Salvage Guys, some really good information

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dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 9/15/2009 12:26 PM (GMT -6)   
 
I haven't posted in quite some time but have been following the postings and it seems an unusually large percentage of us have a reoccurence happening. I happen to be one of the reoccurence guys so I thought this might help with some decision making.
 
 
 
It lays out the timelines and is a very recent article.
 
David
 
 
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 9/15/2009 4:05 PM (GMT -6)   
Thanks David, that really is a great piece of work. As a Gleason 9, I am just waiting for the other shoe to drop, yet, I can't bring myself to do adjuvant radiation, even tho I know the facts are with we.

If I really could look forward to a median of 6 years before I see a rise, I would be tickled pink. Obvioulsy, as you stated, many of our brothers here have not been so median.

My surgeon from Cleveland Clinic recently looked surprised when I asked him about adjuvant therapy. He said some of that is based on older thinking. Many oncologists are saying that waiting until PSA does rise is a better approach.

Sometimes I get so darned confused. This study seems to back up what he said, whereas there are many others that don't.

Thanks again. Good luck on your journey !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
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
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/15/2009 4:29 PM (GMT -6)   
goodlife, my uro/surgeon and all 3 radiation oncologists I have spoken to since July no longer practice adjunct radiation for surgery failure, all of them said that they like to wait to see 3 rises in a row before calling it reoccurance.

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/15/2009 4:39 PM (GMT -6)   
David, had seen and read this article before, a lot of good information, but a bit depressing too when one can be looking at a 50% chance of the salvage radiation working. Even the latest Rad. Oncol. I met with said that was about the odds at best.

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


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/15/2009 4:53 PM (GMT -6)   
goodlife
I would go along with your doctor -- my reading is that the best current thinking is wait and watch for a PSA rise before going to radiation. This is definitely my uro's opinion too.
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 - now light pads


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 9/15/2009 11:28 PM (GMT -6)   
David 131 Although it seems like there is a large percentage of people getting a reoccurance you have to take in account that a lot of people that do not have a reoccurance do not bother (or want to forget about there cancer) to carry on posting once they get there zero's and in theory do not have to much to say where as the people with problems need more help and advice so post more often which can be misleading

I would be very interested to know how many people have signed up to this forum and how many regular posters there are now
 
 
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 7/27/09
Prostate Gland weighting 34 grms
Gleason upgraded to 3+3 Tumour not closeto prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
 


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 9/16/2009 12:10 AM (GMT -6)   
I was going to note the same thing. Those without recurrence are probably just not posting. When I first started lurking here, I thought "With all these members having a recurrence is there a high recurrence rate for prostate cancer in general?"

IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 9/16/2009 12:19 AM (GMT -6)   
I think you're right, Squirm. Those with possible or actual recurrence are more likely to "stay in the game."

I think the odds are still good for a "cure" for most patients.

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 9/16/2009 12:28 AM (GMT -6)   
An interesting study...it seems there is more published studies about SRT. What I didn't see in the article was what type of radiation treatment was used. 3DCRT, EBRT, IMRT?

But then I also think, if SRT is somewhat quickly becoming a reputable secondary option, shouldn't it be the the primary treatment instead? It just doesn't make sense.

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 9/16/2009 12:37 AM (GMT -6)   
Colin45 and Squirm: Take a look at the 'where are we from' thread ---- the list goes back into the mists of time. By definition, if PCa isn't a problem then a support group is about as useful as a bicycle is to a fish.

When first diagnosed, panic.

Then, the treatment decision --- not an easy time.

Then THE DAY --- treatment arrives. Major stress.

Now, the frightening wait for pathology, if surgery was elected.

Next, piddling all over the carpet --- not an easy time.

Then the realization that not only has Willie gone into hiding (bad locker room image) but may be brain dead. Not nice!

Then the trauma of the first PSA, and perhaps the next.

And, by now, for most, fewer pads, a zero PSA, a Willie that can work in a pinch, and that's better than a stiffy in a pine box, so we live with it.

And the cat has kittens, the car has to go in for servicing, there's a big project at work, your brother with "THAT" wife is coming to stay for a week, Costco beckons, your grandchildren want to go to McDonalds, and first thing you know, life has reared it's ugly head and you've gone for hours without thinking about PCa and when you are drifting off to sleep you suddenly remember you meant to get to the prostate group to say hello --- but it will have to be tomorrow.

For some tough, the PSA doesn't behave, the pipe plugs, Willie won't wake up, and it's still a fresh pad every couple of hours ---- major need of support.

And that, I bet, is the story of this group. The lucky guys mean to stick around and be supportive --- but season tickets to football, cleaning the garage, dinner out with friends, shopping with the wife, all and more overwhelm good intentions.

