radiation after surgery

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student25
New Member


Date Joined Aug 2009
Total Posts : 13
   Posted 10/21/2009 4:28 PM (GMT -6)   
hey guys!

First I want to thank you for your answers to all my previous questions. Without this forum and its people it would've been much more difficult to deal with my dad's diagnosis. So thanks!!

I have another question for those in the know..

We went to the doctor yesterday, who said my dad's prognosis is good. We met with the radiation oncologist to discuss further treatment. He suggested starting hormone therapy now, and then waiting until December 22nd to start Adjuvant. As per this plan, he'd start radiation a little over 3 months after surgery (which was done on Sept. 2nd).

My question is how soon, on average, did you guys start radiation? My dad is concerned the wait is too long, and I have no idea what to say to that. I've read some primary literature that states it should be done within 3-12 months. Would you agree with this?

I know my dad's in good hands, but nonetheless I'm having him seen by a prostate oncologist at Emory for a second opinion. In the meantime, it'd be great to hear your thoughts on the matter.

Thanks again, for everything.

-----
PSA 5.21
Pathology Report:
Lymph nodes clear
prostate gland 34.6 grams
Gleason the same at 3+4 = 7
Tumor confined to prostatic capsule
Negative margins
'several areas' of perineural invasion noted.
'small focal area' of vascular invasion noted.
right seminal vesicle positive for neoplasia.
urethral margin/apex free of neoplasia.

pathologic staging T3b, N0, MX-stage III

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 10/21/2009 6:30 PM (GMT -6)   
As long as he starts HT now it doesn't matter. HT will keep any cancer from growing for quite awhile. It will also make the radiation more effective.

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


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 10/21/2009 8:17 PM (GMT -6)   
I started my IMRT two weeks after surgery and my HT a week later.

Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 10/23/2009 12:27 PM (GMT -6)   
Your doctor knows best about your dad's case and three moths of healing is not unreasonable. In my case, my uro was very clear that he would not want to even consider radiation until after the three month PSA. He said that he used to advise starting earlier but that it did not seem to make any difference and did add stress to the body. Luckily, in my case I am still pulling zeros.
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
6 mo. PSA 0.00 -- 1 light pad/day


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 10/23/2009 2:01 PM (GMT -6)   
Hi Student,
Welcome your Dad to Club T3b for me. In conference with my urologist/surgeon, a medical oncologist/hematologist, and a radiation oncologist, the consensus opinion was to start Adjuvant Combination Therapy ASAP. See my numbers below. A lot like your Dad's. Took my first injection of Lupron Depot 30 mg (4-month shot) on 10/21. Got it in the buttock. Aside from some soreness there, two days post-injection I'm not feeling much discomfort at all. Radiation will start right around 12/21. Set-up sessions will commence around 12/1. Perhaps by then I will be feeling an uncontrollable urge to do a lot of shoe shopping, but we'll have to wait and see on that.
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.

10/21/09          First Lupron injection.

 

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?)

 

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 10/23/2009 4:10 PM (GMT -6)   
geezer, my uro/surgeon had the same attitude about RT after surgery, wanted to see a genuine 3 PSA span of rises first.
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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.

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