T3b Post-op. Treatment Plan is Set.

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Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 10/8/2009 2:01 PM (GMT -6)   

T3b Post-op. Treatment Plan is Set.  My wife and I met this week with a medical oncologist/hematologist and with a radiation oncologist. Both agree that I need to begin ASAP treatment with Adjunct Combination Therapy. The positive margins and perineural invasion are too dangerous to wait for PSAs to rise. I agree. My Urologist will administer the Lupron. He wants to start with a 1-month injection to test my tolerance, then increase it to a 12-week dose. This will be relatively short-term, 6 months. IMRT will begin 2 months after the Lupron start, with preliminary work starting just after Thanksgiving. Anticipating about 35 treatments.

 

I feel some relief knowing what is coming, and have hopes that this aggressive treatment approach will put a stop to this thing for a long time. And so, on with life!

 

All the best.

Roger


 

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage T3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjunct Combination Therapy to begin ASAP.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night. (Pressure off the bladder neck?)

 

“I’d rather die while I’m living, than live while I’m dead.” (Jimmy Buffett. Changes in Latitude, Changes in Attitude.)

 


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 10/8/2009 2:21 PM (GMT -6)   
Roger

Sounds like a good plan. I am glad that your doctors are proactive and try to make ahead of what is coming.

Good luck on your treatment and will pray for you.

Jennifer

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/8/2009 3:56 PM (GMT -6)   
ROger, having a good plan in place is part of the battle, glad you go one. Sounds fairly agressive, and I hope it works well for you. Keep us posted.

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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 202
   Posted 10/9/2009 5:24 PM (GMT -6)   
Hi Roger,
Sorry to hear you're having to do the adjunct therapy so soon after surgery.  It looks like you're doing the smart thing and you've got a good plan.
 
Best wishes.
Dave
Age:54
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/10/2009 1:19 AM (GMT -6)   
I agree with this plan. Aside from the very well design test to see the effects of ADT on you, I have travelled this road. I was able to go to 4 month shots from the start without issues. I will see my Chief of Staff on Wednesday to get my latest zero.

Doting Daughters dad had great news this week, too. I believe this is a great plan...

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!


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 10/10/2009 4:56 PM (GMT -6)   
Don't be shy about learning all you can about anything that may benefit your quality of life, quality of treatments and options you have as a patient. You like some others of us have entered into 'limbo land' you don't know exactly how it all will go, and frankly your docs do not know with absolute certainty either, although they have seen many patients and have clinical experience, yada..yada. Don't panic you should do well in any event, my stats were really bad and non-curative status, including total urinary blockage. Well I am doing very well thus far and it is 7.7 yrs. now since seeing the emergency room. This should give some hope to others whom are in limbo land (aka the jungle of PCa)- sometimes I call it the Twlight Zone- it can be that bizzare, it is weirder than fiction at times and looks so unreal, that an outsider would say you are kidding, aren't you. We wish it were a dream, but it is not.

Lupron, zoladex, eligard, and other LHRH drugs will work on the majority of PCa cases and patients and do there thing....the question is for how or how well you may tolerate such, too. It does not hurt a patient to look down the road and listen up to anything that could be of value to you either now or later on. There was a study at John Hopkins recently about long term useage of LHRH drugs as perhaps causing more viralent PCa to deal with, maybe truthful (might not), myself I question everything, and have good reasons to in my history with PCa.

This also depends on your perspective, do you go with whatever a doc says is your perhaps 'only protocol and methods'? Do you get envolved in frank discussions about possibly going intermitttent on drugs at some time frame, optional drugs, no drugs, second opinion ok with your current doc? If you study the cr_p out of this and read plenty and read PCa newsletters and get multi-opinions you will see this PCa is far from black and white, and docs don't agree on identical treatments/protocols.....and with real reasons. Hope is eternal, support can be beautiful (like from folks herein) and new stuff is being discovered. After about 2 yrs. go by you will have a different perspective or reflect differently on PCa, than you probably do right now. When it is newer and in your face and looking dismal it is hard to shake off, even daily what you are dealing with. When you see stabilization of psa numbers and some more time goes by and realize you are still here, then you might restart the living portion of your life and you probably will smell and taken in the roses and the details of living, more so than ever before.

