The new doctor called me at home, a first for me.

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/14/2009 9:36 PM (GMT -6)   
A few hours after I got home, the new rad. oncologist that I met with this morning called me at home.  Didn't recognize the number and didn't know who it was.  She said she was really concerned about me, and had done some more thinking about my case after our meeting.  She still wants me to come in next Monday morning, but she wants to change the treatment to IMRT instead of conventional, and may want to up the grys above 70.  She told me to disregard the instructions her office had given me about taking an enema and drinking 1/2 liter of water on the way to the office.  She is really concerned about my blockages.  BTW, its been slightly less than a month since the laser correction surgery I had, and already, I have all the bladder neck pains, and my flow is less than 50% of what it was for about the first week after the catheter was taken out.  Very disheartening to me, to be honest.  I don't think this next step is going to be the easy path for me like it for others that have done it.
 
I was shocked that the doctor herself called me directly, not sure any of my other doctors did that on their own calling me at home.  That impressed me.
 
Don't know much about IMRT, so trying to bone up on it real fast.
 
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


mikey1955
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Date Joined Dec 2008
Total Posts : 673
   Posted 9/14/2009 10:01 PM (GMT -6)   

Hey David,

Been away for awhile and really busy. Haven't caught up on any posts. Seems like your new ONC is on the ball, ask lots of questions. Always impressed me when a doctor called me at home...also, usually worried me, too.

All for now, talk soon.

 

Mike


-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.
-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.


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 9/14/2009 10:09 PM (GMT -6)   
David,
I'm amazed and impressed by your Onco calling you at home and paying attention to the details of your situation. I have a feeling that you are in good hands. Best of 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
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
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


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 9/14/2009 11:11 PM (GMT -6)   
David, Sounds like this Lady Dr. has a great interest in your condition. I am pleased that she took the time to call you on her own. That speaks loudly to me. 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 : 25393
   Posted 9/14/2009 11:23 PM (GMT -6)   
Thanks, Mike, EdC, and Jeff. My wife and I feel real good about the good lady doctor. I know one of her patients well, for years, and she spoke highly of this doctor while undergoing treatments for an advance case of breast cancer. Said this doctor was one of the most concerned and compassionate she had ever met. So far, my gut reaction about this doctor is checking out.

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


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 9/14/2009 11:38 PM (GMT -6)   
Hi David,

That's quite unusual to have a doctor call. I'm really glad to hear it. Just reading between the lines, it sounds like she has consulted with other health care professionals on your behalf.

'Looks like you got a good one there!

Please take care.

All the best,

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


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 9/14/2009 11:40 PM (GMT -6)   
Weird, cause I asked if it was IMRT....hummm....

Sounds like a great doctor. Last time a doctor called me at home, was....never.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/15/2009 7:40 AM (GMT -6)   
Squirm, yes weird, because I couldnt find a reference in my notes to the method, and then she calls me.

Barry, for sure. She had already consulted with my uro/surgeon 3x to my knowledge prior to this vist. Plus she talked to the rad. oncologist and the medical oncologist that treated my ultra rare triple bout of cancer that ended 9 years ago, and had read all the notes on those cases. She is on top of things so far.

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


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 9/15/2009 7:49 AM (GMT -6)   
It is obvious this woman has your best interest's at heart. I've always wondered if the patient is just another face they see. This shows she is obviously studying your case and want's to succeed with you! Now go beat this cancer.

Larry
Father treated for Prostate Cancer in 1997 with Proton Beam - Still doing well.
My Stats
Age at diagnosis 54, PSA 5.1
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7, 2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
 
Post Surgery - Dr. Spared 100% of Nerves on the left side.
Estimated that 50 - 70% of the nerves were spared on the right side.
 
