Got back earlier from my visit with the 3rd Radiation Oncologist. We spent a full hour together, nothing rushed. I really liked her, probably late 40s, early 50s, I am a bad judge of age. She was very serious minded, but had a good dry sense of humor like my uro/surgeon does.
She too, feels I am in a serious situation, mostly because of both my pre-surgery psa velocity, and post surgery psa velocity. She feels the surgeon did an excellent job on his end. She strongly feels that HT is gross overkill at this point, and she would rather reserve that for the future, if needed. Now that makes 2 out 3 rad. oncologist that didn't reccomend HT, my own uro/surgeon and my own GP, and myself. So I am comfortable with that. She surprised me and did a DRE, first for me by a woman doctor, she laughed and said relax, that she had tiny narrow fingers. It didn't hurt a bit, but that makes the 4th DRE since surgery, so boys, don't think it's over with.
I go in Sept. 21, next Monday, for CT's and mapping and testing. She did give me a throrough physical exam too, which surprised me, as the other 2 rad. oncolg. didn't bother. BTW, she has 28 years experience, and has a lot of experience with prostate cancer.
She said the big mistake would be in waiting at this point, there is too much risk of my psa of taking off and racing past the safefty point. In her experience, she said she sees the most agressive PC in men in their 40s and 50s, and that most of the indolent cases are men in their 60s and 70s. She, too, believes that Gleason 7s can be very dangerous, and that they shouldn't be treated lightly as if they were lesser Gleason 6 cases. It is the "4" cancer cells that make it so unpredictible and dangerous in her opinion. Often Gleason 7 cases are undertreated or not given the correct and most agressive primary treatment. She said they often act more like Gleason 8/9, then they would ever act as a 6.
From studying my case in detail, she too, said she would have reccomended surgery as a primary treatment. That makes all 3 radiation oncologist having that same opinion, just for the record.
I will be getting 70-72 grys, spread over 35 sessions. Hopefully they will be over with by Thanksgiving. She said I could be assured I will have continual and future blockage stictures, and will be working with my uro/surgeon to come up with a game plan to make it less painful and tramatic as what I have been through. She even mentioned a pre-empt possibility of going ahead and installing a suprapubic catheter, to make it through the treatments and for the weeks immediately after. She is going to consult with my other doctor on that.
She was a straight shooter, I like that and wanted that. Told her all about HW, she's going to check us out. So guys, I do have re-accurance, the post doubling time is steep in her opinion, but she is hopeful that it is still in the prostate bed. So my next battle is ahead of me, this SOB PC is going to get clobbered with tons of radiation, hope it dies.
I will ammend this post as I think of more she said and look at my notes later.
David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out 38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, does not rec. HT at this time, mapping on 9/21/9