Livin Lavida Loca- large glass, sunnyday
 "I wouldn't join a club that would have me as a member" (Groucho Marx)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 10/10/2009 5:16 PM (GMT -6)   
Zufus,

That was one of your better posts !
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)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 10/11/2009 6:00 AM (GMT -6)   
Thanks 'goodlife' maybe this shows I am not always a half glass, person.  (LOL) 

Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 10/11/2009 10:16 AM (GMT -6)   
Thanks to everyone for your encouraging responses. Looking ahead even two years to low psa numbers does give me hope that the future at least will not include PCa, and 7+ years survival is really positive!
I think most patients are put on a 2-year course of HT, but I'm hoping for only a 6-month course, then seeing how it goes.
Last week I met for the first time with a medical oncoogist for a consult, and got a slightly different perspective on the disease and treatment from her. This doctor is both an oncologist and a hematologist, with both an MD and a PhD. She took an unbelieveably detailed history, and then ordered several blood tests to determine posible vitamin deficiencies, both B12 and D. I believe she feels there are links to cancer growth and blood health. I also have diverticulosis, as do many men my age (67). The bacteria growing in the pockets deplete B12 and weaken the red blood cells (I think). As she gets back to me on the results of the tests, I may find myself getting some vitamin treatments prescribed. If so I will report on them.
 
All the best.
Roger

 

 Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.

2/6/09              Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro

4/20/09            TRUS  w/needle biopsy

4/23/09            Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.

                        CT scan and Bone Scan both negative. Stage T2C.

8/27/09            DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.

9/8/09              Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion.  Stage T3b.

9/30/09            PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Prostate Oncologist and Radiation Oncologist. Appointments set for 10/8.

10/8/09            Met w/ both oncologists. Adjunct Combination Therapy to begin ASAP.

 

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradually getting better, with dramatic reduction in leakage around 9/20. Currently on 1 pad during the day and one at night (for security). Actually totally dry at night. (Pressure off the bladder neck?)

 

“I’d rather die while I’m living, than live while I’m dead.” (Jimmy Buffett. Changes in Latitude, Changes in Attitude.)

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/11/2009 11:05 AM (GMT -6)   
Zufas, I don't think anyone would doubt your in-depth knowledge of the subject. You just gave good, sound advice.

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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 10/12/2009 6:56 PM (GMT -6)   
Roger the Onco/Hemo doc is definitively a plus in my estimation, I have a fabulous Onco/Hemo doc whom also is passionate about PCa issues, findings, research and also spends his own time directing (once a month) a support group he started up, which is very open, informative, fair minded, and not agenda based (if it was I wouldn't be there). Has own practice outside of local Hospital which is where the group meets once a month. There is no pushing anyone towards or into a modality even at this venue hospital location, which is just the meeting place.

It took me two years before I decided to ditch my uro-doc and switch to the kind of doc I actually needed and have been a happy camper for the last 5 yrs. with this doc., also world of difference in how I am treated and followed up with. The uro-doc was "all about the money", no quality time, no open advice, just take your Lupron or Zoladex and see me the rest of your life. It is totally different with the doc I have now and I am not looking for anyother, I see how I am treated and kept in consultation with etc., no agendas, no sermons on 'this is what you have to do', right kinds of tests are being done (which uro-doc was clueless on). But hey it's not about me right now, it is about you and other new guys. I think you are in good hands, but always monitor your doc(s) is a good idea just in case something doesn't pass the smell test.

Peace and calmness find its way to you

(Thanks David-Purg for the acolades, too)
 "I wouldn't join a club that would have me as a member" (Groucho Marx)

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