Case in point: I had my first doctor meeting post surgery this morning ---- boring! Nothing to report. Nada. Same old, same old. I'm not even bothering to post about it. No support needed. BUT if my next PSA is up you can bet your last dollar I'll be here hourly, just like I used to be.

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"  


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 789
   Posted 9/16/2009 3:27 AM (GMT -6)   
Hi everyone, well in my case, as my PSA was 0.5 after the surgery, my Urologist suggested radiation because there was a good chance that the remaining Pca cells were in the prostate bed, given the fact that my post operative pathology was so good in regard to no cancer found in lymph nodes etc.

In my opinion I think that follow up radiation gives you a good chance of zapping any cells that are there, IF they are there, the cells sending the PSA signal in my body are obviously elsewhere and looks like I am on the wrong side of the 50%.

I would still do the radiation, doing nothing is not giving yourself a chance, in my opinion take every method suggested (within reason) to kill the beast!

Just my 2 pennies worth.

Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept.
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)
PSA 11th March 09 0.5
PSA 3rd Augiust 09 0.6


GarthK
Regular Member


Date Joined Feb 2009
Total Posts : 74
   Posted 9/16/2009 5:11 AM (GMT -6)   
I think I agree with the above posts that argue that this, or any, forum is probably not representative of a good cross-section of all those that have been treated. I was one of the fortunate (few? many?) that had low numbers and early detection. Whenever I look at the various nomographs, I am told that I have almost nothing to be concerned about. When I come back to HW and read about those of you whose battles continue, and that seems to be a pretty high percentage, I get the feeling that something doesn't add up. My take on the answer is that this group of really great folks doesn't statistically represent all those who have been treated for PCa but is weighed pretty heavily in favor of those who needed follow-up treatment or who had more advanced cases to begin with. When I go back in time in the posts, I see a lot of names that I don't recognize and I think they are folks like me where the initial treatment did the job and they are no longer active.

Sounds pretty cold and I don't mean it that way! This group performs an absolutely vital function for those going thru the battle. I was logged in almost constantly when I first started the process and the answers I and others got were invaluable to me in making my treatment decisions with my Uro. I am no longer nearly as active, mostly checking in to follow the progress of those who helped me (hang tough, Purg) and to add an occasional thought or comment that might help someone else.

So, does this change the value of this group? Not a bit! It's still one of the best places for those of us newly diagnosed or going thru the battle to gather for good fellowship and advice. Does it accurately represent all of those treated for PCa? Probably not. Fact is, most treated for PCa probably never made it to this forum and that's too bad IMHO because they would've found it an great place to join.

Keep up the Good Work and best of luck to those whose battles continue!

Garth
Vitae:
DOB: Q4'46, HT: 5'9", WT: 180
PCa:
PSA: <2.5, DRE: Slight enlargement, one node
Biopsy: 12/08
Cores: 4 of 12+ positive, Gleason: 3+3
Surgery: RRP on 1/21/09
Catheter: 15 days
Pathology:
Adenocarcinoma occupying 5% of prostatic volume (right posterior aspect)
Gleason: 3+2, No extraprostatic extensions, Perineural invasion within prostate only
No angiolymphatic invasion, No seminal vesicle invasion, Clear margins
AJCC: pT2a
Post-op PSA's
3/10/09 < 0.014 (undetectable by machine)
6/10/09 < 0.014 (undetectable by machine)
9/8/09 < 0.014 (undetectable by machine)


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 9/16/2009 11:20 AM (GMT -6)   

Guys:  The comment about an increased group of reoccurence guys was just an off the cuff comment, nothing scientific.  The important part of the post in my opinion was the information from the article.

One of the reasons that I finally decided on surgery was the ability to have a fall back treatment(SRT) if the surgery didn't work.  A 50% chance of cure after reoccurence is better than nothing at all.

David

 

 

 


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/16/2009 11:57 AM (GMT -6)   
Garth, good to hear from you. Many of your points are valid, in the bigger picture of things, we are a small group. Wouldn't want someone's total view of PC being based on our stats and troubles. Glad you are doing ok, the best thing is never to even know about this place, let alone have to join it, but once here, as you know, its a great and comforting place to be.

Not planning on giving up anytime soon, too mean a buzzard here. Just getting ready to get into the next battle, salvage radiation.

Hope your numbers stay that way for many years to come, my friend.

Keep us posted from time to time.

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/16/2009 12:03 PM (GMT -6)   
David - dkob, I didn't find anything wrong or offensive in your remark, speaking for myself. Facts is facts.

Yes, many of us surgery guys take the surgery as our primary treatment for the very reason you said. If it fails, you are still open to radiation treatments for a secondary treatment. I am in the situation right now.