Final Path report
20% of the prostate Invovled
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear
Positive Margin 1.8 cm in length Noted in Right Apex


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 9/15/2009 8:18 AM (GMT -6)   
David,
I will second Larry's comments and that hopefully is a good sign. My last visit to my surgeon lasted 5-10 minutes and I knew at that time I would switch back to my regular urologist after my 6 month PSA. Your a trooper and handling this well, although each of us has our moments. But just feel like you are now in good hands that will help guide you thru these troubled waters. Take care and keep us posted.
Michael
Dx with PCA 12/08 2 out of 12 cores positive
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margins not involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only
 started ED tx 7/17, slow go
Great family
Michael


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 9/15/2009 8:55 AM (GMT -6)   
Completed 37 treatments IMRT in July of 2009.
Pretty painless and the least evasive. Didn't need to drink any water before each treatment.  They usually do a cat scan, make a cast pillow for your lower extremities, then develop a computerized plan for the treatment. They took X-rays once a week during treatments for the doctor to view and adjust the positioning. You should do just fine.  Good luck.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 9/15/2009 9:40 AM (GMT -6)   
Thats good news that your doctor seems like this is much a priority and concern for her as you. My doctor called me several days after my surgery to give me my path results before I came back in. He knew how much of a mess I was mentally, and it meant the world to me that he called when he got the results right away. For this type of care and concern I am so thankful for the doctor I selected. Good Luck!!
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 : 25393
   Posted 9/15/2009 9:59 AM (GMT -6)   
Larry, I do believe her sincerity at this point.

Micahel, she makes me feel a little less like a statistic and more like a person, with feelings and hurts and so forth. Off to a good start for sure.

bootheel, its only because of my other issues that I have any fears or worries about it, but the new dr and my uro/surgeon are tag teaming to make sure it goes as smooth as possible

shu, i still say, that overall, there are a lot of good caring doctors and nurses, it really isnt all about the money in their professions.

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


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 9/15/2009 10:02 AM (GMT -6)   
Bootheel said...
Completed 37 treatments IMRT in July of 2009.
Pretty painless and the least evasive. Didn't need to drink any water before each treatment.  They usually do a cat scan, make a cast pillow for your lower extremities, then develop a computerized plan for the treatment. They took X-rays once a week during treatments for the doctor to view and adjust the positioning. You should do just fine.  Good luck.

There is also another techonology that is sometimes coupled with IMRT, called IGRT, this uses imaging to help position the beam as the targetting area can move, especially based on the content of the bladder and colon, daily.

Is this what you had?


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/15/2009 11:24 AM (GMT -6)   
The way the new doctor was trying to describe the change in treatment method over the phone, she said it wouldn't be needed for me to drink a bunch of liquid ahead of time, she was worried about aggervating the bladder neck with extra stress. Guess I will have to wait for Monday to find out exactly what is in store.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/15/2009 11:51 AM (GMT -6)   
Enjoy the tattoos and the leg cast. I had 38 IMRT sessions conformal (7 Position) and did great with it. Only SE was fatigue and I didn't know I had it until we stopped and I felt a bit more energy.

Tony


 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!

Post Edited (TC-LasVegas) : 9/15/2009 11:08:06 AM (GMT-6)


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 9/15/2009 12:02 PM (GMT -6)   
You guys and your pubic tans...and no bikini lines....jk
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/15/2009 12:08 PM (GMT -6)   
Absolutely Les,
Who needs a tanning salon?

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 9/15/2009 12:32 PM (GMT -6)   
David,
IMRT is a more accurrate way of delivering radiation; It directs thousands of small radiation beams from all directions and can conform to odd shapes while avoiding normal tissue. It does much less damage to surrounding tissues and organs than normal EBRT.
I had a CAT scan before every treatment so they could adjust the radation to the position of the prostate that day. I would guess that she wants to use IMRT to avoid damage to your ureatha and bladder neck.
Johnt

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/15/2009 12:57 PM (GMT -6)   
JohnT, good answer, It makes sense what you are saying. I believe she said it was like 3-D radiation, and could be really targeted better. Thanks.
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

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