Surprise at the end of SRT

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Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 10/20/2009 8:29 PM (GMT -6)   
Saw a radiation onc today and got an unpleasant surprise. He quoted a recent European study where high risk patients where on ADT for 6 months vs. 36 months. He says three year group had a much better survival rate. How does it concern me? He wants me on ADT for much longer than the originally discussed 2 months after treatment. He started with 3 years, then said that he would recommend 2 and would settle for one. We agreed to give it 6 months and reevaluate then. But I am not happy that he sprung this on me at the last moment. I am getting a 3-months shot tomorrow.
 
Incidentally, tomorrow is the last (#40) treatment and I am looking forward to not having to shlep to the radiation center evrey day.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/20/2009 10:27 PM (GMT -6)   
Geebra,

I am most happy to hear at least that you are about to end your SRT . What was his reasoning to prolong the ADT so much?

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 - began IMRT SRT - 39 sessions/72 gys.


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 10/21/2009 9:24 AM (GMT -6)   

Geebra:  My onc. quoted the same stats, I told him I didn't know if I could make three years so we decided to take it six months at a time.  He also said if I was to go the full three years there was almost a guaruntee that E.D. would become a permanent problem.  Dammed if you do and dammed if you don't.

I'm just comming up on the two month mark of ADT and it hasn't been too bad so far. 

Good luck

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
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/21/2009 9:29 AM (GMT -6)   
David,

This is the annoying thing about PC, no matter how much you study and learn, and try to make the right decision, the cancer has a mind of its own.

I see you originally wanted RT, but changed and had surgery, and now several months later, reaccurance is at your doorstep, and now you will have RT in the form of SRT. Same path I have been on, though I havent been on the other drugs you mentioned.

Good luck ahead for you, brother
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 - began IMRT SRT - 39 sessions/72 gys.


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 10/21/2009 9:58 AM (GMT -6)   

Purg: Thanx for the plug, you of all people know that you really never know what's around the corner.  When I begin to wonder "why me" I go to the YANA sight, read a few stories and realize how lucky I am to be in the postioin I am in.  I truly believe we're not that far away from this disease becomming something like diabetisis, chronic and a shot or pill will keep it under control.  Keep the faith. 

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
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/21/2009 11:01 AM (GMT -6)   
David,

I am hoping the next generation of PC guys will have some better tests and less invasive treatments to look forward too, and when we can tell the 'harmless" cases from the "bad" cases, we can save a lot of money and misery.

When I sit waiting at the clinic, and I am usally among the youngest, you see so many people in worse shape from other cancers and diseases. It does help to keep the self pity undercontrol a bit when you see decrepit looking people being wheeled to radiation on hospital beds.

My wife, a nurse, telling me about a really sad PC case. Guy is 43, had a PSA by default on a blood screening, was real high, did biopsy right away, and he's a Stage 4 and Gleason 10, already spread to ribs, spine, lymph nodes, seminal's, and head. They are putting him straight onto chemo. And to add to it, no history of family PC.
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 - began IMRT SRT - 39 sessions/72 gys.


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/21/2009 11:50 AM (GMT -6)   
Yeah, when my father started HT, they recommended 2 years and when he got his last shot a couple of weeks ago the Radiation Oncologist tried to tell him that new studies are recommending 5 years. My dad didn't go for it. :) We are hoping his PSA will stay undetectable and allow him a permanent HT vacation.
Father's Age DX 62 (now 64)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Oct. 9, 09 PSA <.01 Last Lupron Shot
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/21/2009 1:02 PM (GMT -6)   
Studies are showing that the longer HT on cycles are working better at controlling PSA. This isn't being disputed. But the question of the benefits of longer terms on mortality is still unconfirmed. But the QoL advocates side says the longer you control the PSA the better the QoL in many patients. Of course I just completed a 2 and a half years on cycle and I am still awaiting my "T" levels to rise. My team said they would recommend longer but acknowledged that I want a break. Hopefully it was worth two and a half years...

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)
Hormone Therapy May '07 to September '09 ~ Currently off.
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (October 7, 2009): <0.1

My journey is at: www.caringbridge.org/visit/tonycrispino

My InfoLink page is at Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 10/24/2009 9:10 AM (GMT -6)   
Hi Geebra,

I am in year two of a 2 to 3 year course. Doctor says take a look at 2 years and if PSA is down we can consider a "holiday". But he also says latest studies indicate better results for advance patients with a 3 year program. As much as I hate the hot flashes I will most likely stick with the three year time frame.

Best to you.
Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
 
 
 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 10/24/2009 9:36 AM (GMT -6)   
You guys are all so great. I don't know if I'll be following in your footsteps, or not, but I find lurking on these threads an inspiration and I know if my PSA does rise and I need to find more treatment, my HW buds will be here for me. And, please know, up here in soon to be frozen Canada, you've got a fan rooting for you.

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"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week.    

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