
He will see me in a month.  He is going to consult with my surgeon next week and compare notes.  He agreed that we can not move ahead until these blockage issues are resolved.  He said if need, he could radiate with a catheter in place.  Instead of me drinking a bunch of water to fill  the bladder while they zap, they could fill the cath full of water, zap, then release the water.
 
He said in my case, having a positive margin was a good thing. Because if there wasn't one, and my body was producing psa, then it would probably mean that it was distant instead of being in the prostate bed.
 
Based on his 30 years, his magic cutoff number is a post surgery psa of .50, at that level he mostly sees 100% sucess, from .50 to 1.0, he said its down to 50%, and anything over 1.0, not much point doing it.
 
I told him about our group, hes thinks thats a great idea, and he said I was probably one of the most informed patients he'd ever talked to.  Kind of made me feel good.
 
He did say, there is no doubt in his mind, that I do have reaccurance.  He mentioned other tests available, but he said that none of them could absolutely confirm or detect reaccurance with a psa of .16.  Below, I will post another thread about some of his other comments related to PC.
 
Glad to be home,
 
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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 8/14/2009 6:15 PM (GMT -6)   
David: I am so pleased to hear that you had such a good consult with the Rad. Onc. It sounds like this guy shoots from the hip and ready to take care of you.

Good Luck my friend.

Jeff T
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
 10th month  PSA <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/14/2009 6:19 PM (GMT -6)   
Thanks Jeff, I told him in the first 30 seconds, that I was a reality person, and not to blow any smoke up my a**. I was blunt with him and he was blunt with me. If I have to make a tough decision thats how I want it to be.

David
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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 


mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 8/14/2009 6:30 PM (GMT -6)   

Hi David,

As Jeff said, it sounds like you had a good consult with the oncologist. From what you said he said, maybe it is a good idea to consider waiting before rad treatment and the PSA numbers he was talking about. Been reading more and more about that lately. I don't have enough knowledge yet but I know others here are more informed. After I was told I had an EPE, I saw a radiation oncologist. She mentioned standard protocol was HT and RT, but in many cases starting to look at RT only now.

Take some time and know you have lot's here pulling for you.

Mike


-Hernia, mesh and large scar, surgery early 2006
-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Bone scan Dec 08: Negative
-Barium enema X-ray March 09: Small diverticulosis
-MRI with endorectal coil (April 09 as part of a study)
-3D advanced TRUS (April 09 as part of a study)
-CT (April 09 as part of a study)
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 8/14/2009 6:46 PM (GMT -6)   
Greetings, David.  Glad you had a good consult and everything he said sounds very favorable for you. Now get that blockage taken care of next week and then you can get ready for this next round of treatments.  It's always good to get confirmation that you made a good choice.  Look forward to hearing some good reports next week.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4226
   Posted 8/14/2009 7:31 PM (GMT -6)   
David,
Sounds like you found a well informed doctor. Good luck with your treatment. My Rad onco also recommended Lupron, but my oncologist convinced him that Casodex works just as well with about 20% of the side affects as a prep to radiation.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/14/2009 8:04 PM (GMT -6)   
Yeah guys, I was left with a lot to think about, but fortunately, don't have to make a rash or super fast decision. Again, not a trace of denialism in my body, just want to do this right, and feel right about it when I do it. If I were 20 years older, I might choose to do nothing more, but at 57 with a beautiful loving wife of 35 years, 3 great kids and 2 grandchildren so far, I want to live as long as I am allowed to.

My youngest son, the one with the most empathetic heart, said dad, sounds like you are in for a hell of a fight ahead, but you are strong and your whole family is behind you.

Right now, I got to get through this corrective surgery, a little nervous ,be a fool if I wasn't, and I know there will be pain after for a week or two or more, but I am a big believer in responsible use of pain meds when needed.

Hopefully when I meet the rad oncologist again in a month, I will be well on the healing side of this next step, and hopefully peeing a decent stream on my own.

Today was day 25 on this catheter, and the spasms were wicked bad most of the day, my poor bladder and weiner are just so tired of this unwanted visitor.

Thanks for all your support and care.

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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 8/14/2009 9:32 PM (GMT -6)   

David,   It sounds like you have a prolonged battle with the beast ahead of you.  Enjoy some time with your beautiful wife and family this weekend.  I look forward to good reports from you in the coming weeks.  We would all like to see you get some relief.

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
 
 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 8/14/2009 10:25 PM (GMT -6)   
David, I love that 100% number!

I'm thrilled for you. I can sense things are turning, and I'm never wrong about my gut feel unless it has to do with women, the stock market, or if I've got enough gas in the boat to make it to the marina for a fill.

Now, on to the blockage being a thing of not so fond memory,

Sheldon AKA Sleepless
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
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 8/14/2009 10:48 PM (GMT -6)   
Hi David,

Like others, very happy about this first session with the Radiation Oncologist. The prognosis sounds very good and I know you're up for the battle ahead.

I hope you can enjoy the weekend with your supportive family.

We're looking forward to seeing you on the other side of your corrective surgery.

Best regards,

Barry a.k.a Idaho
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 : 25380
   Posted 8/15/2009 6:27 AM (GMT -6)   
Barry, not sure I am up to it, but the alternative still sucks at age 56

Sheldon, actually in my life, my gut feelings about anything were usually the right choice, its when I thought around them I get into trouble

Dan, thanks. My wife, youngest son, and I , are going over into NC across the mtns to Hendersonville to do something I like, some serious antiquing and lunch at a great german resturant. Hoping the cath gives me a greak so I can enjoy myself.

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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/15/2009 3:54 PM (GMT -6)   
OHIO, great post, want to thank you. brought up some good points. this time around, if i am dealing with reaccurance, i am trusting my self more in how to deal with it. btw, the new radiation oncologist, freely stated that he guarantees nothing with PC, hes' been dealing with us men for 30 years and he mentioned that it was more erratic than many other cancers he deals with. That won points with me.

Hope you are holding your own too, brother.

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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/15/2009 4:57 PM (GMT -6)   
good info there ohio state, thanks.
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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 

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