As far as the 50% factor goes, that's a very subjective thing. I am hoping to be in the 50% that it works. So far, I keep ending up on the wrong side of the good statistics, lol. In my meeting with the 3rd radiation oncologist, she said I was looking at best about 40% success, due to my psa velocity issues, both pre-surgery and post surgery. Least she was being honest.

From looking at your personal stats, I think you did wise to change from Radiation to Surgery, 1/3rd of your biopsy cores were cancerous and you were listed as a Gleason 8. Some would disagree, and you still have a valid back up in case.

Hope you go forever with your kind of numbers,

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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/16/2009 12:05 PM (GMT -6)   
Just a note:
I am approaching my 3rd year here. I have seen probably a couple thousand come through HW. The vast majority are done after initial treatment and only return with PSA updates if at all. I have seen some go away and return much later with reoccurance, but luckily very few. That vast majority of those who stay here and continue posting, like myself, usually have more advanced cases or continuing side effects. And with continuing treatment for these things this has been a great haven for discussion. Those who stayed that did not have advanced cases or continuing side effects have been here with warm and open hearts helping others...pretty amazing stuff if you ask me...

David,
I fully understand the feeling that 50% is better than nothing. I decided on adjuvant therapies rather than awaiting for relapse to take steps in hopes of gaining another 11% improvement in odds over salvage therapies. When you think about it, that's just 1 in ten guys who fared better. But it was the best I could hope for...

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!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/16/2009 12:09 PM (GMT -6)   
Tony, I think you were addressing the other David (too many of us, lol), but I agree with your sentiments and his. Whether its 50% or the 40% I was told this week, it sure beats the heck out of zero chance. I will take my 40-50% opportunity while its valid and on the table.

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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 9/16/2009 1:05 PM (GMT -6)   
It's difficult to talk about reoccurrances without looking at one's primary stats. If there are 25% reoccurrances after surgery and Gleason 6 has a 5% reoccurrance rate then we have to assume that most all reoccurrances are G7 and above. There are three possible reasons for a reoccurrance: The PC is systemic and has already escaped the prostate and the bed and is in the bloodstream at the time of treatment. The surgery failed to remove all of the prostate tissue; this is common, and some PC cells are still in the left behind tissue. PC cells have entered the prostate bed and the surgical margin didn't get them.
Squirm, I tend to agree with your line of thinking that radiaton would do a better job of klling cells at the margins as radiaton has a 15mm margin and also kills any PC cells left in the hard to remove prostate tissue.
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 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


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 9/16/2009 1:32 PM (GMT -6)   

Tony and Purgatory (the other David):  As we travel down this road we know that the %'s have a tendency to decrease with each new attempt at cure or remission.  To me the key is to keep trying because what else is there ?  Whether my chance of cure is 48% or 41%, I'll take the shot and not look back.  As we know %'s are for the Drs. and hope is for us.

David 


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/16/2009 1:36 PM (GMT -6)   
Well said...:-)

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!


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 9/16/2009 4:09 PM (GMT -6)   
Hi JohnT
It's something that I still cannot quite understand yet. I think it's *reasonable* to say that surgery has about an 80% success rate, and radiation about 75%, with respect to median stats. What I don't understand is why does radiation therapy fall behind surgery? If it's used as a backup option if surgery fails, why not use it as the primary treatment to begin with? I'm starting to speculate that the 75% success rate of radiation is based from the older delivery technology, such as EBRT and not IMRT. Perhaps in the near furture when further studies comparing surgery vs radiation, radiation will overtake surgery on successful outcomes. Just my guess at the moment.

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 9/16/2009 4:36 PM (GMT -6)   
Squirm...I hadn't heard that the "success" rates were that much different. I understood it was more a matter of which method is the best for the patient i.e. depending on the age, gleason and PSA numbers. At least that is what my original doc said. Also there are two types of radiation treatments used as primary treatment. Internal and external. I think the only reason for pressing surgery would be is if the person can handle it, a more accurate staging and pathology could be done, which also helps in the prognosis of the disease. Otherwise, I heard outcomes were all about the same with only the side effects being slightly different. Learning something new all the time.
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 9/16/2009 6:14 PM (GMT -6)   
In cases of localized PC the results are similar with surgery, seeds or external. The overall cure rate may be less for radiation because the more advanced cases are usually recommended for radiation.
It's really difficult to make head to head comparisons because differences in gleason, PSA, tumor size and location, doctor's skill level, diet, patient's imune system, ect all have a meaningful impact on the final outcome, and we also have to consider luck.
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 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 9/16/2009 7:37 PM (GMT -6)   
John, I am starting to believe good old fashioned luck has become a factor in all the many variations and differences we men react to with PC and its treatments and for sure, its side effects.
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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